Pharmacology Flashcards by Emily Crawley

If 1 pill missed of COCP ?

Take pill even if have to take 2 pills in one day and carry on as normal
No emergency contraception needed

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If 2 pills missed of COCP in week 1?

Emergency contraception needed (if has had intercourse in the pill free week or week 1)

Take the last pill even if have to take 2 in one day and omit earlier missed pills. Then continue as normal.

Use condoms/other contraception for 7 days

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If 2 pills missed of COCP in week 2?

Take the last pill even if have to take 2 in one day and omit earlier missed pills. Then continue as normal.

Use condoms/other contraception for 7 days

Emergency contraception not needed

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If 2 pills missed of COCP in week 3?

Take the last pill even if have to take 2 in one day and omit earlier missed pills. Then continue as normal.

Use condoms/other contraception for 7 days

Emergency contraception not needed

should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

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What is used as emergency contraception?

Levonorgestrel (a progesterone) - 1.5mg single dose

EllaOne/Ulipristal (progesterone receptor modulator) - 30mg single dose

Copper IUD

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When can levonorgestrel (levonelle) be used as emergency contraception?

Within 72 hours of UPSI

Dose must be repeated if she vomits within 2 hours of taking

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When can EllaOne/Ulipristal be used as emergency contraception?

120 hours after UPSI

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Who should not receive Ulipristal?

Caution in severe asthmatics

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How does Ulipristal work as emergency contraception?

Inhibits ovulation by inhibiting LH secretion / no LH surge (progesterone receptor modulator)

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Does Ulipristal effect regular hormonal contraception?

Yes - reduce the effectiveness of other hormonal contraception:

COCP should be started/restarted 5 days after taking
POP should be restarted 7 days later

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When can an IUD be used as emergency contraception?

Within 5 days of UPSI OR up to 5 days after ovulation

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Pharmacological mx of ectopic pregnancy

Methotrexate

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What drugs are used in the management of urge incontinence?

Antimuscarinics: Oxybutynin, Tolterodine & Darifenacin

B3 agonist: Mirabegron

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What drug is used for symptomatic relief in obstetric cholestasis?

Ursodeoxycholic acid

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Which antibiotic is used for the treatment of group b strep?

Benzylpenicillin

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What SSRI can be used in postnatal depression?

Paroxetine (Fluoxetine has too long a half life)

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What is the name of the contraceptive patch?

Evra patch

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How is the contraceptive patch taken/used?

4 weeks - wear for 3 weeks and have 1 week off (need to change the patch weekly for those first 3 weeks)

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Delay in changing the contraceptive patch at the end of week 1 or 2?

If <48 hours change immediately and no other precautions needed

If >48 hours change immediately and use barrier contraception for the next 7 days.

Consider emergency contraception if the lady has had UPSI during this patch free interval or in the past 5 days

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Delay in removal of the contraceptive patch at the end of week 3?

Remove ASAP and apply new patch on the usual cycle start day

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If forget to reapply patch at the end of patch free week (week 4)?

Use barrier contraception for the next 7 days

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What antibiotic is used for mastitis and how long for?

10-14 days of Flucloxacillin

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Time until contraceptives are effective?

IUD - instant
POP - 2 days
COCP, injection, implant, IUS - 7 days

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What contraception can be used in a patient with breast cancer?

Copper IUD

ALL hormonal contraceptives are contraindicated in breast cancer

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What medication is safe to use in pregnancy for thrush/candidiasis? And why can't fluconazole be used?

Clotrimazole Pessary Fluconazole is contraindicated in pregnancy due to risk of congenital abnormalities

Dose of Folic Acid used in Pregnancy

Normal risk of neural tube defects: 0.4mg a day pre-conception and continue till 13 weeks 5mg daily if higher risk of neural tube defects

How long after stopping the COCP does breast cancer risk return to that of a normal woman / woman not on COCP ?

10 years after stopping COCP

How long can a copper IUCD be left in for ?

5-10 years

How long can the Mirena IUS be left in for?

Up to 5 years

What are the risks and side effects associated with the IUCD ?

``` Expulsion Perforation PID / infection from insertion Increased risk of ectopic pregnancy Dysmenorrhoea Menorrhagia ```

List some contraindications to the IUCD

``` Copper allergy Wilson's disease Pregnancy Acute PID Cervical cancer Distorted uterine cavity (fibroids) ```

How does IUCD work as a contraceptive?

Prevents implantation | Toxic to sperm

What's the name of the progesterone implant?

Nexplanon

How often does the nexplanon implant need to be changed?

After 3 years

How does the nexplanon implant work?

Inhibits ovulation (Progesterone inhibits LH)

Side effects / negatives of the nexplanon implant ?

Delay returning to fertility | Erratic bleeding

Common side effects of the COCP

- Breast tenderness - VTE / stroke risk increased - Increased risk of breast cancer (and cervical cancer) - Mood changes - Weight gain - Headaches - Bloating - Reduced libido - Breakthrough bleed

What can reduce the effectiveness of the COCP ?

Ullipristil Acetate (emergency contraception, progesterone receptor modulator) CYP450 INDUCERS (Carbamazepine, Rifampicin, Alcohol, Phenytoin, Griseofulvin/Gliclazide, St John's Wart)

MOA COCP

Inhibits ovulation Thickens cervical mucus Prevents implantation (atrophic endometrium and inhibits progesterone receptor synthesis in the endometrium)

Contraindications to COCP

Absolute (UKMEC 4): - >35 and smoking >15 a day - Migraine with aura - Personal history of VTE disease or thrombogenic mutation - History of stroke or IHD - Uncontrolled HTN - Breast feeding <6 weeks postpartum - Breast cancer (current) - Major surgery / prolonged immobilisation Relative (UKMEC 3): - >35 and smoking <15 a day - BMI >35 - FMH thromboembolism (first degree relative) - Controlled HTN - Known BRCA1/2 gene mutations

MOA POP

``` Thickens cervical mucus Inhibits implantation (inhibits progesterone receptor synthesis in the endometrium) ``` Inhibits ovulation in some women

SE POP

``` Erratic bleeding Breast tenderness Weight gain Acne Less effective than COCP / pregnancy ```

Contraindications for the POP

Current breast cancer Trophoblastic disease Severe liver disease

What are the hourly windows for missing the POP

Levonorgestrel = 3-4 hour window Cerazette (desogestrel) = 12 hour window

How often should the progesterone depot injection be given?

Every 3 months

What is the COC ring called?

Nuvaring

What are the side effects of the Mirena IUS

Increased risk of PID Increased risk of ectopic pregnancy Perforation Expulsion

List some examples of 'natural methods' of contraception

Withdrawal Breast feeding (90% effective in the first 6 months) Calendar method Assess cervical mucus (thin until ovulation, thick after ovulation) Basal body temperature (increases after ovulation) Measure LH surge using 'persona' urine test

List some examples of barrier contraception

``` Condoms - male and female Diaphragm Cervical cap Sponge Spermicides (nonoxinol-9) ```

Who shouldn't use spermicides as contraception?

HIV positive: increases risk of transmission as it irritates the vagina

What is the failure rate associated with COCP and POP

0.3%

What is the failure rate associated with the IUCD

0.6%

What is the failure rate associated with progesterone injection

0.3%

What is the failure rate associated with Mirena IUS

0.1%

What is the failure rate associated with condoms (male and female)

Male - 2% | Female - 5%

What is the failure rate associated with the diaphragm

What is the failure rate associated with natural methods

9-25%

What is the failure rate assocaited with vasectomy

0.1%

What are the Fraser guidelines?

Those under 16 y/o may be prescribed contraception without parental permission if: - They understand the doctors advice - They cannot be persuaded to inform their parents - They are likely to begin or continue having intercourse with or without contraception - Physical or mental health will suffer without treatment - It is in the young person's best interest

What is the difference between the Fraser guidelines and Gilick competence?

Fraser guidelines apply to contraception ONLY, whereas Gilick competence applies to children <16 who have legal capacity to consent to examination and treatment

What drug should be given alongside inserting the IUD?

Azithromycin prophylaxis if STI screen results unavailable

MOA Misoprostol

Prostaglandin analogue | Causes myometrium contractions

Risk of cancers associated with COCP

Increased risk: - Breast - Cervical Reduced risk: - Endometrial - Ovarian