GP Flashcards
What categories are used to judge risk of starting contraceptives
and how many stages are there?
UKMEC, 4 staegs
UKMEC 1: No restriction (risk minimal)
UKMEC 2: Benefits outweigh risks
UKMEC 3: Risks outweigh benefits
UKMEC 4: Unacceptable risk (CI)
Contraceptive risk factors: considerations in * Breast cancer
No hormonal contraceptives
Options: Copper coil / barrier methods
Which contraceptive is contraindicated in cervical/ endometrial cancer
IUS (intrauterine system - i.e. Mirena coil)
Which contraceptive is CI in wilsons disease
IUD ( copper coil)
RF in COCP (10)
*≥ 35yo
*≥ 15 cigarettes per day
*Uncontrolled HTN (particularly ≥160 / ≥100)
*Migraine with aura
*History of VTE
*Major surgery with prolonged immobility
*Vascular disease or stroke
*IHD, cardiomyopathy or AF
*Liver cirrhosis and liver tumours
*SLE and antiphospholipid syndrome
what hormone(s) are in the implant
Progestogen only
what hormone(s) are in depot?
Depo-provera is a Progestogen-only injection
why is depo classed as UKMEC 2 in <20yo
reduces BMD
describe the contraceptive advice for COCP/POP postpartum
- COCP – from day 21, use condoms additionally for 7 days - unsafe in breastfeeding
- POP - from day 21, use condoms additionally for 2 days - safe in breasfeeding
(As very infertile <21 days postpartum
When can IU methods NOT be used post partum
48hrs - 4weeks post partum ( fie outsdie the range
What should be communicated to someone starting COCP on day 4 of menstrual period
Use contraceptive, No additional contraception is required
Starting < day 5
* Starting on day 1 of cycle (day 1 of period) immediate protection
* No additional contraception is required if the pill is started ≤ day 5 of the menstrual cycle.
What should be communicated to someone starting COCP on day 6 of menstrual period
- check pt not preggers
- require condom for 7 days
Starting > day 5
* Requires extra contraception (i.e. condoms) for the first 7 day
* Ensure woman is not already pregnant before starting the pill.
Advice for switching between COCP
Finish pack –> start new pack immediately, no pill-free period.
Advice for switching from traditional POP to COCP
o Switch at anytime
o Require extra contraception ( e.g. condoms) for 7 days
** except dostrogel - no additional contraceptive needed
Advice for missing 1 COCP
- Take the missed pill ASAP (even if this means taking two pills on the same day)
- No extra protection
Advice for missing > 1 COCP
generally
day 1-7
day 8-14
day 15-21
- Take the most recent missed pill ASAP (even if this means taking two pills on the same day)
- Additional contraception (i.e. condoms) is needed, if the pill taken regularly, for 7 days straight
o Day 1 – 7 of the packet emergency contraception if unprotected sex occurred
o Day 8 – 14 of the pack no emergency contraception is required
o Day 15 – 21 of the pack no emergency contraception is needed. Skip the pill-free period, take next pack immediately .
how does the function of desogestrel differ from traditional POP
Both
* Thickens the cervical mucus
* Alter endometrium (so it’s less accepting of implantation)
* Reducing ciliary action in the fallopian tubes
Desogestrel also
* Inhibits ovulation
Advice for starting contraceptive pill
day 4
day 6
day 1-5 = immediate protection
day >5 = additional contraceptive for 48hrs
Advice for switching contraceptives (POP)
How long does a Woman / Man need contraceptives following sterilisation
woman - until next menstrual period ( ovum may have already reached uterus during that cycle)
man - 2 months ( with test @ 12 wks due to length of time sperm remain in tubes)
2 key S/E of depot
weight gain
low BMD - so not suitable in >45yo women
In a 28day cycle, what day is the suspected day of ovulation
day 14
ovulation day is 14 days before next cycle (28-14 day 14), (32-14 = day 18) etc
7 steps in verifying death
- Identify ( check wristband)
- Carotid pulse
- Pain (squeeze trapezius muscle)
- Pupillary light response - confirm absece ( fixed and dilated pupils)
- Heart sounds ( confirm absence) - for a FULL MIN
- Lung sounds ( confirm absence) - for a FULL MIN
- Note time of examination completion - this is the OFFICIAL time of death
