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PHARM 443 : Sex Ed/MSK > LECTURE 6 > Flashcards

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?

A

3 weeks

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
Q

How soon can you ovulate after MIFE/MISO ?

A

early as 8 days afterwards

26
Q

When would you use the tools for terminating a pregnancy ( except dilation/evacuation) ?

A

Before the 13 weeks (1st trimester)

27
Q

What are the contraindications of MIFE/MISO ?

A

Ectopic pregnancy , uncontrolled asthma, Chronic adrenal failure, porphyria, allergy , ambivalent about abortion

28
Q

What are the relative contraindications for MISE/MISO ?

A

IUD inserted , long term CS, anemia

29
Q

How is the MIFE/MISO dosage ?

A

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
Q

What are the SE of MIFE/MISO ?

A

Cramping : * miso*
Vaginal bleeding : after miso , bleeding is heavier and with blood clots
Pts effects from MISO : fever, n/v, Dizziness, fatigue

31
Q

What should a rpm do when a pt comes with a rx for MISE/MISO ?>

A

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
Q

What is a pt counseling for MISE/MISO ?

A

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
Q

What are the RED flags of MIFE/MISO ?

A

Amount of bleeding ( lemon zine > 2 hours) , maxi pads for >2 hours

Pain no matter the analgesics

N/V/Fever after the MISO

34
Q

When would you need a another dose of MIFE or MISO in abortion setting ?

A

Vomitting < 1 hour for MISE
Vomitting before MISO absorption

35
Q

When can pt return on CHC or IUD after medical abortion ?

A

Ovulation after 8 days from medical abortion

CHC —> right away after MISO dose
IUD —> wait until the abortion is confirm

36
Q

What is the timeframe for the pregnancy to pass in MIFE/MISO vs Methotrexate+ MISO ?

A

MIFE/MISO is fast = 2 to 24hours or 3 days
Methotrexate + MISO = 7 days

37
Q

What is the dosing regimen for methotrexate + MISO ?

A

Oral methotrexate
Vaginal miso

PHARM 443 : Sex Ed/MSK (10 decks)

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