Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IPFC 1 Final > Medical Abortion > Flashcards

Medical Abortion Flashcards

1
Q

Does access to medical abortion increase abortion rates

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What population factors are associated with LOWER abortion rates (5)

A
  • Living in North America or Europe
  • High contraception use
  • High economic development
  • High levels of gender equality
  • Well developed health infrastructures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Generally, what does mifepristone do? then what does misoprostol do?

A

Mifepristone: end pregnancy
Misoprostol: push uterus contents out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What kind of activity does Mifepristone have? What does it cause?

A

Is a progestone receptor modulator
- Strong antiprogestin and antiglucocorticoid activity

Causes
- endometrial degenartaion
- Resumption of PG activity (uterine contractions)
- Softening/dilation of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Role of progesterone with uterine contractions

A

Prevents Prostaglandins which prevents uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does it mean that Mifepristone is a CYP3A4 substrate? When is it less effective? What meds causes more N/V side effects?

A

Less effective if patient is on
- rifampicin
- CBZ
- barbiturates
- St. John’s Wort

More N/V side effects when
- ketoconazole
- Erythromycin
- Grapefruit juice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does it mean the mifepristone is an irreversible inhibitor of CYP 3A4

A

Increase side effects/toxicity of drugs metabolized by CYP 3A4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Mifepristone has anti-glucocorticoid effect. What does this mean?

A

Can block effects of corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Explain the MOA of misoprostol. What does it cause?

A

Synthetic prostaglandin
Causes:
- cervical ripening
- uterine contractions
- Gi smooth muscle stimulation (diarrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What can decrease bioavailability of misoprostol?

A

Antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 3 steps for assessing medical abortion

A
  1. Establish pregnancy
  2. Determine Gestational AGE ( 9 weeks max)
    - last menstrual period (sufficient alone)
    - Pelvic exam
    - Ultrasound (gold standard; prefered when uncertain with LMP or pelvic exam)
    - Beta-HCG levels (inc of this means inc of G. age)
  3. Rule out ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When is LMP accurate? when is it inaccurate

A

Accurate when:
- Typical menses are regular and recorded
- LMP occurred at expected time, usual duration

Inaccurate when:
- Menses is lighter than usual
- Not on expected date
- If they are taking or stopping hormonal contraception
- If patient is breastfeeding (hormones imbalance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main way to rule out ectopic pregnancy?

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How to rule out an ectopic pregnancy if Ultrasound is not available? What is the pregnancy called? is it contraindicated?

A

Called Pregnancy of unknown location PUL (NOT CONTRAINDICATED)
- Consider LMP, clinical symptoms, risk factors, beta-HCG levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are clinical symptoms of ectopic pregnancy? How to treat?

A
  • First trimester bleeding AND/OR abdominal pain
  • may be asymptomatic

Treat: methotrexate, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are risk factors of ectopic pregnancy?

A

Anything that causes inflammation and uterus
- previous ectopic pregnancy
- Tubal surgery/ligation
- Pregnancy conceived with assisted
- Reproduction techniques
- IUD IN PLACE
- History of salpingitis or pelvic inflammatory

17
Q

What are contraindications of abortion (8)? When to avoid (1)

A
  • Ectopic pregnancy
  • Presence of an IUD
  • Unconfirmed gestational age (less effective later in pregnancy)
  • Bleeding (bc Mifepristone causes more bleeding)
  • Chronic adrenal failure (avoid if patient is using long-term systemic glucocorticoid)
  • Inherited poryphyria [disease in which hemeglobin is abnormally metabolized; dark] (can affect early components of heme synthesis)
  • Allergy to MIFE or MISO
  • Uncertainty of abortion

Avoid if you have uncontrolled asthma

18
Q

Doses for Medical abortion?

A

Day 1: MIFE 200mg orally
Day 2-3: 4x MISO 200mcg tabs placed in cheek for 30 min

19
Q

What to expect for bleeding during abortion

A
  • Usually starts within 1-2 hours of MISO (may start after MIFE) (means sucessful)
  • Usually heavier than typical menses
20
Q

When should you go to the hospital for bleeding

A
  • If Soaking 2 maxi pads/hour for 2 hours OR if dizzy, lightheaded or heart racing
21
Q

What are some symptom management for medical abortion to dispense

A

Maxi pads NOT tampons (or anything inserted into vagina)
NSAIDs
Dimenhydrinate (gravol)
Loperimide for diarrhea

  • Ask about contraception plans
    Patient can ovulate as soon as 8 days after
  • Wait 1-2 weeks before intercourse
22
Q

What to do if patient vomits within 1hr of mifepristone

A

take a 2nd dose with antimetic (gravol)

23
Q

What to do if the patient vomits in the first 30 min while misoprostol

A

Assess symptoms within 1-2 hours
- MISO absorbed quickly
- if vaginal bleeding occurs no need 2nd dose
- If not, prescriber reassess

24
Q

When can you start contraception after abortion? when can you insert an IUD?

A

The day misoprostol is taken

IUD at the follow-up visit in 7-14 days

25
Q

When do you follow up?
What are 3 ways to confirm end of pregnancy

A

7-14 days

Clinical exam
Ultrasound
Telemedicine with beta-HCG level and symptom assessment

26
Q

What are some complications of abortion (4)

A
  • Retained products of contraception
  • Ongoing pregnancy
  • Infection
  • Toxic shock syndrome
27
Q

What are the treatment options for an incomplete miscarriage

A

Misoprostol 800mcg intravaginally
**repeat in 3 days if NO expulsion

or surgery if incomplete on day 8

28
Q

What are treatment options of ectopic pregnancy

A
  1. Surgery
  2. Methotrexate (single or 2 dose regimen, 2 is more side effects)
  • 50mg/m2 IM on day 1
    2nd dose on day 4
29
Q
A

IPFC 1 Final (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions