Medical Abortion

Question 1

what are some options for terminating a pregnancy under 14 weeks

Answer 1

medical, vacuum aspiration, electric vacuum aspiration

Question 2

what is the only option for termination of pregnancy >14wks

Answer 2

dilation and evacuation

Question 3

mifegymiso is approved by health canada for use under

Answer 3

63 days or 9 weeks

Question 4

T or F: pharmacists must see the ultrasound confirming pregnancy before dispensing mifegymiso

Answer 4

F

Question 5

T or F: mifegymiso requires witnessed ingestion

Answer 5

F

Question 6

mifegymiso contains

Answer 6

200mg of mifepristone and 800mg misoprostol

Question 7

what is mifepristone

Answer 7

a progesterone antagonist on the endometrium/ myometrium that also has antiglycocorticoid properties

Question 8

misoprostol MOA

Answer 8

a synthetic prostaglandin that induces uterine contractions

Question 9

mifegymiso indication

Answer 9

termination of preg up to 9 weeks

Question 10

list the 6 absolute contraindications for mifegymiso

Answer 10

1. unsure about abortion
2. ectopic pregnancy
3. uncontrolled asthma
4. chronic adrenal failure
5. inherited porphyria
6. allergy to mifepristone or misoprostol

Question 11

list the 5 relative CI for mifegymiso

Answer 11

1. unconfirmed gestational age
2. IUD inserted
3. long term CS use
4. hemorrhagic disorder or anticoagulant therapy
5. anemia

Question 12

mifegymiso interactions

Answer 12

anything that fucks with CYP3A4
corticosteroids- can decrease eff of steroid for 3-4 days

Question 13

RF for ectopic pregnancy

Answer 13

previous ectopic preg
tubal surgery
preg through assisted repro techniques
IUD in place
hx PID/salpingitis

Question 14

how does mifegymiso admin work?

Answer 14

day 1 = mifepristone 200mg PO
day 2-3 = misoprostol 800mg buccal F30 min, swallow fragments
FU day 7-14 with provider

Question 15

with mifegymiso, when should pregnancy pass

Answer 15

within 2-24hrs

Question 16

with mifegymiso, when should cramping start

Answer 16

2-3hrs

Question 17

with mifegymiso, when should bleeding start

Answer 17

1-48hrs after misoprostol

Question 18

with mifegymiso, how long should you rest

Answer 18

3hrs

Question 19

with mifegymiso, how long should bleeding last after misoprostol

Answer 19

2-4hrs

Question 20

AEs of mifegymiso

Answer 20

hot flashes, chills, N/V, fatigue, dizziness/ headache, diarrhea

Question 21

what to take for mifegymiso SEs

Answer 21

NSAIDs
diphenhydramine
loperamide

Question 22

when should pt go to ER after mifegymiso

Answer 22

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

Question 23

when should you return to CHC after mifegymiso

Answer 23

immediately after abortion is complete

Question 24

how soon can ovulation take place after mifegymiso

Answer 24

8 days

Question 25

how soon can you get your IUD back after an abortion?

Answer 25

7-14 days

Question 26

if a pt vomits 45 minutes after their mifepristone dose, do they have to take another one?

Answer 26

yes- if under an hour + take antinausea pill

Question 27

if pt vomits 30 minutes after swallowing their misoprostol fragments, do they have to take another one?

Answer 27

no

Question 28

if pt vomits 20 minutes after they've placed the misoprostol pills bucally, should they repeat this step?

Answer 28

yes- must finish buccal absorption phase

Question 29

what is an off label treatment for abortion

Answer 29

methotrexate/ misop[rostol

Question 30

methotrexate/ misoprostol is available up to _____ gestation and for ____ pregnancise

Answer 30

63 days ectopic

Question 31

which of the following can be used for ectopic pregnancies 1. mifegymiso 2. methotrexate/ misoprostol 3. mifepristone alone

Answer 31

2

Question 32

T or F: mean time to abortion completion is longer with mifegymiso than methotrexate/ miso

Answer 32

F- methotrex/miso takes 7 d compared to mifegymiso 3 d

Question 33

which has more SEs, methotrexate/miso or mifefgymiso?

Answer 33

methotrex/miso

Question 34

how to dose methotrexate/misoprostol

Answer 34

methotrexate 50mg PO/IM, then misoprostol 4x200ug admin high in vagina on days 4,5,6

Question 35

T or F: misoprostol can be used alone for abortion

Answer 35

T

Question 36

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

Answer 36

3- starting dose is 800mcg or 4x200mcg