Medical Abortion Flashcards
what are some options for terminating a pregnancy under 14 weeks
medical, vacuum aspiration, electric vacuum aspiration
what is the only option for termination of pregnancy >14wks
dilation and evacuation
mifegymiso is approved by health canada for use under
63 days or 9 weeks
T or F: pharmacists must see the ultrasound confirming pregnancy before dispensing mifegymiso
F
T or F: mifegymiso requires witnessed ingestion
F
mifegymiso contains
200mg of mifepristone and 800mg misoprostol
what is mifepristone
a progesterone antagonist on the endometrium/ myometrium that also has antiglycocorticoid properties
misoprostol MOA
a synthetic prostaglandin that induces uterine contractions
mifegymiso indication
termination of preg up to 9 weeks
list the 6 absolute contraindications for mifegymiso
- unsure about abortion
- ectopic pregnancy
- uncontrolled asthma
- chronic adrenal failure
- inherited porphyria
- allergy to mifepristone or misoprostol
list the 5 relative CI for mifegymiso
- unconfirmed gestational age
- IUD inserted
- long term CS use
- hemorrhagic disorder or anticoagulant therapy
- anemia
mifegymiso interactions
anything that fucks with CYP3A4
corticosteroids- can decrease eff of steroid for 3-4 days
RF for ectopic pregnancy
previous ectopic preg
tubal surgery
preg through assisted repro techniques
IUD in place
hx PID/salpingitis
how does mifegymiso admin work?
day 1 = mifepristone 200mg PO
day 2-3 = misoprostol 800mg buccal F30 min, swallow fragments
FU day 7-14 with provider
with mifegymiso, when should pregnancy pass
within 2-24hrs
with mifegymiso, when should cramping start
2-3hrs
with mifegymiso, when should bleeding start
1-48hrs after misoprostol
with mifegymiso, how long should you rest
3hrs
with mifegymiso, how long should bleeding last after misoprostol
2-4hrs
AEs of mifegymiso
hot flashes, chills, N/V, fatigue, dizziness/ headache, diarrhea
what to take for mifegymiso SEs
NSAIDs
diphenhydramine
loperamide
when should pt go to ER after mifegymiso
if bleeding through 2 maximads per hour for 2 hours, if pain not controlled, clots size of lemons, fever >38C for >6hrs, V/D/ weaknses for more than 24hrs
when should you return to CHC after mifegymiso
immediately after abortion is complete
how soon can ovulation take place after mifegymiso
8 days
how soon can you get your IUD back after an abortion?
7-14 days
if a pt vomits 45 minutes after their mifepristone dose, do they have to take another one?
yes- if under an hour + take antinausea pill
if pt vomits 30 minutes after swallowing their misoprostol fragments, do they have to take another one?
no
if pt vomits 20 minutes after they’ve placed the misoprostol pills bucally, should they repeat this step?
yes- must finish buccal absorption phase
what is an off label treatment for abortion
methotrexate/ misop[rostol
methotrexate/ misoprostol is available up to _____ gestation and for ____ pregnancise
63 days
ectopic
which of the following can be used for ectopic pregnancies
1. mifegymiso
2. methotrexate/ misoprostol
3. mifepristone alone
2
T or F: mean time to abortion completion is longer with mifegymiso than methotrexate/ miso
F- methotrex/miso takes 7 d compared to mifegymiso 3 d
which has more SEs, methotrexate/miso or mifefgymiso?
methotrex/miso
how to dose methotrexate/misoprostol
methotrexate 50mg PO/IM, then misoprostol 4x200ug admin high in vagina on days 4,5,6
T or F: misoprostol can be used alone for abortion
T
which of the following is false about misoprostol for medical abortions
1. it may be less effective than mifegymiso
2. if often needs repeated dosing
3. starting dose is 200mcg SL or vaginally
4. if there is no response after 3-24hrs, the dose should be repeated
3- starting dose is 800mcg or 4x200mcg
