oral contraceptives

Question 1

Oestrogen examples (combined

Answer 1

estradiol
ethinylestradiol
mestranol

Question 2

Progesteogen content (combined)

Answer 2

norgestimate
desogestrel
levonorgestrel
drosperinone (spironolactone derivative)
gestodene
norethisterone
dienogest
nomegestrel

Question 3

what is zoely

Answer 3

nomesgetreol +estradiol

Question 4

what is qlaira

Answer 4

estradiol with dianeogest

Question 5

what 3 progestogens preferred when acne breakthrough bleeds depression

Answer 5

desogesterol
drosperinone
norgestimate

Question 6

cCombined transdermal patch

Answer 6

EVRA (ethinylestradiol/ norgestamin)

Question 7

combined ring

Answer 7

nuva ring - etonogestrel and ethinylestradiol

Question 8

progestogen only pills

Answer 8

desogestrel - cerelle, cerazette
norethisterone (micronor or noriday )
levonorgestrel ( norgeston)

Question 9

parenteral injection

Answer 9

medroxyprogesterone acetate - depo provera injection
- norethisterone injection
- etonogestrel implant

Question 10

IUD

Answer 10

copper
or levonogestrel releasing.

Question 11

freser guidelines (5) what is it and what are rules

Answer 11

decision whether to give a child under 16, contraception without consent
1) does she understand advice given
2) cannot be convinced to tell parents
3) likely to continue having sex anyway
4) more of a mental detriment not to give her the pill
5) best interest
if she doesn’t meet criteria a parent/ carer can be told

Question 12

two types of oral contraception

Answer 12

COC and POP

Question 13

dosing for coc

Answer 13

one to be taken daily for 3 weeks and 1 week is pill free to allow a withdrawal bleed

Question 14

when can you start COC?

Answer 14

any time in menstrual cycle but if day 6 or later, need contraceptive protection i.e. condom for 7 days

Question 15

what age group cannot have COC

Answer 15

50+

Question 16

4 types of COC

Answer 16

1) monophasic fixed amount of progestogen and oestrogen (21 day prep)
2) multiphasic/ PHASIC (varying amount of progestogen and oestrogen) - 21 day prep
3)every day (ED) prep can be multi or monophonic but (28 day prep) has a strip of placebo tabs
4) low strength oestrogen prep i.e 20mg ethinylestradiol

Question 17

why have phasic preparation

Answer 17

for women who do not have withdrawal bleed
or have breakthrough bleed with monophonic

Question 18

what do oestrogens inc risk of

Answer 18

VTE or arterial thrombosis

Question 19

risk factors of oestrogen and VTE

Answer 19

• AGE>35
• long term immobilisation
• thrombophlebitis
  -type of progestogen ; drosperinone, gestodene, desogesterl
• primary relative under 45 with VTE
• obesity >30
• smoke

(avoid if 2 or more risk factors)

Question 20

oestrogen arterial thrombus risk

Answer 20

diabetes mellitus, htn, migraine without aura

Question 21

how long to stop COC before surgery

Answer 21

4 weeks (for major surgery and surgery to lower legs and limbs = prolonged immobilisation

Question 22

coc and surgery
alternative contraceptive?
when to restart usual contraception?
what to do in emergency surgery?

Answer 22

alt contraceptive= POP
restart on first menses two weeks after full mobilisation
in emergency where coc not stop give thromboprophylaxis

Question 23

coc and travel more than 3 hrs

Answer 23

have compression hosiery and do exercise

Question 24

REASONS TO STOP COC AND OESTROGEN CONTAINING HRT

Answer 24

VTE, stroke, jaundice, blood pressure, prolonged dvt after surgery (dvt risk

Question 25

VTE (coc and OHRT) symptoms

Answer 25

• sudden severe chest pain, dyspnoea, cough blood in sputum- pulmonary embolism?
• unexplained swelling in calf or leg (dvt)

Question 26

Stroke symtoms (OHRT and COC)

Answer 26

serious CNS effect- severe prolong h/a, sudden partial / comp loss of vision (sensory disturb) , slurred speech, faint attack, collapse, first unexplained epileptic seizure, weak ,motor disturb, marked numbness one side body

Question 27

liver dysfunction (coc/ OHRT)

Answer 27

vomiting, persistent abdominal pain, jaundice, dark urine (hepatitis liver enlarge)

Question 28

BP (coc/Ort)

Answer 28

Systolic >160 and diastolic >90 mmHg

Question 29

what are the oestrogen only risks that c/I tx

Answer 29

1) age over 50
2) smoke 40 + cig
3) bmi >35
4) migraine aura, migraine>72hr or tx with ergot derivatives
5) diabete mellitus with comp
6) valvular Heart disease (stroke risk) / pulmonary HD ( with risk of embolism
7)TIA w/out H/A
8) Severe or multiple risk factor (2+ or more)
9) bp >160> 90

Question 30

POP moa

Answer 30

work by thickening mucus in cervix so egg cant be fertilised
alternative when COC or OESTRogen c/I

Question 31

dose for POP

Answer 31

one pill at same time each day on a continuous basis (28 days)
- if started after day 5 of menstrual cycle need 2 days added contraception with condom

Question 32

Hormonal contraceptive s/e combined and POP

Answer 32

Combined: risk of cervical and breast cancer
progestrogen: risk of breast

oestrogen increases risk of cervical