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* FINALS: Obs and Gynae (My Cards) > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

If 1 pill missed of COCP ?

A

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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2
Q

If 2 pills missed of COCP in week 1?

A

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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3
Q

If 2 pills missed of COCP in week 2?

A

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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4
Q

If 2 pills missed of COCP in week 3?

A

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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5
Q

What is used as emergency contraception?

A

Levonorgestrel (a progesterone) - 1.5mg single dose

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

Copper IUD

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6
Q

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

A

Within 72 hours of UPSI

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

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7
Q

When can EllaOne/Ulipristal be used as emergency contraception?

A

120 hours after UPSI

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8
Q

Who should not receive Ulipristal?

A

Caution in severe asthmatics

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9
Q

How does Ulipristal work as emergency contraception?

A

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

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10
Q

Does Ulipristal effect regular hormonal contraception?

A

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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11
Q

When can an IUD be used as emergency contraception?

A

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

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12
Q

Pharmacological mx of ectopic pregnancy

A

Methotrexate

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13
Q

What drugs are used in the management of urge incontinence?

A

Antimuscarinics: Oxybutynin, Tolterodine & Darifenacin

B3 agonist: Mirabegron

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14
Q

What drug is used for symptomatic relief in obstetric cholestasis?

A

Ursodeoxycholic acid

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15
Q

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

A

Benzylpenicillin

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16
Q

What SSRI can be used in postnatal depression?

A

Paroxetine (Fluoxetine has too long a half life)

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17
Q

What is the name of the contraceptive patch?

A

Evra patch

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18
Q

How is the contraceptive patch taken/used?

A

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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19
Q

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

A

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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20
Q

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

A

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

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21
Q

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

A

Use barrier contraception for the next 7 days

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22
Q

What antibiotic is used for mastitis and how long for?

A

10-14 days of Flucloxacillin

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23
Q

Time until contraceptives are effective?

A

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

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24
Q

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

A

Copper IUD

ALL hormonal contraceptives are contraindicated in breast cancer

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25
Q

What medication is safe to use in pregnancy for thrush/candidiasis?

And why can’t fluconazole be used?

A

Clotrimazole Pessary

Fluconazole is contraindicated in pregnancy due to risk of congenital abnormalities

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26
Q

Dose of Folic Acid used in Pregnancy

A

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

27
Q

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

A

10 years after stopping COCP

28
Q

How long can a copper IUCD be left in for ?

A

5-10 years

29
Q

How long can the Mirena IUS be left in for?

A

Up to 5 years

30
Q

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

A 
Expulsion
Perforation
PID / infection from insertion
Increased risk of ectopic pregnancy
Dysmenorrhoea
Menorrhagia
31
Q

List some contraindications to the IUCD

A 
Copper allergy
Wilson's disease
Pregnancy
Acute PID 
Cervical cancer
Distorted uterine cavity (fibroids)
32
Q

How does IUCD work as a contraceptive?

A

Prevents implantation

Toxic to sperm

33
Q

What’s the name of the progesterone implant?

A

Nexplanon

34
Q

How often does the nexplanon implant need to be changed?

A

After 3 years

35
Q

How does the nexplanon implant work?

A

Inhibits ovulation (Progesterone inhibits LH)

36
Q

Side effects / negatives of the nexplanon implant ?

A

Delay returning to fertility

Erratic bleeding

37
Q

Common side effects of the COCP

A
  • Breast tenderness
  • VTE / stroke risk increased
  • Increased risk of breast cancer (and cervical cancer)
  • Mood changes
  • Weight gain
  • Headaches
  • Bloating
  • Reduced libido
  • Breakthrough bleed
38
Q

What can reduce the effectiveness of the COCP ?

A

Ullipristil Acetate (emergency contraception, progesterone receptor modulator)

CYP450 INDUCERS
(Carbamazepine, Rifampicin, Alcohol, Phenytoin, Griseofulvin/Gliclazide, St John’s Wart)

39
Q

MOA COCP

A

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

40
Q

Contraindications to COCP

A

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
41
Q

MOA POP

A 
Thickens cervical mucus
Inhibits implantation (inhibits progesterone receptor synthesis in the endometrium)

Inhibits ovulation in some women

42
Q

SE POP

A 
Erratic bleeding
Breast tenderness
Weight gain
Acne
Less effective than COCP / pregnancy
43
Q

Contraindications for the POP

A

Current breast cancer
Trophoblastic disease
Severe liver disease

44
Q

What are the hourly windows for missing the POP

A

Levonorgestrel = 3-4 hour window

Cerazette (desogestrel) = 12 hour window

45
Q

How often should the progesterone depot injection be given?

A

Every 3 months

46
Q

What is the COC ring called?

A

Nuvaring

47
Q

What are the side effects of the Mirena IUS

A

Increased risk of PID
Increased risk of ectopic pregnancy
Perforation
Expulsion

48
Q

List some examples of ‘natural methods’ of contraception

A

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

49
Q

List some examples of barrier contraception

A 
Condoms - male and female
Diaphragm
Cervical cap
Sponge
Spermicides (nonoxinol-9)
50
Q

Who shouldn’t use spermicides as contraception?

A

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

51
Q

What is the failure rate associated with COCP and POP

A

0.3%

52
Q

What is the failure rate associated with the IUCD

A

0.6%

53
Q

What is the failure rate associated with progesterone injection

A

0.3%

54
Q

What is the failure rate associated with Mirena IUS

A

0.1%

55
Q

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

A

Male - 2%

Female - 5%

56
Q

What is the failure rate associated with the diaphragm

A

6%

57
Q

What is the failure rate associated with natural methods

A

9-25%

58
Q

What is the failure rate assocaited with vasectomy

A

0.1%

59
Q

What are the Fraser guidelines?

A

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
60
Q

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

A

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

61
Q

What drug should be given alongside inserting the IUD?

A

Azithromycin prophylaxis if STI screen results unavailable

62
Q

MOA Misoprostol

A

Prostaglandin analogue

Causes myometrium contractions

63
Q

Risk of cancers associated with COCP

A

Increased risk:

  • Breast
  • Cervical

Reduced risk:

  • Endometrial
  • Ovarian

* FINALS: Obs and Gynae (My Cards) (4 decks)

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