1 Contraceptives

Question 1

MOA of combined oral contraceptives

Answer 1

Suppression of ovulation; cervical mucus thickening; endometrial thinning

Question 2

0.1-0.3% per 100 women years

Answer 2

Failure rate of COC

Question 3

Reasons for failure rate of COC

Answer 3

Poor compliance, reduced absorption, increased metabolism

Question 4

Reduced incidence of these things on COC

Answer 4

Carcinoma of ovary, carcinoma of endometrium, benign breast disease, benign ovarian cysts, fibroids, ectopic pregnancy, pelvic infection.

Question 5

Side effects of COC

Answer 5

Weight gain, acne, not good for bones in long term use.

Question 6

Increase in VTE risk on COC

Answer 6

3-4x (but normal risk only 7 in 100,000)

Question 7

Lamotrigine

Answer 7

The levels of this are reduced by the CHC, so, in the pill free week the symptoms worsen and fit control worsens. Sodium valproate is okay to use.

Question 8

Levonelle

Answer 8

Levonorgestrel

Question 9

ellaOne

Answer 9

Ulipristal acetate. Selective progesterone receptor modulator

Question 10

After levonelle, need to use condoms for…

Answer 10

2 days for POP
7 days for COC
9 days Qlaira

Question 11

After ellaOne, need to use condoms for…

Answer 11

9 days for POP
14 days for CHC
16 days Qlaira

Question 12

After emergency contraception do not use (2)

Answer 12

IUS or dianette

Question 13

Copper coil MOA

Answer 13

Inhibits fertilisation due to direct toxicity.

Question 14

<1%

Answer 14

Failure rate of copper coil

Question 15

300mm2, preferably 380mm2

Answer 15

How much copper should be in the copper coil if using it for long term use

Question 16

The Fraser guidelines

Answer 16

1 understands the advice
2 cannot be persuaded to inform rents
3 likely to online having UPSI
4 if she does not receive treatment her physical/mental health will suffer
5 in is in her best interests

Question 17

20%

Answer 17

Percentage of women who become amenorrhoeic on cerazette

Question 18

DMPA

Answer 18

Depot medoxyprogesterone acetate injection. Aqueous suspension 150mg/ml given every 12 weeks. Most common

Question 19

NET EN

Answer 19

Norethisterone Oenanthate, known as noristerat. Oily 200mg given every 8 weeks. Rarely used

Question 20

Guidance for DMPA use

Answer 20

In adolenscense, use only 1st line if other methods unsuitable or unacceptable. All women re-evaluate risks/benefits at 2 years. in women with lifestyle and/or medical risk factors for osteoporosis consider other methods

Question 21

Norplant

Answer 21

Subdermal implant in 1993, no longer available

Question 22

Implanon

Answer 22

Subdermal implant from 1999.

Question 23

Nexplanon

Answer 23

Almost 100% effect implant.

Question 24

Mirena

Answer 24

Levonorgestrel Intra Uterine System

Question 25

30-50%

Answer 25

% of women who get breakthrough bleeding in first few months of starting oral contraceptives

Question 26

Nuva-ring

Answer 26

Medium acting contraceptive.

Question 27

Evra

Answer 27

20cm2 transdermal patch.

Question 28

Zoely

Answer 28

Nornegestal acetate/estradiol.

Question 29

The 2008 white paper on pharmacy services in England states that pharmacies should be involved in:

Answer 29

``` promotion/access condoms Sexual Heath prescribing/PGDs Advice&EHC STI awareness raising Chlamydia testing Supply contraceptive pill ```

Question 30

18-29

Answer 30

Age group when most unplanned pregnancies occur

Question 31

90%

Answer 31

Percentage of teenage pregnancies in England that are unplanned

Question 32

Potential barrier method failure

Answer 32

Due to: condom rupture, dislodgement or misuse, incorrect insertion of diaphragm/cap, removed too early, torn or dislodges during intercourse

Question 33

Potential IUD failure

Answer 33

Complete or partial expulsion, mid cycle removal

Question 34

Qlaira

Answer 34

A COC which has a complex quadraphasic dosage regime designed to provide optimal cycle control. It has a continuous 28 day cycle with 26 active and 2 placebo tablets. It has different missed pill rules to other COCs. A pill is considered to be missed if taken more than 12 hours late. If this missed pill is in days 1-24 of the cycle, additional precautions are required for 9 days.

Question 35

MOA of EHC if taken after ovulation has occurred

Answer 35

affects the motility of the fallopian tube to prevent the sperm meeting the ovum, it affects the patency of the endometrium to proven implantation

Question 36

16 years

Answer 36

Minimum age for P supply of levonelle

Question 37

18

Answer 37

Minimum (licensed) age for POM supply of elleOne

Question 38

Methods of contraception ok if on enzyme inducing drugs

Answer 38

POP, copper bearing IUDs or the levonrgestrel containing IUS

Question 39

Short term EID

Answer 39

On this, should have CHC with at least 30mcg EE, and use addition contraception. Use tricycling regime

Question 40

Long term EID

Answer 40

on this, should have CHC with at least 50mcg EE and use tricycling regimen. Increase if bleeding.

Question 41

Breakthrough bleeding indicated...

Answer 41

low serum EE concentrations. If other causes, e.g. chlamydia have been excluded, the dose of EE can be increased up to a max of 70mcg

Question 42

3mg levonelle within 120 hours (unlicensed). Not UPA

Answer 42

EC treatment for people on EID

Question 43

After UPSI and EC do preg test....

Answer 43

No sooner than three weeks after

Question 44

IUD is made of

Answer 44

Copper

Question 45

Qlaira pill is late if over

Answer 45

12 hours

Question 46

Qlaira what to do for missed pill

Answer 46

1-17: take pill & use extra con(9 days) 18-24: start new pack & use extra(9 days) 25-26: take pill, no extra 27-28: placebo

Question 47

elective surgery (with immobility) suggest...

Answer 47

COC discontinue 4 weeks prior/ use LMWH | POP is fine

Question 48

emergency surgery suggest...

Answer 48

LMWH & stockings | Stop COC if long period of immobility

Question 49

past history of DVT suggest...

Answer 49

CuIUD (UKMEC1) | POP/IUS (UKMEC 2)

Question 50

Circumstaces where you consider referring a woman requesting EC for IUD?

Answer 50

All

Question 51

History of migraine suggest...

Answer 51

POP

Question 52

Risk to the foetus with EC?

Answer 52

Levonelle - no risk EllaOne - unknown IUD - risk ectopic preg

Question 53

Contraceptives reduced by EI

Answer 53

COC, POP, patches, vag rings

Question 54

EI will effect for what time frame

Answer 54

while taking and until 4 weeks after

Question 55

Tricycling means

Answer 55

3 packs on the trot followed by 4 day PFI