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Obstetrics and Gynaecology > Tutorial 20B: Contraceptive Pills > Flashcards

Tutorial 20B: Contraceptive Pills Flashcards

1
Q

Things to remember for osce

A

COC:

  • Talk to patient about use – 7 day rule, missing pills etc.
  • know trade names and what generation that particular pill was.
  • Chances are, they will give you a 2nd generation pill (look over the guide they give you at family planning)
  • really know how to teach people take the pill, they will actually get you to point out which pill on the packet they’ll need to take in every conceivable situation.

Same question. It was a 21 day COCP. We didn’t need to know trade names. J_ust 7 day rule_, when will I be safe if I miss this one, or when safe in general and when not safe.

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2
Q

What is the function of the COCP?

A

Contains an estrogen (usually ethinylestradiol) and a progestogen

Functions of COCP:

  1. Inhibition of ovulation
  2. Changes cervical mucus: sticky and tough
  3. Changes endometrial thickening: endometrium atrophic.
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3
Q

What are some 2nd generation COCPs?

A

2nd Generation combinations:

  • ethinylestadriol & levonorgestrel
  • ethinylestradiol &norethisterone

Drug names for 2nd generation COCP:

  • Levlon, Monofeme, Norimin (all funded)
  • Trifeme, Triphasil, Brevinor-1 (double check on those).
  • Not funded ones include :
    • Brevinor, Loette, Microgynon 20/30, Nordette, norinyl-1, Synphasic, Triquilar
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4
Q

What are some 3rd generation COCPs?

A

3rd Generation combinations:

  • ethinylestradiol + desogestrel
  • ethinylestradiol + gestodene.

Introduced because these progestogens had fewer adverse lipid effects

However later studies showed a greater risk of venous thromboembolic disease.

No third generation COCP’s are funded:

  • Femodene, Marvelon, Mercilon, Minulet
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5
Q

What are some different types of COCPs?

A

Cyproterone acetate= anti-androgen + oestrogen

  • e.g. Estelle, Diane 35
  • Good for women with PCOS or severe acne
  • Estelle 35 is funded.
  • Yasmin also, but not funded.
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6
Q

What is an important fact about 3rd generation COCPs?

A

None of them are funded

  • progesterone has less adverse lipid effects
  • but increased risk VTE
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7
Q

What is the efficacy of a COCP?

A

99%, if used correctly.

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8
Q

How do you take the COCP?

A

Pack contains either: 21 active pills and 7 non-active pills, or 21 active pills with 7 day break.

  1. If start day 1-5 of menstruation: then covered immediately. If later (>d5) then wait 7days until full protection.
    • This is very important, she asked me if she was safe if she started bleeding 3 days ago= makes her Day 4!
  2. Should be taken at same time every day (+/-12hrs). Not covered until taken 7 pills.
  3. If miss 1 pill, ie. More than 12 hours then:
    1. take it as soon as you remember.
    2. If didn’t remember until next day, take 1 for the day before and take another one from the usual time.
    3. SAFE if only missed 1 pill.
  4. 7 day rule: if miss 2 pills, take other medication (e.g. antibiotics), or having vomiting/diarrhoea within 3 hours of taking the pill,
    1. need to take pill for seven more days before safe again and use another form of contraception.
    2. If fewer than 7 hormone pills left in the pack, finish hormone pills and then miss out inactive pills.
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9
Q

What are the prescribing guidelines for COCP?

A
  • History: exclude relative/absolute contraindications
  • Assess risk factors
  • Always do: BMI, BP, ask about migraines (can be caused by oestrogens), give pamphlet which outlines warning signs/explains how to take pill.
  • Do not prescribe if: 1 absolute, >1 relative Contra, >35 years and any other arterial risk factor (e.g. smoking)
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10
Q

What are the absolute contraindications to COCP?

A
  • PREGNANCY
  • undiagnosed genital tract bleeding
  • past or present circulatory disease
  • liver disease
  • oestrogen dependent neoplasms
  • breastfeeding (decreases volume and quality of milk)
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11
Q

What are some relative contraindications to COCP?

A
  • risk factors for CVD
  • long-term partial immobilisation
  • oligo/amenorrhoea
  • severe depression
  • gallstones
  • hyperprolactinaemia
  • various chronic systemic diseases
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12
Q

What are the advantages of using the COCP?

A
  • Reversible
  • Easy to use
  • Efficacy – 0.2 per 100 women years
  • Decreases rate of: (ENDO & OVO)
    • Endometriosis
    • Endometrial cancer
    • Ovarian Cysts
    • Ovarian cancer
  • Regular menstrual bleeding – lighter and less uncomfortable
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13
Q

What is the COCP protective for?

A

Decreases rate of: (ENDO & OVO)

  • Endometriosis
  • Endometrial cancer
  • Ovarian Cysts
  • Ovarian cancer
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14
Q

What are the disadvantages to using the COCP?

A
  • Difficult to remember to take pill
  • No protection against STIs.
  • Adverse effects
  • Amplifier of CVD risk factors (smoking, hypertension, diabetes, family history, hyperlipidaemia, BMI)
  • Possible increased risk of:
    • invasive cervical cancer w/in 5 yrs (RR=1.5)
    • breast cancer (very mild increased risk)
    • VTE
    • IHD (if smoker and HT)
  • Venous thromboembolism: no pill 1/3000, 2nd gen 3/3000, 3rd gen 6/3000. Start on 2nd gen and move to 3rd if side effects.
  • Small increase of ischaemic stroke (RR=1.5) larger if smoker and hypertensive (RR=10).
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15
Q

What increased risks come with using the COCP?

A

Possible increased risk of:

  • invasive cervical cancer w/in 5 yrs (RR=1.5)
  • breast cancer (very mild increased risk)
  • VTE
  • IHD (if smoker and HT)
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16
Q

What are some side effects of the COCP?

A
  • breast tenderness
  • acne
  • spotting/bleeding between periods (for first 1-2months)
  • headaches
  • nausea
  • weight changes
  • mood changes
  • decreased libido
  • skin changes
17
Q

Which drugs interact with the COCP?

A
  • anticonvulsants
  • anti-TB drugs
  • antiretroviral drugs
  • lasonprazole (PPI)
  • tacrolimus (immune suppressant)
  • St John’s Wort
  • grapefruit
  • antibiotics.
18
Q

Which chronic diseases should you exclude before prescribing the COCP?

A
  • Diabetes (POP or 3rd Gen preferable- may raise insulin needs)
  • IBD: may aggravate
  • Epilepsy: need higher dose
  • SLE: may cause flare of symptoms
19
Q

What are the 8x main categories that you should cover when precribing a COCP?

A
  1. Pill teaching
  2. Side effects
  3. Cancer
  4. Smoking/CVD
  5. Benefits
  6. Fertility
  7. STI
  8. Emergency contraceptive Pill (ECP)
20
Q

What are the 5x main categories which must be covered when pill teaching?

A

Pill teaching – missed pills, when contraceptively safe

  1. Describe pills: Colour of pill meaning i.e. hormone/sugar
  2. When do you start
    • Anywhere: 1st day of period – immediate protection
    • Any day of month – 7 day rule 3.
  3. Where on packet to start
    • Start on day of week (in shaded area): e.g. Today is Monday – therefore take Monday pill
    • Follow arrow on back
  4. Remembering
    • Same time each day
    • 12 hour window
    • Alarm on phone/brushing teeth
  5. Missed Pills rule
    • 2 in a 7 day period
    • Vomit diarrhoea
    • Interacting meds
21
Q

What is the function of the POP?

A

Pill made of one hormone (progesterone)

Functions:

  1. Thickens cervical mucus
  2. Makes endometrium less receptive to implantation
  3. Inhibits ovulation (stops ovaries from releasing an egg each month)
  • Effect continues for 20 hours
  • >96% effective – failure rate 1 in 100 women years
22
Q

What are the important instructions when using POP?

A
  • POP is taken continuously, at the same time each day.
  • +/- 3h or 12h for cerazette.
    • If forgotten should be taken as soon as one remembers and condoms used for 2 days.
  • If intercourse occurs mainly at night the pill should be taken in the morning.
  • Enzyme inducing medications make the POP ineffective.
23
Q

When should you start using the POP?

A
  • Menstruation: day 1-5 – no extra precautions necessary
  • Other times: apply 7 day rule, extra precautions (ie condoms)
24
Q

What are the absolute contraindications for POP?

A
  1. pregnancy
  2. undisclosed genital bleeding
25
Q

What are the relative contraindications for POP use?

A
  1. malabsorption
  2. arterial disease
  3. liver adenoma
  4. severe iver disease
26
Q

What are the advantages to using the POP?

A
  • Simple and easy to take
  • Doesn’t interfere with sex
  • Useful for women who can’t take COCP (antibiotic, prothomboembolic, high maternal age, lactating women)
  • Can be used at any age
  • Can be used by breast-feeding women
27
Q

What are the disadvantages of using the POP?

A
  • Must be prescribed by doctor
  • Must remember to take it daily
  • S/E:
    • Breast tenderness, acne, spotting/bleeding - Irregular menses
    • weight gain
    • loss of libido
    • amenorrhea
    • benign ovarian functional cysts

Obstetrics and Gynaecology (20 decks)

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