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443-SRH and MSK > Medical Abortion > Flashcards

Medical Abortion Flashcards

1
Q

what are some options for terminating a pregnancy under 14 weeks

A

medical, vacuum aspiration, electric vacuum aspiration

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2
Q

what is the only option for termination of pregnancy >14wks

A

dilation and evacuation

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3
Q

mifegymiso is approved by health canada for use under

A

63 days or 9 weeks

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4
Q

T or F: pharmacists must see the ultrasound confirming pregnancy before dispensing mifegymiso

A

F

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5
Q

T or F: mifegymiso requires witnessed ingestion

A

F

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6
Q

mifegymiso contains

A

200mg of mifepristone and 800mg misoprostol

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7
Q

what is mifepristone

A

a progesterone antagonist on the endometrium/ myometrium that also has antiglycocorticoid properties

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8
Q

misoprostol MOA

A

a synthetic prostaglandin that induces uterine contractions

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9
Q

mifegymiso indication

A

termination of preg up to 9 weeks

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10
Q

list the 6 absolute contraindications for mifegymiso

A
  1. unsure about abortion
  2. ectopic pregnancy
  3. uncontrolled asthma
  4. chronic adrenal failure
  5. inherited porphyria
  6. allergy to mifepristone or misoprostol
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11
Q

list the 5 relative CI for mifegymiso

A
  1. unconfirmed gestational age
  2. IUD inserted
  3. long term CS use
  4. hemorrhagic disorder or anticoagulant therapy
  5. anemia
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12
Q

mifegymiso interactions

A

anything that fucks with CYP3A4
corticosteroids- can decrease eff of steroid for 3-4 days

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13
Q

RF for ectopic pregnancy

A

previous ectopic preg
tubal surgery
preg through assisted repro techniques
IUD in place
hx PID/salpingitis

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14
Q

how does mifegymiso admin work?

A

day 1 = mifepristone 200mg PO
day 2-3 = misoprostol 800mg buccal F30 min, swallow fragments
FU day 7-14 with provider

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15
Q

with mifegymiso, when should pregnancy pass

A

within 2-24hrs

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16
Q

with mifegymiso, when should cramping start

A

2-3hrs

17
Q

with mifegymiso, when should bleeding start

A

1-48hrs after misoprostol

18
Q

with mifegymiso, how long should you rest

A

3hrs

19
Q

with mifegymiso, how long should bleeding last after misoprostol

A

2-4hrs

20
Q

AEs of mifegymiso

A

hot flashes, chills, N/V, fatigue, dizziness/ headache, diarrhea

21
Q

what to take for mifegymiso SEs

A

NSAIDs
diphenhydramine
loperamide

22
Q

when should pt go to ER after mifegymiso

A

if bleeding through 2 maximads per hour for 2 hours, if pain not controlled, clots size of lemons, fever >38C for >6hrs, V/D/ weaknses for more than 24hrs

23
Q

when should you return to CHC after mifegymiso

A

immediately after abortion is complete

24
Q

how soon can ovulation take place after mifegymiso

A

8 days

25
Q

how soon can you get your IUD back after an abortion?

A

7-14 days

26
Q

if a pt vomits 45 minutes after their mifepristone dose, do they have to take another one?

A

yes- if under an hour + take antinausea pill

27
Q

if pt vomits 30 minutes after swallowing their misoprostol fragments, do they have to take another one?

A

no

28
Q

if pt vomits 20 minutes after they’ve placed the misoprostol pills bucally, should they repeat this step?

A

yes- must finish buccal absorption phase

29
Q

what is an off label treatment for abortion

A

methotrexate/ misop[rostol

30
Q

methotrexate/ misoprostol is available up to _____ gestation and for ____ pregnancise

A

63 days
ectopic

31
Q

which of the following can be used for ectopic pregnancies
1. mifegymiso
2. methotrexate/ misoprostol
3. mifepristone alone

A

2

32
Q

T or F: mean time to abortion completion is longer with mifegymiso than methotrexate/ miso

A

F- methotrex/miso takes 7 d compared to mifegymiso 3 d

33
Q

which has more SEs, methotrexate/miso or mifefgymiso?

A

methotrex/miso

34
Q

how to dose methotrexate/misoprostol

A

methotrexate 50mg PO/IM, then misoprostol 4x200ug admin high in vagina on days 4,5,6

35
Q

T or F: misoprostol can be used alone for abortion

A

T

36
Q

which of the following is false about misoprostol for medical abortions
1. it may be less effective than mifegymiso
2. if often needs repeated dosing
3. starting dose is 200mcg SL or vaginally
4. if there is no response after 3-24hrs, the dose should be repeated

A

3- starting dose is 800mcg or 4x200mcg

443-SRH and MSK (24 decks)

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