PSA Specialities- O+G Flashcards
What are the risks of taking the COCP?
Small risk of blood clots
Increased risk of breast + cervical cancer
Very small risk of heart attacks + strokes
What advice should be given if COCP on starting with regards to contraception?
In first 5 days of cycle: No need for additional contraception.
Any other point in cycle: alternative contraception should be used (e.g. condoms) for the first 7 days
Advice during pill free period?
UPSI during pill-free period is only safe if the next pack is started on time
List 3 circumstances where the effect of the COCP are reduced
if vomit within 2h of taking
Drugs that induce D+V may reduce effectiveness of OCP (e.g. Orlistat)
if taking liver enzyme-inducing drugs
With which antibiotics should extra precautions be taken with the COCP?
Enzyme inducers e.g. Rifampicin
8 UKMEC 4 contraindications to the COCP
> 35y + smoking >15 cigarettes/day
Migraine with aura
Hx of thromboembolic disease/ thrombogenic mutation
Hx of stroke or IHD
Breast feeding <6w post-partum
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation
+ve antiphospholipid antibodies (e.g. in SLE)
Use of Levonorgestrel as emergency contraceptive
1.5mg (double for BMI >26)
Use within 72h of UPSI
Efficacy decreases with time
If vomit within 3h, repeat dose
Hormonal contraception can be started immediately after
Describe Ulipristal as emergency contraceptive
30mg PO
Use within 120h of UPSI
May reduce efficacy of hormonal contraception- start/ restart after 5 days
Caution in severe asthma
Which emergency contraceptive can be used while breastfeeding?
Levonorgestrel
(wait 1w if use Ulipristal)
What is the most effective method of emergency contraception that should be offered to all?
Copper intrauterine device
Must be inserted within 5 days of UPSI/ within 5 days of predicted ovulation date
What is the implantable contraceptive?
Nexplanon
Inserted in proximal non-dominant arm
Slow release of progestogen
No Oestrogen- can be used if hx of VTE/ migraine
List 4 adverse effects of nexplanon
Irregular/ heavy bleeding
Headache
Nausea
Breast pain
Length of efficacy of insertable contraceptive devices
Copper IUD: 5-10y
IUS (levonorgestrel releasing): 5y
List 5 potential problems of insertable contraceptive devices
IUDs: periods heavier, longer + more painful
IUS a/w spotting then amenorrhoea
Risk of PID in first 20 days
Expulsion risk 1 in 20 within 3 months
Uterine perforation 2/1000
Most common side effect of progestogen only pill
Irregular vaginal bleeding
Advice on missed POP
if < 3h late: continue as normal
if > 3h: take missed pill ASAP, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48h
Which progestogen only pill has a longer window in which the pack can be continued normally with no extra precautions?
Cerazette (Desogestrel)
12h
What are the 2 indications for starting HRT?
Vasomotor Sx: flushing, insomnia, headaches
Premature menopause: to prevent osteoporosis
What is HRT composed of?
Oestrogen to replace diminished levels + progestogen if a women has a uterus to reduce risk of endometrial cancer
Which route of HRT is preferred in those with VTE risk?
Transdermal
(no increased risk)
List 3 possible side effects of HRT
Nausea
Breast tenderness
Fluid retention + weight gain
List 5 complications of HRT
Increased risk breast cancer (increased by progestogen)
Increased risk endometrial cancer (reduced but not eliminated by progestogen)
Increased risk VTE (increased by progestogen)
Increased risk stroke
Increased risk IHD if >10y after menopause
Management of PID
Ofloxacin + Metronidazole PO
OR
IM Ceftriaxone + oral Doxycycline + oral Metronidazole
Management of vaginal candidiasis
- Fluconazole PO 150mg single dose
- Clotrimazole 500mg pessary as a single dose if PO contraindicated
If vulval Sx, consider adding TOP imidazole in addition
Management of vaginal candidiasis in pregnancy
100mg Clotrimazole pessary 7 days
Management for stress incontinence
Pelvic floor exercises
Surgery: colposuspension
Duloxetine
Management of urge incontinence
Bladder training
Oxybutynin (IR) or Tolterodine (IR)
Which drug should be used for urge incontinence in elderly to reduce risk of falls?
Mirabegron
