Womens Health Flashcards
Absolute Contraindications for OCP
MY CUPLETS
Migraine > 35 CAD of CVA Undx gental bleeding Pregnant Liver tumor or liver dx Estogen dependent tumor Thrombus or emboli S: smoker age 35 or OLDER
less that 21 days post-partum
Relative Contraindications for OCP
cigarette smoking < 35 DM w/ NO vascular complications Fibriods Obesity Mirgraine < 35 (on both)
advantages of COC and OCP’s
decreased problems with
- cramps ( increased prostaglandins)
- light more reg periods ( less anemia)
- acne ( suppression of ovaries)
- ovarian cysts ( suppression of ovaries)
- fibrocyctic breasts ( decrease in progestrone)
- lower risk of PID ( progesterone thicken mucus pug)
How do OCP’s work?
thicken mucus plug
and surpresses ovulation
what hormone stays the same amount in OCP’s
estrogen its the progesterone that changes
POP keys
safe for breast feeding mothers
if dose taken 3 hours late - take when remember but use condom for 48 hours
miss one day: take two tablets that day and then back up for 48 hours
Ortho Evra
transdermal patch change each week x 3 weeks
has more estogren exposure
Nuvaring
insert once a month, must be in vagina 7 days to be effective
keys to starting birth control
can start at any time during cycle
use back up method for 7 days
just r/o preg ( no need to get a pelvic or STI testing)
BTB ( breakthrough bleeding) Unscheduled bleeding
likely to occur in first 3 months of new perscription
r/o other things
missed two OCP’s pills
- take two active pills ASAP
- take one pill daily until finished 21 day active pills
- Skip placebo and start new pack
- use condoms
drug interactions with OCP’s
” triple A”
Anticonvulsants : phenobarb, phenytoin
Antifungal : griseofulvin
Antibiotics : amplicilin, tertracyline, rafampin
Pill danger signs
ACHES Abdominal pain Chest pain Headache Eye problems Severe leg pains
Plan B
contains levonorgestrol ( tyep of progresterone)
take 1 st dose asap ( upt 72 hours) after unprotected sex
take second dose within 12 hours of first dose
ParaGuard
IUD - good for 10-12 years
Mirena
5 years
contraindications for IUD’s
recent infection or abortion STD uterine cancer preg undx vaginal bleeding
Depo-provera
injection lasting 3 months
not for women who want to get pregnant in 12-18 months
long term > 5 years use can cause: osteoporosis and weight gain
rec to only use for 2 years or less
Diaphram w/ gell
shouldnt feel it if proper size
can leave inside for 24 hours
additonal spermacide after every act of intercourse
leave in on for 6-8 hours after intercourse
Nexplanon
sudermal only containing progestin
effective for 3 years
use back up
Birth control options for smokers greater than 35 or where estrogen is contraindicated
barrriers IUD Nexplanon Depo- Provera Progresten only pills
dysmenorrhea
uterine pain die first few days of menstraul period caused by prostaglandins
considered OCP’s, Ponstel (nsaid)
Uterine Leiomyomas (fibroids)
benign tumors of the uterus
middle age women complains of heavy menstraul bleeding w/ lower back pain
will see smooth muscular mass on the uterine that is not tender
get a pelvic and transvaginal US
fibroids in post-menapausal women
new onset or rapidly enlarging fibroid - r/o cancer
Drugs contraindiacted in pregnancy
Live anntenuated virus vaccines
- measles, mumps, rubella, varicela, flumist, shingles, oral polio, rotavirus
Quinolones ( achililes tendon, hyperglycemia)
Trimethoprom-sulfamethazole ( hemolytic anemia, can also cause hyperkalemia if mixed ace and arb)
Tetracycline (stain on tooth enamil)
Ace /Arb ( poor kidney formation)
BV
not STI its overgrowth of bacteria on vagina
strong odor, off white thin runny d/c
increased risk of PID, pre-term labor
DX : microscopy / wet smear (amsel criteria)
- will see clue cells > 20 %, WBC and mobiluncus bacteria (squamous epithelial cells whose surfaces and edges are coated with large numbers of bacteria )
- whiff test + and ph > 4.5
tx : metronidazole for 7 days or gel for 5 days
What is a disulferam - like drug reaction
if flaygl is mixed with alcohol ( n/v/ HA high BP)
Trichomonias
STI
unicellular protozoan w/ flagellas infects W and M
severe vulvar and vaginal pruritis w/ green dicharge
vagina will look irritated and red
cervix = punctate hemorrhages and petecchiae ( strawberry cervix)
copious yellow/green frothy discharge
dx: Microscopy / Wet smear ( low power)
- look for protozoa w/ flagelle adn WBC’s
TX: Flagly x 7 dyas
tx sexual partner
Candida Vaginitis
yeast infection
itching and burning, curd liek d/c
DX: Microscopy/wetsmear
- large # WBC’s, pseudohyphae and spores *, may have some RBC if inflammation
TX: OTC clotrimazole or miconazol
can give perscription fluconazole if resistant one dose
Cervical Ectropion
glandular cells inside and around the os. Appears as bright bumps on the cervical surface covered in clear mucus. Teens and younger girls have larger ones.
Nabothian Cyst
a normal fingins. mucous retention cyst
HPV /pap smear testing for under 20
do not screen
HPV /pap smear testing for 21-65
if co-testing every 5 years if not testing HPV then pap q 3 years
HPV /pap smear testing for > 65
no rec if no hx of cancer in 20 years
HPV /pap smear testing for people who have under gone a hysterectomy?
if no hx of cancer than can d/c
coloposcopy does what
obtains cervical and endocervical biopsies
endometrial biospy for what?
do when suspecting endometrial hyperplasia cancer ( post-menopausal bleeding), pap smear with presence of grandular cells . NOT for the cervix
Cytology/pap must include what
both endocervical and squamous epithelial cells
repeat pap if not have both
Atypical squamous cells in pap smear sig age 20 and below
repeat pap in 1 year
Atypical squamous cells in pap smear sig age 21-24
repeat pap in 1 year
Atypical squamous cells in pap smear sig age 25 and older
order HPV testing . if HPV pos but strains are non-oncogenic then repeat in 1 year
if oncogenic types #16 and #18 then refer for colposocopy and cervical biopsy
Atypical glandular cells
common in 40-60 age women
associated with premalignant refer for endometrial and endocervical biopsy
Low-grade squamous intraepithelial lesions and high grade squamous epithelial lesions
do HPV and refer for colposcopy, biopsy and tx
LEEP
leep is a device that cuts through cervix to treat cervical cancer. Depedning on result of biopsy the cancerous can be removed by cryotherapy for mild lesions
Perimenapause
hot flashes, nigh sweats, insomnia, dysfunctional uterine bleeding
meds: soy milk, tofu, wild yams, SSRI, exercise
Menopause
amenorrhea for 12 consectutive months
increased risk of osteoporosis and cad
should you be able to palpate uterus and right ovary in menapuasal person?
no, if you feel ovary w/ smooth surface adn non tender then you should order pelvic and intravaginal US to r/o ovarian cancer
Atrophic Vaginitis
normal part of menapause
chronic lack of estrogen affects the labia, vagina, urethra/
TX: vaginal lubricants
topical and oral estogen rec first ( check if no risk factors)
vaginal ring avail - if intact uterus then add progesterone for 10-12 days a month to prevent hyperplasia of the endometrium
Hormone replacement therapy
its combined estrogen and progesterone
increase risk of : heart disease, stroke breast and unterine cancer dvt adn emboli
if given, give the lowest dose for lowest amoutn of time ( only for people who have moderate - severe menopauseal symptpoms
