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pre-registration revision > Contraceptives/Pregnancy/Menopause > Flashcards

Contraceptives/Pregnancy/Menopause Flashcards

1
Q

For patients taking medication with teratogenic potential, what highly effective contraception should they be advised to use?

A

Sterilisation or long-acting reversible contraceptives (LARCs) such as copper IUD, levonorgestrel intrauterine system (LNG-IUS) and the progesterone-only implant.

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2
Q

What are the different formulations available for combined hormonal contraceptives?

A

Tablets (COC)
Transdermal patches (CTP)
Vaginal rings (CVR)

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3
Q

Combined Hormonal Contraceptives

  • Less than 1% failure rate if used perfectly
    -Include tablets, patches and vaginal rings
    -Not advised to be continued beyond 50 years old as safer alternatives exist.
    -Monophasic preparations are usually the first option for COC; each tablet contains a fixed amount of oestrogen and progesterone.
    -Usually contrain ethinylestradiol as the oestrogen component- first-line is usually a monophasic preperation containg 30mcg or less of ethinylestradiol in combination with levonorgesterol or norethisterone.

Health benefits include:
-Reduced ovarian, endometrial and colorectal cancer risk
-Predictable bleeding patterns
-Acne improvement
-PCOS, endometriosis and premenstrual syndrome symptom management

  • Increased risk of blood clots
A

.

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4
Q

What is the traditional regimen for using CHC?

A

21 days use followed by 7 days off

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5
Q

What are some other tailored regimens that an be used for CHC?

A

-Shortened HFI: 21 days of continuous use followed by a 4 day HFI;
-Extended use (tricycling): 9 weeks of continuous use followed by a 4 or 7 day HFI;
-Flexible extended use: continuous use for 21 days or more followed by a 4 day HFI when breakthrough bleeding occurs;
-Continuous use: continuous CHC use with no HFI.

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6
Q

For how long before surgery should CHC be discontinued for? How long after can it be restarted?

A

At least 4 weeks prior to major elective surgery, any surgery to the legs or pelvis or a surgery that involves prolonged immbolisation of a lower limb.

Can be restarted 2 weeks after full remobilisation

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7
Q

For progesterone-only contraceptives, what formulations are available?

A

Tablets
Injections
Subdermal
Intra-uterine form

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8
Q

What do Oral Progesterone-Only Contraceptives contain?

A

-Contain either levonorgesterol, norethisterone or desogestrel

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9
Q

Parenteral Progesterone-Only Contraceptives

Parenteral long-acting progestogens include the injections medroxyprogesterone acetate and norethisterone enantate, and the implant etonogestrel.
-These are long-acting reversible contraceptive options that work primarily by suppressing ovulation along with other progestogenic effects. As they often lead to amenorrhoea or reduced bleeding, they may benefit those with menstrual problems (such as heavy bleeding or dysmenorrhoea).

A

.

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10
Q

Parenteral Progesterone-Only Contraceptives: Injections

-0.2% failure rate with perfect use, but 6% with typical use
-Depot medroxyprogesterone acetate injections are administered every 13 weeks.
-Delayed return of fertility up to a year after discontinuation

A

.

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11
Q

Parenteral Progesterone-Only Contraceptives: Implant

-Etonogestrel implant provides very effective contraception for up to 3 years
-0.05% failure rate within the first year

A

.

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12
Q

Itra-Uterine Progestogen-Only Systems

Intra-uterine systems (IUS) containing levonorgestrel are long-acting reversible contraceptive options that have a licensed duration of use that ranges from 3–10 years depending on the system used.
-Ovulation is not suppressed in the majority of females (over 75%) who use an IUS. An IUS releasing 20mcg/24hour of levonorgestrel may also have health benefits such as improving pain associated with dysmenorrhoea, endometriosis or adenomyosis.

A

.

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13
Q

PROGESTERONE-ONLY FORMULATIONS ARE SUITABLE FOR WOMEN UNDERGOING SURGERY

A
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14
Q

COC, POOC, patches vaginal rings and emergency hormonal contraception can be considerably reduced by interaction with drugs such as what?

A

Drugs that induce hepatic enzyme activity (e.g. carbamazepine, nevirapine, phenytoin, phenobarbital, primidone, St John’s wort, topiramate and, above all, rifabutin and rifampicin).

Possibly also griseofulvin.

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15
Q

What are some examples of hepatic enzyme inducing drugs?

A

carbamazepine
eslicarbazepine acetate
nevirapine
oxcarbazepine
phenytoin
phenobarbital
primidone
ritonavir
St John’s wort
topiramate

above all, rifabutin and rifampicin

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16
Q

Combined Hormonal Contraceptive Interactions

-If women taking their contraceptives require enzyme-inducing drugs or griseofulvin, they should change to a different contraceptive method such as parenteral progestogen-only contraceptive or IUD.
-Would continue for duration of treatment and for 4 weeks after stopping

A

.

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17
Q

What are some examples of barrier methods of contraception?

A

Condoms
Diaphragms
Cervical caps

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18
Q

Spermicidal Contraceptives

-Spermicidal contraceptives are useful additional safeguards but do not give adequate protection if used alone. They have two components: a spermicide and a vehicle for its delivery (e.g. vaginal gel). They are suitable for use with barrier methods, such as diaphragms or caps; however, spermicidal contraceptives are not recommended for use with condoms, as there is no evidence of any additional protection compared with non-spermicidal lubricants.

-Spermicidal contraceptives are not suitable for use in those with or at high risk of sexually transmitted infections (including HIV); high frequency use of the spermicide nonoxinol ‘9’ has been associated with genital lesions, which may increase the risk of acquiring these infections.

A
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19
Q

What are some emergency contraception methods?

A

Copper IUD
Oral emergency contraceptive (levonorgestrel)

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20
Q

Copper IUD as Emergency Contraception

-Most effective
-Effective up to 120 hours after UPSI
-Not known to be affected by BMI or other drugs

A

.

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21
Q

Oral Hormonal Emergency Contraceptives

-Levonorgestrel or Ulipristal (first line)
-Offered ASAP if copper IUD not appropriate
-Levonorgestrel- most effective if before 3 days, but up to 4 days (less effective)
-Ulipristal- Can be used up to 5 days (120 hours) after sex.
-Higher BMI can reduce the effectiveness

A
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22
Q

Abortion Induction
1. Mifepristone
2. Misoprostol given following on from giving mifepristone

A

.

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23
Q

What is vaginal micronised progesterone used for?

A

The prevention of miscarriage

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24
Q

Contraceptives for Transgender Males

-Condoms
-IUD
-Progestogen-only methods (pill, injection, implant, IUS)

OESTROGEN CONTAINING METHODS CAN AFFECT HORMONE THERAPY.

Emergency contraception: All three types are safe
-Morning after pill containing levonorgestrel
-Morning after pill such as ellaOne
-IUD copper coil (most effective but needs fitting by a doctor)

A

.

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25
Q

Emergency Contraceptives

EllaOne- more effective than levonelle
-Can be taken up to 5 days after UPS
-Contains ulipristal acetate, which stops progesterone working normally

Levonelle (levonorgestrel pill)
-Can be taken up to 3 days after UPS
-Not as effective as EllaOne

Copper IUD- most effective
- Normally used as an ongoing contraception but can be used as an emergency too
-No more than fivce days after UPS/five days after earliest time you could have ovulated
-Need a doctor to fit it, which is often difficult; reason why the pills tend to be preferred.

A
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26
Q

Menopause Diagnosis

Menopause is considered early if it occurs before 45.

Perimenopause is the period in time where there is irregular cycles in periods, prior to POSTMENOPAUSE where a woman has had no period for 12 consecutive months.

Diagnose in women over 45 based on:
- Vasomotor symptoms and irregular periods
-Women who have not had a period in at least 12 months and not using hormonal contraception.
-Based on symptoms in women without a uterus.

A

.

27
Q

What are some symptoms of menopause?

A

-Vasomotor symptoms- hot flushes, sweats
-Musculoskeletal symptoms- joint and muscle pain
-Mood changes
-Vaginal dryness
-Low libido
-Menstrual period irregularity/loss

28
Q

REMEMBER:

Estradiol is a form of OESTROGEN
Norethisterone is a form of PROGESTERONE

A

.

29
Q

HRT are available as either oestrogen-only preparations, or as combinations of both oestrogen and progesterone.

A

.

30
Q

HRT Options For Women in Menopause

  • Two options for managing vasomotor symptoms: oestrogen alone (ONLY in women that do not have a uterus) or combination therapy of progesterone and oestrogen (usually this one).

-Offer testosterone for menopausal women with low sexual desire if HRT is not effective.

-Offer vaginal oestrogen to women with vaginal atrophy.

-Explain that unscheduled vaginal bleeding is a common side-effect of HRT within the first 3 months, but report if it occurs after 3 months.

A

.

31
Q

What should be offered to women with low libido that are menopausal?

A

Testosterone

32
Q

Long-Term Risks vs Benefits of HRT

Risks:
-Increased VTE risk with ORAL preparations.
-Small increased in coronary heart disease for combined preparations.
-Oral oestrogen is associated with a small increase in stroke risk.
-Combined preparations are associated with a small increase in risk of breast cancer- reduces after stopping HRT, is associated with length of time on HRT.

Benefits:
-Decreases osteoporosis risk
-Improves the symptoms of menopause= quality of life improvement

A

.

33
Q

What are the three most effective contraceptives?

A

Contraceptive implant
IUS
IUD

These would be the top 3 options for patients that need to prevent pregnancy, e.g. valproate patients

34
Q

What is mastitis?

A

When the breast becomes swollen, hot and painful. Most common in breastfeeding women, but can also occur in non-breastfeeding women, and men.

35
Q

What are some symptoms of mastitis?

A

-a swollen area on your breast that may feel hot and painful to touch – the area may become red but this can be harder to see if you have darker skin

-a wedge-shaped breast lump or a hard area on your breast

-a burning pain in your breast that might be constant or only when you breastfeed

-nipple discharge, which may be white or contain streaks of blood

You may also get flu-like symptoms, such as aches, a high temperature, chills and tiredness.

36
Q

Mastitis Treatment

DOES NOT always require antibiotics

-Soak a cloth in warm water and place on breast
-Rest and drink plenty of fluids
-Paracetamol and ibuprofen
-Continue to breastfeed if breastfeeding
-Start feeds with sore breast first
-Express milk from breasts in between feeds
-Massage breast to clear blockages

DO NOT take aspirin

A
37
Q

What are some self-care tips that can be used to help treat mastitis?

A

-Soak a cloth in warm water and place on breast
-Rest and drink plenty of fluids
-Paracetamol and ibuprofen
-Continue to breastfeed if breastfeeding
-Start feeds with sore breast first
-Express milk from breasts in between feeds
-Massage breast to clear blockages

38
Q

Mastitis and GP Referral

Refer if:
-Patient has mastitis but does not breastfeed
-Patient has felt unwell for a further 24 hours, despite continuing to breastfeed and do other care tips

A

.

39
Q

Contraindicated Medications Whilst Breastfeeding

-Codeine
-Decongestant tablets
-Some nasal decongestants
-Aspirin for pain relief
-Herbal remedies

A

.

40
Q

Which contraceptives are safe whilst breastfeeding?

A

Condoms
Any progestogen-only method (PO pill, implant and the injection)
IUD/IUS

41
Q

Which laxative should be avoided in full-term/unstable pregnancy?

A

Senna

42
Q

Why should trimethoprim be avoided in the first trimester of pregnancy?

A

It is teratogenic

43
Q

REMEMBER: Children under 3 months old with a temperature of _ degrees or higher are at risk of serious illness.

A

38

44
Q

-Emergency Contraception can NOT be sold to someone under 16 unless a PGD is in place to allow it. They must be referred, either to a doctor or to a pharmacy with a PGD.
-Must be sold to the person taking it, not a representative.
-Make sure the patient is not already pregnant, as can cause ectopic pregnancy.
-If patient is sick within 3 hours after taking, it may not have worked. Another pill should be taken.

A

.

45
Q

What are some brand names of COC’s?

A

Microgynon
Rigevidon
Yasmin
Cilique

46
Q

What are some brand names of progesterone-only contraceptives?

A

Cerelle
Cerazette

47
Q

Medroxyprogesterone is a long-acting contraceptive given by IM injection. It is also known as Depo-Provera- it can caused irreversible _ loss.

A

Bone

48
Q

Management of Missed Contraceptive Tablets

-Less than 12 hours late: Take tablet as soon as remembered, contraceptive protection is not reduced.
-More than 12 hours: Contraceptive protection may be reduced.

Always best to advise patient to use extra protection for 7 days following a fully missed dose.

A

.

49
Q

Phenytoin, Carbamazepine and topiramate can decrease the effectiveness of COC.

A

.

50
Q

What is the age limit on the supply of levonorgestrel as emergency contraception OTC? What about for EllaOne (ulipristal)?

A

Levonorgestrel- not for under 16s

EllaOne- females of childbearing age, if they’re considered to be competent.

51
Q

UTI’s in Pregnancy:

-Nitrofurantoin is first choice, but cannot be used at term.
-Cefalexin is second choice

A

.

52
Q

What can happen if ondansetron is taken during the first trimester of pregnancy?

A

Increases risk of baby having a cleft lip/palate

53
Q

Which contraceptives are most effective for use in epilepsy alongside enzyme-inducing drugs such as carbamazepine?

A

Depo Injection
IUD
IUS

54
Q

How long should statins be stopped before trying to conceive?

A

3 months- potentially teratogenic

55
Q

What is the first line treatment for gestational diabetes if the BG reading is over 7 mmol/L?

A

Isophane insulin

56
Q

How long after stopping methotrexate treatment should women refrain from getting pregnant? What about men, for fathering a child?

A

6 months, for both

57
Q

How long should women wait after stopping mycophenolate treatment before trying to get pregnant? What about for men, in terms of fathering a child?

A

Women: 6 weeks
Men: 3 months

58
Q

What is the recommendation for getting a mammogram?

A

Recommended every 2 years for women aged 50-74 if they are average risk

59
Q

What is the recommendation for women getting smear tests?

A

Every 3 years from 25-49, then every 5 years from 50-64, then 65+ only if one or more of the last test results were abnormal.

60
Q

Which vitamin is potentially contraindicated in pregnancy and should therefore be avoided?

A

Vitamin A- potentially teratogenic

61
Q

Which drug is safe to treat DVT in pregnancy?

A

Dalteparin

62
Q

If norethisterone tablets are used to delay menstruation, what should the dosing instructions be?

A

Take one tablet three times a day, start 3 days before period is expected.

63
Q

How long after stopping isotretinoin should a female wait before trying to conceive?

A

3 years

Also can’t drink alcohol for 2 months after stopping treatment

pre-registration revision (24 decks)

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