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Gynekologi > Prevensjonsmidler > Flashcards

Prevensjonsmidler Flashcards

1
Q

Hva innebærer menstruasjonssyklusen?

A
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2
Q

Hvordan kan man bruke “safe periods” som prevenasjonsmiddel?

A
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3
Q

Hva er Pearl indeksen?

A

The Pearl Index is a way to evaluate the quality of different contraceptive techniques. We usually describe it as the number of women who got pregnant during 1 year of constant use of a given method, out of a group of 100 women.

In other words, if 100 women tried method “A” for an entire year and 6 of them got pregnant, the birth control index for the “A” method would be equal to 6.

I.e., the number of pregnancies in 1200 observed months of use (women-months)).

Used in clinical trials for assessing the effectiveness of a birth control method.

Andelen kvinner (%) som blir gravid ved ett års bruk av prevensjonsmetode.

Én verdi for perfekt bruk og én verdi for «typisk bruk»

Lik PI ved begge vurderinger = mer effektiv prevensjonsmetode.
Regnes som «svangerskap per 100 kvinneår i en befolkning» = hvor mange svangerskap ville oppstå hos 100 kvinner ila. ett år, gitt at det til enhver tid er 100 kvinner som er eksponert.

PI uten prevensjon: ca. 85 %

No use of contraception has a PI 85: ca. 7 pregnant after 1 month (among 100 users).

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4
Q

Hvilke barrieremetoder kan brukes som prevensjonsmiddel?

A
The word condom (from latin “condus”) means collect. The first descriptions are from ancient Egypt around 3000 B.C. In China from 2000 B.C. they used oily silk paper. Casanova used condoms made of animal´s small intestines. Linen has also been used to make condoms. First from mid 1800 century the rubber was invented resulting in better quality and user friendliness.
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5
Q

Hvordan fungerer en kobberspiral som prevensjonsmiddel?

A
The Copper IUCD is made of plastic and a thin copper string winded around the stem. It must be inserted into the uterus by a medical doctor. The IUCD can be there for a period of up to 5 years. It may be used by never-pregnant women as well. The most important mechanism of action is that sperm cells in contact with the copper will be destroyed and hence not able to fertilize the egg. In addition, if fertilized, the egg´s implantation into the endometrium is inhibited by the irritating IUCD.

https://www.helsenorge.no/sex-og-samliv/prevensjon/spiral/

https://www.youtube.com/watch?v=bCiPz-jV0rM

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6
Q

Hva er fordelene/ulempene med kobberspiraler?

A
Pearl index of 1, hence ca 2 pregnant after 2 years (among 100 users).
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7
Q

Hvilke progestin intrauterine midler har man tilgjengelig i Norge?

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8
Q

Hvilke egenskaper har Kyleena?

A
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9
Q

Hvilke egenskaper har Mirena/Levosert?

A
The mechanism of action of the hormone-loaded IUD is a foreign body reaction. This causes also an increase in the viscosity of cervical mucus and, to a minor extent inhibition of ovulation. The Pearl index is 0.2-0.5. Mirena har effekt i 5 år hvis det brukes til behandling av kraftige menstruasjonsblødninger (idiopatisk menoragi); byttes etter 5 år.

https://www.youtube.com/watch?v=zgi3mbW2YdA

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10
Q

Hva er en “Minipille”?

A
The reliability of low dose progestin-only pills (POPs) depends strongly on compliance. The mechanism of action of most POPs is the increase in viscosity of the cervical mucus and, to some extent inhibition of ovulation.
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11
Q

Hvilken type medikament er Nexplanon?

A
P-stav. Implants increases the viscosity of the cervical mucus and inhibits ovulation to a reasonable extent. This is a single rod providing controlled release of the progestin etonogestrel over three years. Visuable on x-ray

https://www.youtube.com/watch?v=es1beyv25fQ

https://www.youtube.com/watch?v=5FPwnyoI3Qs

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12
Q

Hvordan er blødningsmønsteret hos pas. som bruker Nexplanon?

P-stav.

A
Menometrorrhagia, also known as heavy irregular menstrual bleeding, is a condition in which prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal. It is thus a combination of metrorrhagia (intermenstrual bleeding) and menorrhagia (heavy/prolonged menstrual bleeding).
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13
Q

Hvilke egenskaper har Nexplanon?

A

The implant:

  1. Increases the viscosity of the cervical mucus.
  2. Provides ovulation inhibitory serum etonogestrel concentrations within one day, and is therefore immediately effective.
  3. The contraceptive efficacy of Implanon is extremely high; no pregnancies occurred in over 70,000 cycles.
    This gives Implanon a Pearl index of 0.
  4. After removal of the rod, return of the menstrual cycle is rapid, in fact so rapid that if there is no pregnancy wish, immediate continuation of contraception is required. Either by inserting a new implant or in another way.
  5. The bleeding pattern is comparable to other progestogen-only methods.
  6. Side effects during use of Implanon are generally low.
  7. During the use of Implanon dysmenorrhea improved, which can be regarded as a noncontraceptive benefit of Implanon use.
  8. No clinically important changes were observed with regard to the metabolic parameters.
  9. Insertion and removal of Implanon are easy to perform.
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14
Q

Hvilken effekt har potente progestiner ved bruk som prevensjonsmiddel?

A
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15
Q

Hvilke typer prevensjonsmidler er Ceracette/Desirette/Vinelle?

A
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16
Q

Hvordan er blødningsmønsteret ved bruk av Cerazette/Desirette/Vinelle?

A
Oligomenoré er menstruasjonsintervaller lengre enn 35 dager, kortere enn tre måneder. Som regel er også blødningene uregelmessige.

https://sml.snl.no/oligomenor%C3%A9

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17
Q

Hva slags type prevensjonsmiddel er Slinda/Zlynda?

18
Q

Hva er Depo-Provera og hva er fordelene/ulempene ved bruk av dette preparatet?

A
Medroxy progesterone acetate = MPA. The mechanism of action of depot injectables is inhibition of ovulation and the increase in viscosity of the cervical mucus. Return of fertility can take up to 1 year. The Pearl index for this method is 0.1 - 1.2.
19
Q

Hvilke anbefalinger har WHO ved bruken av Depo-Provera?

20
Q

Hva er de positive og de negative aspektene ved bruk av prevensjonsmidler som bare inneholder gestagen?

21
Q

Hvordan fungerer “angrepillen”?

A
COC; Combined oral contraceptive.
22
Q

Hvilke typer preparater finner man i Norge som bare inneholder gestagen?

23
Q

Hvordan fungererer kombinerte hormonpreparat som prevensjonsmidler?

A
Progestin is responsible for the atrophy of the endometrium, by inhibiting mitoses and reducing the amount of estrogen receptors.
24
Q

Hvilke kombinasjonspreparater har man tilgjengelig i Norge?

Prevensjonsmidler

A
Here is an overview of the different combinations and different levels of the combined progestin- and estrogen mono-phasic contraceptives available in Norway.

https://emetodebok.no/kapittel/prevensjonsmidler/

25
Q

Hvilke ikke-orale kombinerte prevensjonsmidler har man tilgjengelig?

26
Q

Hvordan er nivået av ethinyl estradiol basert på om man bruker piller, plaster eller vaginalring?

27
Q

Hvilke andre typer kombinerte orale prevensjonsmidler finnes?

28
Q

Hva er de positive og negative aspektene ved bruk av kombinerte hormonelle prevensjonsmidler?

30
Q

Ved hvilke pasient tilfeller skal man foreta nøye valg når det gjelder prevensjon?

31
Q

Hvilke kontraindikasjoner finnes for kombinerte hormonelle prevensjonsmidler?

32
Q

Hvilket prevensjonsmiddel har gode resultater når det kommer til å hindre uønsket graviditet?

33
Q

Hvordan er det med prevensjonsmidler for menn?

Sett bort fra kondom

A
From Abbe et al 2020 (picture on top); on Male hormonal contraception: 1. Androgen plus progestin formulations hold promise as a marketable, reversible male contraceptive over the next decade. 2. Oral, transdermal, subdermal, and injectable drug formulations and demonstrated the short-term safety and reversibility. 3. The most commonly reported side effects: weight gain, acne, slight suppression of serum high-density cholesterol, mood changes, and changes in libido. 4. Efficacy trials of hormonal male contraceptives have demonstrated contraceptive efficacy rates greater than that of condoms. Mariani et al 2023: “The spermatozoon emerges as a source of druggable targets for on-demand, non-hormonal male contraception based on disrupting sperm motility or fertilization”. Candidates specifically expressed or enriched in spermatozoa: 1. Enzymes (PP1γ2, GAPDHS, and sAC), 2. Ion channels (CatSper and KSper), 3. Transmembrane transporters (sNHE, SLC26A8, and ATP1A4), 4. surface proteins (EPPIN) However, no pharmacological agent has reached clinical developmental stages. One reason is the slow progress in translating the preclinical and drug discovery findings into a drug-like candidate adequate for clinical development. Thus, intense collaboration among academia, private sectors, governments, and regulatory agencies will be crucial to combine expertise for the development of male contraceptives targeting sperm function by (i) improving target structural characterization and the design of highly selective ligands, (ii) conducting long-term preclinical safety, efficacy, and reversibility evaluation, and (iii) establishing rigorous guidelines and endpoints for clinical trials and regulatory evaluation, thus allowing their testing in humans.

https://academic.oup.com/humupd/article/29/5/545/7152434

34
Q

Gi en oversikt over sikkerheten av prevensjonsmidler?

Hindre uønsket graviditet

35
Q

Hvilke hormonelle midler er tilgjenglig? Hva er kostnaden ved bruken av disse (Norge)?

A
The Norwegian Government give some economical support for girls aged 16 to 22 years corresponding to around 125 NOK for 3 months (2022). The pharmacy will subtract the support.
36
Q

Hva er LARC, og hvilke konstander har disse?

A
From February 2015, women between 16 and 22 years of age may get economical governmental support for several kinds of contraceptives like COC, patch, injectable, implant, hormonal IUCD and copper IUCD. The support depends on the product and the girls age at initiation.

https://www.helsenorge.no/sex-og-samliv/prevensjon/bidragsordning-for-prevensjonsmidler

https://emetodebok.no/kapittel/prevensjonsmidler/

37
Q

Hvor mye koster nødprevensjon?

39
Q

Hvilke punkter er med i WHO sin evaluering når det kommer til prevensjonsmidler?

40
Q

Hvilke risikofaktorer er definert av WHO, og gir større risiko for sykdom/uønskede hendelser ved bruk av prevensjonsmidler?

Gynekologi (14 decks)

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