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Oral board studying Prep book > Smoking cessation > Flashcards

Smoking cessation Flashcards

1
Q

How do you address patients with tobacco use?

A
  1. Inquire about smoking tobacco
  2. Go through the 5A’s
  3. Readdress at future visits
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2
Q

What are the 5A’s of smoking cessation?

A

Ask about tobacco use
Advise to quit tobacco use
Assess willingness to quit
Assist with quitting
Arrange follow up

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3
Q

What are ways you can assist a patient with tobacco cessation?

A

Behavior counseling
Pharmacologic therapy

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4
Q

What are behavior counseling options for smoking cessation?

A

Smoking support group
Smoking cessation hotlines
Office support
Requesting family and friend support

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5
Q

What are pharmacologic options for smoking cessation?

A

Nicotine replacement (patch, gum, lozenges, nasal spray)
Varenicycline
Bupropion

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6
Q

What is the goal of family planning?

A

Goal is to help the patient reach their reproductive goals through supporting them to make informed decision regarding contraception and fertility that are aligned with those goals

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7
Q

What are your steps to contraceptive counseling?

A
  1. Determining what the patient reproductive goals are
  2. Ask if the patient is interested in discussing contraception and prevention of pregnancy
  3. Asking if the patient has an idea of what is important to her in a contraceptive method
  4. Discuss each method including how often its used, menstrual effects, side effects, non contraceptive benefits, efficacy, effect on future fertility
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8
Q

What is the failure rate for contraceptive methods during the first year?

A

LARCs + vasectomy + tubal= less than 1 pregnancies per 100 women in the first year

Combined contraceptives + depo= 4-7 pregnancies per 100 women in the first year

Condoms+ diaphragms+ pull out + fertility tracking = 13 pregnancies per 100 women in the first year

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9
Q

Noncontraceptive benefits of combined hormonal contraceptives?

A

Regulate menstrual cycle
Reduction in dysmenorrhea
Reduction in endometriosis related pain
Reduction in menorrhagia
Reduction is symptoms of PMS or PMDD
Reduction in risk of ectopic pregnancy
Reduction in risk of benign breast disease
Reduction in new ovarian cysts
Reduction in risk of ovarian cancer
Reduction in risk of endometrial cancer
Reduction in risk of colon cancer
Reduction in acne
Reduction in hirsutism

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10
Q

Noncontraceptive benefits of levongestrel IUD?

A

Reduction in menstrual cramps
Reduction in pelvic pain related to endometriosis
Reduction in menorrhagia
Reduction in endometrial hyperplaisa
Reduction in risk of cervical cancer
Reduction in PID

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11
Q

Non contraceptive benefits of copper IUD?

A

Regular menstrual cycles
Reduction in risk of cervical cancer

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12
Q

Non contraceptive benefits of depo injection?

A

Reduction is menstrual cramps
Reduction in menstrual bleeding
Reduction in risk of endometrial cancer

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13
Q

Non contraceptive benefits of progestin only pills?

A

Reduction in risk of endometrial cancer

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14
Q

What factors can you use to assess probability of pregnancy prior to initiating contraception?

A
  1. Correctly and consistency using a reliable form of contraception
  2. Within 7 days of start of menstrual cycle or postabortion/miscarriage
  3. Within 4 weeks postpartum
  4. No intercourse since last normal menstrual cycle
  5. Fully breast-feeding and amenorrhea in last 6 months
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15
Q

When is the appropriate time to start combined hormonal contraceptives postpartum?

A

Should not be started prior to 21 days postpartum due to increase risk of VTE

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16
Q

Tell me Depo mechanisms of action, dose, interval, efficacy in 1st year, side effects, changes to menstrual and non contraceptive benefits?

A

Mechanism of action= suppresses GNRH–>LH surge decrease–>ovarian supression
Dose= 150mg q 3months
Efficacy= 6% or 4-7/100 women in 1st year
Side effects= bone loss, AUB, weight gain, HA, mood changes
Menstrual= AUB, amenorrhea
Noncontraceptive benefits= reduction in risk of endometrial cancer, menorrhagia, dysmenorrhea

17
Q

Tell me POP mechanisms of action, dose, interval, efficacy in 1st year, side effects, changes to menstrual and non contraceptive benefits?

A

Norethindrone or drosperinone
Mechanism of action= inhibit ovulation, thickens cervical mucus, endometrial atrophy, tubal motility
Dose 0.35mg daily or 4mg (24/4)
Efficacy= 5-9% 4-7/100 women win 1st year
Side effects= unscheduled bleeding, follicular cysts, increased acne
Menstrual changes= unscheduled bleeding
Noncontraceptive benefits= reduces risk of endometrial cancer

18
Q

What are some contraindications to POPs?

A

Liver disease
Undiagnosed abnormal uterine bleeding
Pregnancy
Breast cancer

19
Q

Tell me levonorgestrel IUD mechanisms of action, dose, duration, efficacy in 1st year, side effects, changes to menstrual and non contraceptive benefits?

A

Mechanism of action= endometrial atrophy, thickens cervical mucus, inflammatory changes of endometrium and Fallopian tubes
52mg, 19.5mg, 13.5mg
Mirena/liletta, kyleena, skyla
Dose= 20mcg daily; 17mcg; 14mcg
Duration= 8,8,5,3
Efficacy= 0.2% in 1st year
Side effects=unscheduled uterine bleeding
Menstrual changes= AUB, amenorrhea
Noncontraceptive benefits= reduction in ednometrial cancer, cervical cancer, menstrual cramps, menorrhagia, endometriosis pain, PID

20
Q

Tell me etonogestrel implant mechanism of action, dose, duration, efficacy in 1st year, side effects, changes to menstrual and non contraceptive benefits?

A

Mechanism of action= thickens cervical mucus, tubal motility, endometrial atrophy, suppresses GNRH–> decreases folliculargenesis and ovulation
Dose= 68mg etonogestrel
Efficacy = 0.05% in 1st year
Side effects= unscheduled bleeding, HA, breast tenderness
Menstrual changes; Unscheduled bleeding, amenorrhea
Noncontraceptive benefits= reduces endometrial hyperplasia, pelvic pain from endometriosis, reduces menorrhagia

21
Q

Tell me combined hormonal contraceptives mechanism of action, dose, interval, efficacy in 1st year, side effects, changes to menstrual and non contraceptive benefits?

A

Mechanism of action= inhibition of ovulation through inhibiting GNRH, thickens cervical mucus, endometrial atrophy, tubal motility
Dose= Estradiol 20-35mcg; progestin 1-3mg
Efficacy= 7% typical use 4-7/100 women in 1st year
Side effects= unscheduled bleeding, breast tenderness, HA, nausea
Menstrual changes= regulates menstrual cycles
Noncontraceptive benefits

22
Q

Contraindications to combined hormonal contraceptives?

A

35years + smoking 15+ cigarettes/day
CVD risk factors (HTN, diabetes, smoking)
Severe HTN (160/110)
VTE
History of stroke
Breast cancer
Cirrhosis
Migraine with aura
Diabetes for 20+ years

23
Q

Which combined hormonal contraceptive pill do you use in practice?

A

Spintec
35mg ethinyl estradiol + 0.25mg of norgestimate

24
Q

What are the contraceptive patches on the market?

A

Xulane= 35mcg ethinyl estradiol + 150mcg of noregestimate

Twirla= 30mcg ethinyl estradiol + 120mcg levongestrel

changes weekly for 3 weeks and 1 week without patch

25
Q

What is the vaginal ring on the market for hormonal contraception?

A

Nuvaring
120 mcg Etongestrel + 15mcg ethinyl estradiol
In place for 3 weeks and removed for 1 week

26
Q

What is the size of the implant?

A

40mmx2mm

27
Q

What is the proper placement of implant?

A

Locate the medical epicondyle of the humerus
Go 8-10cm lateral to medial epicondyle and 3-5cm posterior to sulcus between biceps and triceps muscle

28
Q

Why do you want to make sure you are 3-5cm posterior to the sulcus?

A

To avoid the neuromuscular bundle in the sulcus

29
Q

What nerves could be injured with insertion or removal of nexplanon?

A

Medial ante brachial nerve
Ulnar nerve

30
Q

Complications from implant insertion?

A

Irriation/rash
hematoma
bruising
infection
migration of device

31
Q

What is the size of the 52mg levongestrel IUD?

A

32x32mm

32
Q

What is the size of kyleena and Skyla IUD?

A

28x30

33
Q

Options to treat unscheduled uterine bleeding from contraceptive methods?

A

NSAIDS
Combined hormonal pills
Supplemental estrogen

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