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Repro > Short acting reversible contraception > Flashcards

Short acting reversible contraception Flashcards

1
Q

Name 3 examples of short acting contraception

A

Combined hormonal contraception (CHC)
Progesterone only pill (POP)
Emergency hormonal contraception (EHC)

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2
Q

What are non-contraceptive benefits of CHC?

A 
Heavy menstrual bleeding
Painful periods
Acne
Irregular periods
Premenstrual symptoms
Endometriosis
Menstrual migraine (no aura)
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3
Q

What are the 3 types of CHC available?

A

Combined oral contraceptive 20-30ug EE
Combined transdermal patch 33ug EE
Combined vaginal ring 15ug EE

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4
Q

What is the CHC mode of action?

A

Inhibiting ovulation via action on hypothalmic-pituitary-ovarian axis to reduce luteinising and follicle-stimulating hormones
Alters cervical mucous
Renders endometrium unfavourable for implantation

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5
Q

What is the standard regime for the Combined oral contraceptive?

A

Daily for 21 days
stop for 7
first 7 inhibit ovulation and remaining 14 maintain anovulation
Follicular activity may resume after 9 pills have been omitted.

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6
Q

What’s the standard regime of Combined transdermal patch?

A

One patch applied for 1 week to suppress ovulation

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7
Q

What is the standard regime for the combined vaginal ring?

A

Ring placed in vagina and left for 21 days

Ring free interval for 7 days

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8
Q

What 3 factors should be taken into account when prescribing CHC?

A

Absorption
Metabolism
Metabolic effects

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9
Q

What may affect absorption?

A

GI conditions

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10
Q

What may affect metabolism?

A

Liver enzyme induction

Drug interaction

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11
Q

What do you do if you forget one pill?

A

Relax, take as soon as remembered

Take rest as normal

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12
Q

What do you do if you forget 2 pills in a row?

A

Take most recent
Take rest at normal time
Use condoms or abstain until 7 pills have been taken consecutively

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13
Q

What do you do if you’ve went more than 48 hours without taking a pill?

A

Days 1-7: Consider EC
Days 8-14: No extra instructions
Days 15-21: Omit free pill interval

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14
Q

How long does the patch have high efficacy?

A

up to 9 days (7 days + 48hrs)

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15
Q

How long can the patch free interval be before efficacy is reduced?

A

9 days (7 days + 48hrs)

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16
Q

How long can the ring be left out of the vagina before efficacy is reduced?

A

48 hours

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17
Q

How long can the vaginal ring be worn before efficacy is reduced?

A

4 weeks

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18
Q

What are the added risks of CHC?

A

Venous thrombosis
Arterial thrombosis
Adverse effects on some cancers

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19
Q

What levels do CHC reduce?

A

Antithrombin III and protein S (Alteration in clotting factor)

20
Q

What can happen with CHC and patients with significant arterial wall disease?

A

Superimposed arterial thrombosis

21
Q

What is increased with CHC?

A

Fibrinolytic activity (Redcued in heavy smokers)

22
Q

What is a major side effect of CHC?

A

venous disease (Venous thromboembolism)

23
Q

What are risk factors for a VTE?

A 
Obesity
Smoking
Age
Known thrombophilia
VTE in first degree relatives
Up to 6 weeks post natal
24
Q

Describe Cypoterone Acetate?

A

Co-cyprindiol
Acne and hirsutism treatment
Ethinyl-estradiol 35ug/cyproterone acetate 2mg

25
Q

What else can the combined oral contraceptive cause?

A

Systemic hypertension
Cut off is 140/90
Arterial disease

26
Q

What is an aura/ (migraine aura)

A

Scotoma
Altered sensation
Smell or taste
hemiparesis

27
Q

What examinations are performed before prescribing a contraceptive agent?

A

BP and BMI
Smear test status
Risk factors

28
Q

What cancers does the pill help prevent against?

A

Ovarian and Endometrial

29
Q

What else can the pill help with?

A 
Acne
Small breasts
Hirsutism
ovarian cysts and PCOS
bleeding
premenstrual syndrome
30
Q

What are side effects of the pill?

A

Unscheduled bleeding
Mood changes
Weight gain

31
Q

What are the side effects of the combined transdermal patch?

A

Breast pain
Nausea
Painful periods

32
Q

What are side effects of the vaginal ring?

A

Less bleeding problems
acne
irritability
mood changes

33
Q

What is the emergency contraception?

A 
Levonelle 1500 (progesterone)
Ulipristal acetate (anti-progesterone) - hormonal contraception interferes with action of ulipristal acetate
34
Q

How long should contraception be avoided for after emergency contraception?

A

5 days

35
Q

What is the Progesterone Only Pill (POP)?

A

levonorgestel norethisterone

36
Q

What is the longer lasting POP?

A

Etonorgestrel

37
Q

What is the mode of action of a POP?

A

Thickening of cervical muscous

Etonorgestrel suppresses ovulation

38
Q

What are the secondary effects of the POP?

A

Levongestrel suppresses ovulation
Decreased endometrial receptivity to blastocyst
Reduction in cilia activity in fallopian tube

39
Q

What are the risks of POP?

A

Little effect on metabolism

40
Q

What interactions involve the POP?

A

liver enzyme inducers - cytochrome P40

41
Q

What are suitable alternatives for the POP?

A

DMPA
IUS
Cu-IUD

42
Q

How do you take the POP?

A

Daily at same time
no break
within 24-27 hours of last dose

43
Q

How do you take the longer lasting POP?

A

Daily at same time
no break
within 24-36 hours of last dose

44
Q

What do you do if you miss one POP?

A

Emergency contraception plus 2 days extra protection

45
Q

Which type of POP is has higher efficacy?

A

Etonorgestrel

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