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Therapeutics 2 > mod 9 contraception > Flashcards

mod 9 contraception Flashcards

1
Q

what are the options for emergency contraception? Why would you use one over the other?

A
  1. LNG-EC pills (plan B)
    - no prescription, most effective within 24h, can be used up to 5 days after unprotected sex
    - may not be as effective in BMI above 25
  2. Ulliprisal Acetate (ELLA)
    - need script
    - can be taken up to 5 days
    - equally as effective in women above 25 BMI
  3. Copper IUD
    - need script
    - the most effective method can be used up to 7 days
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2
Q

after you prescribe emergency contraception to a patient, do they need to take a pregnancy test?

A

yes they will need a pregnancy test 21 days after copper IUD insert or if no menstrual period within 21 days of given EC.

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3
Q

What considerations do you need to take if a patient is taking Carbamazepine (tegetrol) for seizures when prescribing emergency contraception?

A

you need to double the dose if on carbamazepine, as its not as effe

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4
Q

What things do you need to evaluate when considering a medical abortion for suspected ectopic pregnancy?

A
  1. Beta HCG levels
  2. patients risk factors of ectopic pregnancy
  3. the location of the gestational sac by ultrasound

you cannot perform a medical abortion if you suspect ectopic pregnancy, which is why you need to consider these above^

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5
Q

what are the contraindications to all medical abortions?

A
  1. ectopic pregnancy
  2. IUD in place
  3. Hemorrhagic disorders
  4. Anemia less than 95hg
  5. allergy to drug
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6
Q

What are the contraindications to medical abortion using Mifepristone/Misoprostol?

A
  1. uncontrolled asthma
  2. IBD
    3.Chronic adrenal failure
  3. Inherited porphyria
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7
Q

What are the contraindications to medical abortion using Methotrexate/Misoprostol?

A
  1. Active liver disease
  2. Active renal disease
  3. IBD
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8
Q

would this patient qualify for a medical abortion?

  1. They have symptoms of abdominal pain, pallor, vaginal bleeding
  2. They have an IUD
  3. an intrauterine gestational sac is absent
  4. their beta Hcg is above 2000 u/L
A

no, they cannot get a medical abortion further invetigtion is needed to ensure they are not having an eptopic pregnancy

this patient has symptoms of an ectopic pregnancy
and they have risk factors
AND their HcG is above 2000

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9
Q

would this patient qualify for a medical abortion ?

  1. gestational sac cannot be visualized in intrauterine or extrauterine space
  2. This patient has no risk factors or symptoms of an ectopic pregnancy
  3. Their beta HcG is below 2000
A

yes it is safe for this patient to proceed with medial abortion

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10
Q

would this patient be able to have a medical abortion?

  1. Gestational sac is visualized yolk sac/fetal pole not present
  2. no symptoms or risk factors for ectopic pregnancy
A

yes

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11
Q

in the first trimester, what is the recommended technique for abortion ?

A

Vacuum aspiration either manual or electric is the recommended technique of abortion in the first trimester

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12
Q

Up to how many days can you have a medical abortion ?

A

if you use mifepristone/misoprostol then its up to 63 days

Methotrexate can be used up to 70 days

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13
Q

can you use misoprostol only for a medical abortion?

A

you can but its not advised because often you need multiple treatments

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14
Q

After you provide a patient with a medical abortion when do you need to follow up with them?

A

a follow up should be booked as early as day 3, but most are booked at 7-14 days

a urine beta will be collected, and an 80% decrease of beta-hCG confirms completion of medical abortion

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15
Q

true or false?

Medical abortion have no impact on future fertility with a return to fertility as early as 8 days

A

true

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16
Q

how early can a patient start hormonal contraception after having a medical abortion?

A

They can start taking hormonal contraception on the same day that they take their misoprostol administration

17
Q

if a patient uses emergency contraception levenorgestrel, when should they start hormonal contraception?

A

hormonal contraception should be started within 24 hours of taking emergency levenorgestrel

and patient should abstain from sex for 7 days or use a condom/back up

18
Q

if a patient uses emergency contraception ulliprastal-EC when should they start hormonal contraception?

A

they will need to wait 5 days after taking ulliprastal, and use back up contraception for the first 5 days AND for the first 14 days after starting hormonal contraception!

19
Q

after taking mifegymiso (mifepristone/misoprostol) how long do you have to wait before trying to conceive?

A

you must wait 4 weeks before trying to conceive

20
Q

what contraception is advised in postpartum mothers (regardless of breastfeeding status)

A

progesterone only is always advised doesnt matter if thy are breastfeeding or not

21
Q

how shortly after an abortion can you insert an IUD?

A

anytime after even immediatley, but if you wait 6 weeks its less likely to fall out

22
Q

If you are prescribing birthcontrol to your patient who is complaining of acne, what considerations would you make ?

A

Products that contain third generation progestins (eg, desogestrel, norgestimate) are less androgenic and may be helpful in acne.

23
Q

what is lactational amenorrhea ? and how is this a form of contraception?

A

This method is highly effective for the first six months after childbirth, provided the woman breastfeeds the baby at least every four hours during the day and every six hours through the night, and that her menstrual period has not yet returned. After six months fertility may return at any time.

24
Q

which method of contraception is the least effective (natural methods)

A

apparently fertility awareness, so you avoid having sex during a fertile 5 day window

pulling out… it apparently more effective than this

25
Q

What would you do if you patient just started their birth control and in the first month they had break through bleeding?

A

let them know this is normal within the first 3-6 months

26
Q

What would you do if your patient who just started hormonal birth control had breakthrough bleeding beyond 6 months and its not related to an infection/structural cause?

A

you would change their birth control to either one with higher estrogen if the bleeding occurs on day 1-9, or one with higher progesterone if it occurs on day 10-21

Day 1 to 9: estrogen deficiency
Day 10-21: progestin deficiency

27
Q

how would you classify mild, moderate, and severe nausea/ vomiting in a pregnant women?

A

Mild: ≤1 hour of nausea with ≤2 instances of vomiting and retching/day

Moderate: ≤6 hours of nausea with ≤2 instances of vomiting and retching/day

Severe: >6 hours of nausea, vomiting or retching with >5 occasions/day

28
Q

What medications do you use to treat mild nausea/vomiting in pregnancy?

A

ginger tablet 250mg q6
pyridoxine 25mg q8

29
Q

if a pregnant person has severe nausea and vomiting, or hyperemesis gravidarum what are the first line treatments?

A

start/continue with the ginger/pyridoxine but then add:

Dimenhydrinate 50mg po/iv/pr
Diphenhydramine 25mg ^
Promethazine

30
Q

what are your second line agents for severe nausea/vomiting in a pregnant women who NOT dehydrated?

A

second line agents include:

Chloropramazine
Metoclopramide
Prochlorperazine

31
Q

when do you give tdap vaccine during pregnancy?

A

27-32 weeks

32
Q

true or false?

Avoid NSAIDs and full doses of ASA in 3​rd trimester. Limit codeine to short-term use in pregnancy

A

true

33
Q

what supplementation of iron is reccomended during pregnancy?

A

Supplementation with 16–20 mg/day is recommended

34
Q

how much caffeine can you drink during pregnancy?

A

Consume ≤300 mg/day

35
Q

if you are considered high risk for neural tube defect during prgnancy what dose of folic acid do you take before pregnancy, during and after?

A

Prenatal X3 months 4mg

then from 0-12 weeks continue on 4mg

12 weeks to 6weeks post partum/as long as you breast feed you can drop down to 0.4-1mg

36
Q

how often do you change the Evra (estrogen +norelgestromin) patch?

and what do you do if the patch falls off for more than 24 hours?

A

you change the patch weekly,

and if it falls off for more than 24 hours start a new patch and restart a 3-patch cycle

and do not apply to breast tissue
avoid if pt weighs more than 90kg

37
Q

what symptoms require urgent consult for patient taking oral contraceptives?

A

Abdominal pain (severe)
Chest pain (severe),
Headaches (severe)
Eye problems
Severe leg pain

38
Q

Can Plan B be used in patients at risk of thrombosis?

A

yes

39
Q

Which is the failure rate (pregnancy) with male condoms in typical use?

A

18%

Therapeutics 2 (12 decks)

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