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PBL PY2 Fall > Medical Abortifacients > Flashcards

Medical Abortifacients Flashcards

1
Q

legal definition of abortion

A

termination of pregnancy by various means such as surgery before the fetus is able to sustain independent life

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2
Q

World Health Organization definition of abortion

A

various clinical conditions such as spontaneous and induced abortion (both viable and non-viable pregnancies), incomplete abortion and intrauterine fetal demise

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3
Q

what is the 2nd most common reproductive health procedure?

A

abortion

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4
Q

1 in __ women have an abortion

A

3

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5
Q

has the number of abortions been increasing or decreasing since 2005?

A

decreasing

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6
Q

what % of abortions are reported as medical abortions?

A

4%

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7
Q

definition of induced abortion

A

voluntary ending of a pregnancy

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8
Q

surgical abortion definition

A

removal of a pregnancy with teh use of instruments or aspiration of uterine cavity

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9
Q

medical abortion definition

A

use of one or more medications to interrupt a pregnancy

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10
Q

definition of abortifacients

A

drugs used to induce a medical abortion

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11
Q

induced abortions occur most often in the ___ trimester. Up to ____ days gestation

A

1st; 12 weeks or 84 datys gestation

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12
Q

what are the 4 options for medical abortion?

A
  1. Mifegymiso (mifepristone 200mg and 800mcg misoprostol) as 1 pill
  2. Mifepristone 600mg and misoprostol 400mcg as 2 pills
  3. methotrexate 50mg IM or vaginally & misoprostol 800mcg vaginally 3-7 days later
  4. misoprostol 800mcg PO or vaginally Q3H for 12H
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13
Q

effectiveness of mifegymiso for medical abortion

A

~95-98% up to 49 days and 95-99% up to 63 days

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14
Q

effectiveness of individual mifepristone and misoprostol

A

92% up to 49 days

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15
Q

effectiveness of methotrexate and misoprostol

A

> 90% up to 49 days

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16
Q

effectiveness of misoprostol vaginally

A

85% up to 49 days

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17
Q

what medical abortion option is approved and available in Canada for this indication?

A

Mifegymiso

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18
Q

is mifepristine available as a single entity in Canada?

A

no

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19
Q

is misoprostol approved for the indication of medical abortion in Canada?

A

no

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20
Q

what comes in the Mifegymiso box?

A

Green box: 1 tab of mifepristone 200mg

Orange box: 4 tabs misoprostol 200mg

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21
Q

what is the indication for Mifegymiso?

A

medical termination of a pregnancy within 63 days (9 weeks) gestation as measured from last period

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22
Q

what is the MOA of mifepristone in abortion? (two main parts)

A

blocks progesterone receptors (w/o activating them). Lack of progesterone causes the endometrial lining to break down and bleeding starts 9so endometrium can no longer support a growing embryo)

Also increases prostaglandin levels and dilates the cervix

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23
Q

what is the MOA of misoprostol in medical abortion?

A

induces cervical ripening (cervical thins, soften, relaxes and dilates) and uterine contractions to facilitate evacuation of contents

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24
Q

misoprostol is a synthetic form of _____ (E1)

A

prostaglandin

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25
what are 6 important contraindications to medical abortion?
1. ambivalence 2. severe uncontrolled asthma 3. hypersensitivity to ingredients 4. IUD 5. longterm corticosteroid use 6. anemia w/ hemoglobin <95g/L
26
why is medical abortion c/i in severe uncontrolled asthma?
MIFE is an anti-glucocorticoid and can compromise control of severe asthma attacks
27
why are medical abortions c/i in patients with a current IUD?
more likely to be ectopic pregnancy and a missed diagnosis can be life-threatening
28
why is longterm corticosteroid use a relative c/i for medical abortion?
steroid effectiveness can be reduced for 3-4 days after MIFE
29
explain the SIG for Mifegymiso
1. mifepristone pill is taken with a glass of water (either at clinic or at home) 2. 24-48hrs later, 2 misoprostol tablets are placed on either side of the mouth between the cheek and gums for 30min. Any remaining fragments are swallowed with water plan to rest for 3 hours after taking miso pills
30
is there an interaction between NSAIDs and mifegymiso?
No, bc the mechanism of NSAIDs is to decrease the making of new prostaglandins, so it does not have any action on pre-existing prostaglandins (which the MIFE would act on)
31
what day of the week is it suggested to take the medical abortion pills to avoid symptoms on weekdays?
take MIFE on friday and MISO on saturday
32
vaginal bleeding starts ____hrs after MISO
1-48hrs
33
t/f the bleeding with medical abortion is heavier than menstrual period
yes
34
the heavy bleeding of medical abortion lasts ____hrs and light spotting can last until ____
2-4hrs; next menstrual period
35
t/f the blood released after medical abortion contains blood clots
t
36
how should a patient be advised to manage bleeding after medical abortion?
sanitary pads (DO NOT USE TAMPONS), can use panty liners for the light bleeding that may last 30 days of tx
37
how much blood is alarming after a medical abortion?
saturating 2 or more pads/hour for 2 consecutive hours
38
heavy bleeding after MA should not last more than ___days (red flag)
16
39
what are 4 red flags for bleeding after MA?
1. excessive bleeding 2. dizziness or racing heart 3. heavy bleeding >16 days 4. foul-smelling vaginal discharge
40
pain and cramping with MA starts within __hours of taking MISO
4
41
the increased pain after an MA may last up to ___hours
24
42
how can the pain of MA be managed?
ibuprofen, naproxen (acetaminophen is less effective), heating pad, rest
43
what are the 2 red flags for pain after MA?
1. cramping lasting >16 days | 2. cramping/pain not improving with pain medications
44
what is a common GI sx after MA?
diarrhea (may also have N/v, headache, fever, chills)
45
the GI side effects of MISO can be minimized by ___
taking MISO after a snack
46
when is a fever a red flag after MA?
if its >38C for >6hrs and malaise (weakness, nausea, vomiting, diarrhea)
47
when is feeling sick a red flag after MA?
feeling sick with/without fever for >24hrs after MISO
48
what are some things on a supportive care checklist a PhC should go over w/ patient before a MA?
1. do they have pad and liners 2. do they have a contraceptive plan 3. do they have pain meds 4. do they have support 5. do they have a follow-up appointment and know the red flags and what to do?
49
t/f 24 hour phone coverage must be available to patients using mifegymiso
t
50
conformation of completion of MA should be done ___ weeks after taking MA
1-2 weeks
51
PhC can follow up with patient ___days after MA to ask about appropriate admin and any side effects
2-3 days
52
how can confirmation of MA be done?
1. transvaginal ultrasonography (TVUS) | 2. HCG blood test
53
when after MA can hormonal contraception (POC or CHC) be started?
on the day of or day after MISO
54
when after MA can an IUD/IUS be inserted?
after a follow-up visit that confirms completion of abortion
55
is an ultrasound needed prior to Rx for MA?
no
56
health Canada recommends MA be used how late into pregnancy?
9 weeks or less
57
the SOGC guidelines recommends MA can be used how far into pregnancy?
10 weeks or less
58
Can NPs prescribe for MA?
no
59
Do PhCs need to stock a limited quantity of mifegymiso?
no, they should be stocked as much as any other med based on patient demand
60
does the first dose of MA need to be a witnessed dose?
no
61
t/f mifegymiso is universally covered in canada at no cost to patients
t

PBL PY2 Fall (21 decks)

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