LECTURE 6 Flashcards

Emergency COntraceptive and Medical Abortion

1
Q

What are the different types of EC ?

A

Hormonal : Levonorgestrel , Ulipristal and uzpe method

Intrauterine COntraceptive : Copper or LNG IUD

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2
Q

What are the main mechanisms by which hormonal EC acts ?

A

*** interferes with ovulation through Progestin

Prevent fertilization ( stops sperm binding)

prevent contractility to more the ovum through the fallopian tube

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3
Q

Which EC prevent ovulation ?

A

LNG EC
Uliprsital

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4
Q

Which EC prevets fertilization ?

A

Cu-UID

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5
Q

Which EC prevents implantation ?

A

Cu-IUD

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6
Q

When does LNG EC works the best ?

A

before the LH surge and prevent ovulation

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7
Q

What happens during the ovulation with LH levels ?

A

LH surge

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8
Q

What is the timeframe of effectiveness of LNG EC ?

A

3 days and maybe 5 days

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9
Q

What is the most important DDI to remenber for its interaction with hormonal EC ?

A

Rifampin: inducer that cause the increase in the metabolism of EC

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10
Q

Whar are the ADR of hormonal EC ?

A

Spotting/breakthrough, abdominal cramping, nausea/vomiting and others

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11
Q

After the use of LNG, when can we expect the return of menses ?

A

~ 3 weeks

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12
Q

What is the MOA of ulipristat ?

A

selective progesterone agonist or antagonist
directly affects the follicular rupture

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13
Q

Why do we need to hold CHC or POP before restarting it after ulipristal É

A

ulipristal has a strong bind to the progesterone receptors and needs time to be removed before CHC or POP can be initiated.

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14
Q

How many days should the patient wait after taking Plan B forfor starting CHC/POP ?

A

Wait 5 days

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15
Q

How many daysof backup after ulipristal ?

A

14 days of backup after waiting 5 days of waiting

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16
Q

How do I do the yupze regimen ?

A

100 mg extradiol, 500 mg LNG or 1 mg Norgetrol
repeat after 12hours

17
Q

If pt want to use CHC after ulipristat , what can you let them know ?

A

hold CHC/POP for 5 days but have have 14 days backup

18
Q

What is the ADR betwen hormonal EC vs ypzpe method ?

A

Yupze has more ADR : N/V, breast tenderness and spotting

19
Q

What are the contraindications for copper IUD ?

A

pregnancy, history of recent PID, STI

20
Q

When would you expect return of menses after the emergency pills?

21
Q

What is gestational age ?

A

The time after the last period day

22
Q

What is the MOA of Mifepristone ?

A

Progesterone antagonist on the endo/myometrium
+ anti glucocorticoids effect

leads to uterine contraction, cervical softening and dilation

23
Q

What is the MOA of Misoprostol ?

A

Synthetic PGs
Uterine contraction , soft cervix to expel pregnancy

24
Q

How effective is MIFE/MISO ?

A

95-98% gestational up to 70 days

25
How soon can you ovulate after MIFE/MISO ?
early as 8 days afterwards
26
When would you use the tools for terminating a pregnancy ( except dilation/evacuation) ?
Before the 13 weeks (1st trimester)
27
What are the contraindications of MIFE/MISO ?
Ectopic pregnancy , uncontrolled asthma, Chronic adrenal failure, porphyria, allergy , ambivalent about abortion
28
What are the relative contraindications for MISE/MISO ?
IUD inserted , long term CS, anemia
29
How is the MIFE/MISO dosage ?
Day 1 : MIFE - 1 tab Day 2 /3: miso 800mcg under *TONGUE* for 30 minutes and swallow Day 7-18 : f/u on pregnancy
30
What are the SE of MIFE/MISO ?
Cramping : * miso* Vaginal bleeding : after *miso* , bleeding is heavier and with blood clots Pts effects from MISO : fever, n/v, Dizziness, fatigue
31
What should a rpm do when a pt comes with a rx for MISE/MISO ?>
Indication —> abortion Effective : 0-70 days for it to work CI : ectopic pregnancy, UID in place, history of PID Assessment : can the patient follow the instruction F/u : in 7- 14 days
32
What is a pt counseling for MISE/MISO ?
Directions ( < 70 days of gestation) ADR ( pain take Tylenol ) Irreversible ( lose pregnancy in 2-24 hours) Adherence because —> failure is embryotoxic F/u in 7 -14 days
33
What are the RED flags of MIFE/MISO ?
Amount of bleeding ( lemon zine > 2 hours) , maxi pads for >2 hours Pain no matter the analgesics N/V/Fever after the MISO
34
When would you need a another dose of MIFE or MISO in abortion setting ?
Vomitting < 1 hour for MISE Vomitting before MISO absorption
35
When can pt return on CHC or IUD after medical abortion ?
Ovulation after 8 days from medical abortion CHC —> right away after MISO dose IUD —> wait until the abortion is confirm
36
What is the timeframe for the pregnancy to pass in MIFE/MISO vs Methotrexate+ MISO ?
MIFE/MISO is fast = 2 to 24hours or 3 days Methotrexate + MISO = 7 days
37
What is the dosing regimen for methotrexate + MISO ?
Oral methotrexate Vaginal miso