Passmed O&G - Pharmacological Managements

Question 1

2 emergency contraceptives

Answer 1

Levonorgestrel - within 72 hrs
Ulipristal (EllaOne) - within 120 hrs

Question 2

Atrophic vaginitis

Answer 2

Topical oestrogen

Question 3

Endometriosis

Answer 3

1st - NSAIDs and/or paracetamol
2nd - COCP or medroxyprogesterone acetate

Question 4

Hyperemsis gravidarum

Answer 4

Oral cyclizine or promethazine
Oral prochlorperazine or chlorpromazine

Question 5

Menopause symptoms - vasomotor sx, vaginal dryness

Answer 5

Vasomotor sx = fluoxetine, citalopram, venlafaxine
Vaginal dryness = vaginal lubricant/moisturiser, vaginal oestrogens

Question 6

Vaginal candidiasis

Answer 6

Oral fluconazole
Clotrimazole intravaginal pessary (pregnancy)

Question 7

Fibroids

Answer 7

Menorrhagia = levonorgestrel IUS, NSAIDs, tranexamic acid, hormonal contraceptive
Shrink fibroid = GnRH agonist

Question 8

Abortion

Answer 8

<9 weeks = mifepristone then 48 hrs later prostaglandins
Otherwise surgical

Question 9

Pelvic inflammatory disease

Answer 9

Oral ofloxacin + metronidazole
OR
IM ceftriaxone + oral doxycycline + metronidazole

Question 10

Antenatal medications

Answer 10

Folic acid 400mcg from conception (make this 5mg if obese)
Vitamin D 10mcg

Question 11

Gestational diabetes

Answer 11

Fasting glucose <7 = trial of diet + exercise, if not met then metformin, if still not met then insulin (short-acting)
Fasting glucose >7 = start insulin

Question 12

Group B streptococcus

Answer 12

Intrapartum benzylpenicillin

Question 13

Medications for inducing labour

Answer 13

Vaginal prostaglandin E2 (dinoprostone)
Oral prostaglandin E1 (misoprostol)
Oxytocin

Bishop score <6 = prostaglandin (either)
Bishop score >6 = amniotomy + IV oxytocin infusion

Question 14

Management of postpartum haemorrhage

Answer 14

IV oxytocin
Ergometrine slow IV or IM

Question 15

Preeclampsia

Answer 15

Oral labetalol
Nifedipine if asthmatic
Hydralazine if others not tolerated

Question 16

Intrahepatic cholestasis + pruritus in pregnancy

Answer 16

Ursodeoxycholic acid for symptomatic relief

Question 17

Endometritis (post-partum/puerperal pyrexia)

Answer 17

IV clindamycin + gentamicin

Question 18

VTE prophylaxis in pregnancy

Answer 18

LMWH (DOACs + warfarin contraindicated)

Question 19

Preterm pre labour rupture of membranes

Answer 19

Oral erythromycin + antenatal steroids