WOMEN

Question 1

how do progestins help in coc

Answer 1

blocks LH surge + estrogen
suppresses FSH release
prevents ovulation

Question 2

factors to choose high/low dose for estrogen
1. adolescence/age more than 35
2. underweight <50kg
3. peri-menopausal
4. fewer side effects
5. obesity or > 70.5kg
6. early to mid cycle breakthrough
7. non adherence

Answer 2

1-4 low
5-7 high

Question 3

type of agents to choose for pts w oily skin/acne

Answer 3

drosperinone/cyproterone(diane)

Question 4

risk of cyproterone? what kind of pts should take

Answer 4

thromboembolism. only if patient has both acne issues and needs contraception

Question 5

monophasic vs multiphasic coc

Answer 5

monophasic: take everyday, less complicated dosing
multiphasic: tend to have lower progestin (less side effects such as acne, hair growth)

Question 6

if you start coc on first day of period, need contraceptive?

Answer 6

no

Question 7

if you start coc on first sunday of cycle, need contraceptive?

Answer 7

7 days

Question 8

if you start coc now, need contraceptive?

Answer 8

7 days and potentially till next cycle begins

Question 9

late bleeding should have more estrogen or progestin

Answer 9

progestin

Question 10

in which groups to avoid /contraindicated in coc

Answer 10

• age > 40
• family history of breast cancer (only can use POP)
• breast cancer currently STOP
• migraine with aura CI

Question 11

which factors do estrogen increase production of in coag cascade

Answer 11

7,10, fibrinogen

Question 12

what is the contraindication for smoking

Answer 12

smoke more than 15 sticks a day and more than 35 years old

Question 13

what do estrogens do in COC

Answer 13

suppress FSH release
stabilised endometrial lining

Question 14

why are the progestin only pills more troublesome

Answer 14

Need to be taken about the same time everyday

Late dose by >3h: back up 2d

Question 15

if patient experiences nausea, vomiting, bloating, what component of COC should you reduce

Answer 15

estrogen

Question 16

what is the 1 contraindication for progesterone only pill

Answer 16

current / hx of breast cancer

Question 17

how should you start POP

Answer 17

if within 5 days of start of menstrual cycle, no backup needed

otherwise +2d backup

Question 18

side effects of progestin injections (list 2)

how long can one be on progestin injections

Answer 18

1. weight gain
2. short term bone loss

max 2 years

Question 19

what is the main difference between levonorgestrol and copper IUD

which can be used for emergency contraception?

Answer 19

levonorgestrol: reduces flow

copper: increases flow

copper

Question 20

how long can a copper vs levonorgestrel IUD be put in place before replacing?

Answer 20

copper: 10 years
levo: 5 years

Question 21

warning signs rendering immediate discontinuation (ACHES)

Answer 21

abdominal pain
chest pain
headaches
eye problems
severe leg pain

Question 22

who should avoid transdermal coc patches

Answer 22

women more than 90kg

Question 23

what risk is greater in transdermal patches than coc pills

Answer 23

VTE

Question 24

non pharm for mild vasomotor symptoms (list 5)

Answer 24

1. lower room temp
2. decrease intake of caffeine, spicy food
3. smoking cessation
4. exercise
5. healthy eating

Question 25

herbal tx for menopausal women

Answer 25

black cohosh, dong quai, red clover leaf, ginseng

Question 26

preferred thp for headache in preg

Answer 26

sumetriptan, avoid ergotamines

Question 27

are nsaids contraindicated in preg

Answer 27

3rd trimester

Question 28

abx c/i in preg

Answer 28

fql, tetracyclines, bactrim