Women and Children First Flashcards
1
Q
- Describe to a patient why we give HRT ?
A
- Women get menopausal symptoms because their body decreases the amount that it produces the hormones oestrogen and progesterone
- This results in menopausal symptoms such as hot flushes, weakened bones, vaginal dryness and brain fog
- HRT fairly simply replaces those hormones in the body and thus relives the menopausal symptoms
2
Q
- What forms can HRT come in ?
A
- Tablets, skin patches, gels and implants such as the Mirena Coli
3
Q
- Who can take HRT
A
- Patients with symptoms where the risk/benefit ratio is favorable
- Women with early menopause until the age of natural menopause (around 51) even if they are asymptomatic
- Women under 60 years who are at risk of osteoporotic fracture in whom non-oestrogen treatments are unsuitable
4
Q
- Advantages of HRT
A
- Reduction of vasomotor symptoms e.g. hot flushes
- Improved mood and depressive symptoms
- Improved urogenital symptoms e.g. dryness, sexual function and passing urine
- Reduced risk of developing osteoporosis
- Cardiovascular protection
5
Q
- How long after starting HRT do vasomotor symptoms improve ?
A
- Within 4 weeks of starting
- Maximum benefit is gained by 3 months
- Some studies have suggest it is as effective as 87% compared to a placebo
6
Q
- By how much does HRT reduce the risk of CVD ?
A
- ~50% if it is taken within 10 years of starting the menopause
7
Q
- What are oestrogen related side effects of HRT ?
A
- Breast tenderness, leg cramps, bloating, nausea and headaches
8
Q
- What are progesterone related side effects of HRT ?
A
- Premenstrual syndrome-like symptoms, breast tenderness, backache, depression and pelvic pain
9
Q
- When does breakthrough bleeding occur in the first 3-6 months with continuous HRT ?
A
- Breakthrough bleeding is common in the first 3-6 months with continuous combined HRT
10
Q
- What are the main risks of HRT ?
A
- VTE
- Ischemic stroke
- Breast cancer
- Endometrial cancer (no risk if combined HRT)
11
Q
- Contraindications of taking HRT
A
- Current, past or suspected breast cancer
- Known or suspected oestrogen-sensitive cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
- Idiopathic or current VTE unless anticoagulated
- Active or recent arterial thromboembolic disease (angina or MI)
- Untreated hypertension
- Active liver disease with abnormal liver function tests
- Pregnancy
12
Q
- What are some advantages of the copper coil ?
A
- Most effective
- Can be left in place for at least 5 years
- Not effected by enzyme inducing medication or BMI
13
Q
- Disadvantages of copper coil
A
- Requires a procedure to insert it
- Can make periods heavier and not may be acceptable method for patients with pre-existing heavy menstrual bleeding or painful periods
14
Q
- How long is levonorgestrel effective ?
A
- 72 hours
- Unlicensed up to 96 hours
15
Q
How else is levonorgestrel known ?
A
Plan B
16
Q
- Common side effects of levonorgestrel ?
A
- Nausea, vomiting and delayed or early periods
- If the patient vomits within 3 hours then they may repeat the dose
17
Q
- What are the advantages of levonorgestrel ?
A
- Safe and well tolerated with few side effects
- Safe for breastfeeding
- Other contraception methods such as POP can be started immediately after taking plan B
18
Q
- What are disadvantages of levonorgestrel ?
A
- Can be effected by enzyme inducing medications e.g. carbamazepine, phenobarbital, phenytoin, rifampicin and St John’s wort.
- Less effective if BMI > 26 or >70Kg
- If this applies then double dose
- Ineffective if the LH surge has begun
19
Q
- What drugs are enzyme inducers ?
A
- Carbamazepine, phenobarbital, phenytoin, rifampicin and St John’s wort.
20
Q
- For who long is Ulipristal acetate effective ?
A
- 5 days or 120 after UPSI
21
Q
- Advantages of ulipristal acetate ?
A
- Safe and well tolerated with few side effects
- Has a longer window than levonorgestrel
- Can still delay ovulation even if the LH surge has begun
22
Q
- Disadvantages of ulipristal acetate ?
A
- Less effective if progesterone has been taken in preceding 7 days or following 5 days
- This means that if they have been using the pill in the prior 7 days they should not used ulipristal acetate
- Less effective if taking enzyme inducing medications
- Not recommended in patient with severe asthma taking oral glucocorticoids
- Breast feeding must be avoided for 7 days after using
23
Q
- What should be obtained in a history before prescribing emergency contraception ?
A
- Details of the UPSI including dates and times
- Any other episodes
- Safeguarding – sexual and/or domestic abuse
- Details of menstrual cycle
- Sexual history to access for risk of STIs
- Past medical history (asthma)
- Drug history
24
Q
- Will emergency contraception stop an existing pregnancy ?
A
- No
25
24. What follow up should a patient requesting emergency contraception receive ?
- All patients should be advised to take a pregnancy test 3 weeks after UPSI to ensure they have not become pregnant
- This should be done even if they have bleeding as this may not represent a normal period
26
25. Which emergency contraception should hormonal contraception be avoided ?
- Ulipristal acetate
27
1. What will happen on vaccine day ?
- Nurse will ask how the baby is including whether they have been unwell, whether they have any medical conditions and if they have any allergies
- This is to make sure it is safe to have the vaccine
- The vaccines will be given as an injection usually in the thigh
28
2. What are common side effects of vaccines ?
- Crying, irritability and loss of appetite
- Local reactions (pain, redness or swelling at the injection site)
- Fever
29
3. What are more serious side effects of vaccines ?
- Allergic reactions
- Anaphylaxis (1 in 1 million)
- Febrile convulsion
30
4. How does measles present ?
- Prodromal – irritable, conjunctivitis and fever
- Kolpik spots (buccal mucosa)
- Rash – starts behind the ears and then to the whole body
- Diarrhoea
31
5. How does Mumps present ?
- Fever
- Malise and muscular pain
- Parotitis (earache or pain on eating)
32
6. Complications of Mumps ?
- Orchitis
- Hearing loss
- Meningoencephalitis
- Pancreatitis
33
7. Complications of measles ?
- Otitis media
- Pneumonia – MCC of death
- Encephalitis
- Febrile convulsions
- Myocarditis
34
8. How does rubella present ?
- Low grade fever
- Maculopapular rash initially on the face before spreading to the whole body
- Lymphadenopathy:
35
9. Complications of rubella ?
- Arthritis
- Thrombocytopenia
- Encephalitis
- Myocarditis
