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GU 2 Flashcards

1
Q

Question

A

Answer

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2
Q
  1. What’s the MHRA warning on Nexplanon?
A

Report neurovascular injury and migration

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3
Q
  1. What are the advantages of using a POC IUD over a copper IUD?
A

POC IUD:<br></br>- Choice when excessively heavy periods<br></br>- Rapid return to fertility after removal<br></br><br></br>Advantages of progestogen-only IUD Vs copper IUD:<br></br>== reduction in blood loss, improvement in dysmenorrhoea (painful periods) and dcr in pelvic diseases (PID) with PID<br></br>== in primary menorrhagia - bleeding dcr significantly within 3-6mths<br></br>- Mirena & Levosert both licensed for contraception & menorrhagia<br></br>- Jaydess licensed for contraception only

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4
Q
  1. What must someone do before surgery with regards to their POC?
A

Nothing needs to be done
There is no risk of aquiring DVT or PE

remember only the Oestrogen causes that.

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5
Q
  1. What are the problems associated with spermicides?
A

Don’t protect you from STDs

They cannot be used as a form contraception

It is not as effective as other methods.

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6
Q
  1. What can damage barrier methods?
A

**Products eg
1. petroleum jelly (Vaseline),
2. baby oil
3. oil-based vaginal and rectal

likely to damage condoms and diaphragms made from latex rubber,

thus making them ineffective as contraception and protection against STIs**

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7
Q
  1. What are the different types of EHC?
A
  1. Copper IUD
  2. Hormonal
    i.e., ellaone (ulipristal) and levonelle (levonogestral)
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8
Q
  1. What’s the most effective type of emergency contraceptive method?
A
  • Best form of emergency contraception is the copper IUD,
  • most effective hormonal type of emergency contraception is ellaone**

(memory trick number one is the best)

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9
Q
  1. What’s the most effective form of hormonal EHC?
A

ELLAONE

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10
Q
  1. What are the doses of Ella One and Levonelle?
A
  1. Ellaone (30mg) and levonelle (1.5mg).
  2. Remember EHC doses always in mg
  3. and standard contraceptives always in mcg.
  4. Levonelle 1,5 x20=30 of ellaone
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11
Q
  1. What time frame can Ella One and Levonelle be given?
A
  1. Ellaone it has to be taken within 5 days of upsi
    (unprotected Coitus)
  2. levonelle it is within 3 days of upsi
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12
Q
  1. Which form of EHC is first line?
A

Ellaone is number 1

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13
Q
  1. Which form of EHC is affected by weight and what can be done?
A
  • Levonelle is affected by weight
  • Ulipristal is NOT
  1. IF BMI over 26 or weight over 70kg give a double dose of levonelle
  2. (3mg= 2x1.5mg) or give a **single dose of ella one**
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14
Q
  1. Can EHC be given in P+BF?
A

Shouldn’t be using contraceptives whilst pregs,

so for pregs no.

**For Ellaone no breastfeeding for 1 week **

but for levonelle it’s extremely fine

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15
Q
  1. What must be done if someone vomits after taking EHC?
A

If vomit within 3 hours take another dose, if vomit after 3 hours don’t need to worry

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16
Q
  1. Which things reduce the efficacy of EHC?
A

Drug interactions especially the enzyme inducers scrapbs gp , also body weight (people with bmi over 30), time taken (sooner better), vomiting+ diarrhoea

17
Q
  1. What are the contraindications of each form of EHC?
A

Levonelle - Cautions:<br></br>- Crohn’s disease (severe malabsorption syndromes)<br></br>- Past ectopic pregnancy<br></br>- Ciclosporin (toxicity)<br></br>- Overweight - double dose (>70kg / BMI=26)<br></br>- CI in breast cancer & acute porphyria<br></br><br></br>Ellaone - Cautions:<br></br>- Can use >1 in same cycle (levonelle = okay but not recommended due to SEs & incr menstrual irregularities)<br></br><br></br>CIs:<br></br>- Severe asthma treated by oral CS (not recommended)<br></br>- Avoid in severe liver impairment<br></br>- Undiagnosed vaginal bleeding, breast, cervical, ovarian & uterine cancer

18
Q
  1. When can someone start hormonal contraception after taking EHC?
A

For levonelle can be taken hormonal contraception immediately after. For ellaone can be taken hormonal contraception 5 days after.

19
Q
  1. What’s the full counseling points when taking EHC?
A
  • If vomit within 3 hours take another pill<br></br>SE - menstrual irregularities associated counseling -<br></br>1. Next periods may be early or late<br></br>2. Use barrier protection until next period<br></br>3. If lower abdo pain, see GP to rule out ectopic pregnancy<br></br>4. If periods are abnormal (light, heavy, brief or absent), take pregnancy test (at least 3 weeks after unprotected sex)<br></br>5. If period more than 7 days late or abdo pain might be pregnant, need to do pregnancy test.
20
Q
  1. If someone comes in for EHC, but can’t take it due to DDI’s, what can be done instead?
A

Give copper IUD or increase dose of levonelle to double the normal dose

21
Q
  1. Which forms of contraception do and don’t get affected by enzyme-inducing drugs?
A

Combined hormonal contraceptives are affected, the oral progesterone-only, progesterone implants. Depot shots and norethisterone injection and copper IUD are not affected by drug interactions

22
Q
  1. If someone can’t be changed from an oral form of contraception to a parental because of the DDI’s, then what can they do now to prevent pregnancy?
A

Depends on how long they are taking the inducer for. If inducer taken for a short time (i.e., less than 2 months), they can use a condom, and if taking it for more than 2 months, they can use a monophasic combined hormonal contraceptive at a dose of 50mcg daily or more, or can use a copper IUD. 50mcg of monophasic is a higher dose than the standard strength of 35mcg, thus better.

23
Q
  1. What do prostaglandins and oxytocins do and what are they used for?
A

They are used for abortions, helping women with labor, to minimize blood loss from the placenta, and to induce uterine contractions with different levels of pain

24
Q
  1. Which drugs are used for abortions?
A

Gemeprost, misoprostol, and mifepristone<br></br><br></br>Induce abortion<br></br>Gemeprost (prostaglandin analogue) - given as a pessary == Induces abortion and ripens cervix before surgical abortion<br></br>Mifepristone (anti-progestogen) - facilitates == Sensitizes uterus to prostaglandin so shorter time and lower dose of prostaglandin needed<br></br>Misoprostol (prostaglandin analogue) - PO or PV<br></br><br></br>Premature labor prevention<br></br>- Salbutamol/terbutaline<br></br>- Atosiban (oxytocin antagonist)<br></br>- Indometacin (COX inhibitor stops synthesis of prostaglandins)<br></br>- Nifedipine

25
Q
  1. What drugs are used to induce labor?
A

Dinoprostone, oxytocin, and misoprostol (unlicensed)<br></br><br></br>Medication to prevent and treat bleeding in labor, abortion, miscarriage<br></br>- Ergometrine<br></br>- Oxytocin (combination more effective than alone)<br></br>- Carbetocin<br></br>- Carboprost - in severe post-partum hemorrhage<br></br>- Misoprostol

26
Q
  1. What drug is used for ectopic pregnancy?
A

Systemic methotrexate used for the management of ectopic pregnancy

27
Q
  1. What’s vaginal atrophy and what drugs are used to treat it?
A

Thinning, drying & Inflammation of vaginal walls due to less estrogen production (occurs mostly after menopause)<br></br>- Topical estrogens = vaginal tablets, rings, and creams eg. vagifem<br></br>- Non-hormonal vaginal moisturizers eg. replens MD == Risk of hyperplasia and carcinoma increased with prolonged use

28
Q
  1. What’s ED and what are the risk factors that can cause it?
A

ED is the inability to attain or maintain an erection that is sufficient to permit satisfactory sexual performance. Can have physical or psychological cause. Can be due to side effects of drugs (e.g., antihypertensives, antidepressants, antipsychotics, cytotoxic drugs, recreational drugs - alcohol). Lifestyle changes (reduce alcohol and don’t smoke)

29
Q
  1. What first-line treatment is used for ED?
A

Phosphodiesterase type 5 inhibitors ie sildenafil increases blood flow to penis - delayed effect with food

30
Q
  1. What are some examples of short-acting PDE5 inhibitors?
A

Short-acting & for occasional use prn<br></br>- Sildenafil (1hr before sex)<br></br>- Avanafil (30mins before sex)<br></br>- Vardenafil (25-60mins before sex)<br></br>- Tadalafil (30mins before sex) == long-acting - used for spontaneous/not scheduled or those that have frequent sexual activity

31
Q
  1. What are the key side effects, CI, and interactions with using PDE5 inhibitors?
A

SEs due to vasodilation<br></br>- Hypotension, flushing, headaches, migraine, dyspepsia, nasal congestion, palpitations, and tachycardia<br></br><br></br>CIs due to reduced blood perfusion<br></br>- MI, unstable angina or recent stroke, hypotension, SBP <90mmHg or taking nitrates due to incr risk of hypotension<br></br><br></br>Interactions (with vasodilators; low BP/antihypertensive effect)<br></br>- Nitrates, alpha blockers (once stabilized, then initiate), CCB, nicorandil

32
Q
  1. If PDE5 inhibitors don’t work or are unsuitable, what else can be used?
A

Alprostadil == given intracavernosal (base of penis), intraurethral or topical application - not PO == can cause priapism [prolonged erection lasting 4 hours or more-seek medical help, apply ice pack]

33
Q
  1. What patient & carer advice is surrounding alprostadil prostaglandin analogue?
A
  • Report any erection > 4 hours<br></br>- Use condoms to avoid local reactions to women of child-bearing age, pregnant or lactating women.
34
Q
  1. Bacterial vaginal and vulval infections
A

Bacterial vaginosis: metronidazole 2g single dose<br></br>Vaginal trichomoniasis: metronidazole 2g single dose

35
Q
  1. Fungal vaginal and vulval infections
A
  • Candidal vulvitis = imidazole external cream eg. miconazole clotrimazole<br></br>- Vaginal candidiasis == imidazole pessary/internal cream eg. clotrimazole == oral treatment = fluconazole, itraconazole<br></br>- Vulvovaginal thrush in pregnancy ’ topical imidazole for 7 days eg. clotrimazole pessary<br></br>- Recurrent vulvovaginal ’ 6mth treatment
36
Q
  1. Intrauterine device give examples and explain?
A

Less suitable in <25yrs as incr risk of pelvic inflammatory disease<br></br>1. Copper<br></br>2. Levonorgestrel-releasing == dcr bleeding and period pain + lower risk of pelvic inflammatory disease == rx by brand as varying indications, duration of use, and introducers - Mirena = 5yrs (contraception, oestrogen-opposition in HRT, menorrhagia) - Levosert = 3yrs (contraception, menorrhagia) - Jaydess = 3yrs (contraception)

37
Q
  1. Side effects Intrauterine SEs - pain on insertion & bleeding
A
  • Uterine perforation ’ report severe pelvic pain after insertion, sudden change in periods, pain during sex, pain or incr bleeding for more than a few wks or unable to feel threads<br></br>- Risk of infection - main risk in the first 20 days == pre-insertion chlamydia screening for high-risk groups eg. <25yrs, new partner, multiple partners in the past yr, regular partner with other partners, local prevalence, and history of STI == antibiotic prophylaxis for emergency contraception ’ treat as emergency if sustained pain during next 20 days<br></br>- Removal of IUD - do not remove IUD mid-cycle unless additional contraceptive is used for 7 days<br></br>- If removal essential and unprotected sex occurs ’ EHC<br></br>- If pregnant remove in the first trimester
38
Q
  1. Spermicidal contraceptives
A

Barrier alone (condoms, caps, diaphragms) = less effective but can be reliable in well-motivated couples who also use spermicide. Not suitable if high risk of STI - high use associated with genital lesions and increased risk of acquiring infections

GU (3 decks)

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