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GPhC Exam > Contraception > Flashcards

Contraception Flashcards

1
Q

Name non-hormonal contraceptives

A
  • barrier methods - condoms, diaphragms, cervical cups
  • spermicidal contraceptives - in addition only (not alone)
  • IUD (Cu-coil) - contraindicated in pelvic inflammatory disease or unexplained vaginal bleeding
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2
Q

What damages latex products

A

petrolium jelly, baby oil, oil based products

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3
Q

Name progesterone only contraceptives

A

Levenorgesterel, norethisterone, desogestrel

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4
Q

Progesterone only administration

A
  • no pill free period - take every day
  • same time of day for max efficiency
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5
Q

Progesterone only precautions

A
  • no additional precautions if started in first 5 days of cycle
  • 2 days precaution if started after that
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6
Q

Progesterone only missed pill rule

A
  • within 3 hours otherwise missed
  • desogesterel within 12 hours otherwise missed
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7
Q

Name parenteral progesterone only contraceptives

A

Injections (99.8% effective), Implants (99.95% effective)

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8
Q

Name a progesterone only injection and side effects

A

Depot medroxyprogesterone acetate - every 13 weeks
- loss of bone density
- delayed return to fertility for up to 1 year after stopping

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9
Q

Name a progesterone only implant and side effects

A
  • Etonogestrel (Nexplanon)
  • lasts upto 3 years
  • MHRA: neurovascular injury and migration of implant - remove ASAP
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10
Q

Name types of combined hormonal contraceptives

A

tablets, patches, vaginal rings

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11
Q

When not to use combined hormonal contraceptives

A
  • in 50 years + as safer alternatives exist
  • hypertension
  • 35 years plus and smoker
  • risk factors for CVD
  • migraine with aura
  • new onset migraine w/o aura during use of CHC
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12
Q

Health benefits of combined hormonal contraceptives

A
  • reduces risk of ovarian, endometrial and colorectal cancer
  • aligns bleeding pattern
  • reduces dysmenorrhea and menorrhagia
  • manage symptoms of PCOS, endometriosis and premenstrual syndrome
  • improves acne
  • reduces menopausal symptoms
  • maintain bone density in peri-menopausal females under 50
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13
Q

CHC types of preparations

A
  • monophasic - fixed amount of oestrogen and progesterone in each active tablet
  • multiphasic - varying amounts of the 2 hormones e.g. diff levels in first 2 weeks compared to last week
  • oestrogen - ethinylestradiol, mestranol, estradiol
  • on 21 day regimen = monthly withdrawal bleed (doesn’t represent physiological) during 7 day hormone free interval - some come as 21 active 7 dummy to improve coherence
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14
Q

STOP taking CHC if

A
  • calf pain/swelling/redness - DVT
  • chest pain/breathlessness/coughing blood - PE
  • loss of motor sensory function - stroke
  • severe stomach pain - hepatotoxicity
  • very high BP - hemorrhagic stroke
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15
Q

Seek advice with CHC if

A
  • signs of breast cancer - lumps/nipple pain
  • new onset migraine
  • high BP
  • persistant unscheduled vaginal bleeding
  • high BMI (>35)
  • DVT/PE
  • blood clotting abnormality
  • CVD
  • 50 year plus
  • newly developed contraindication
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16
Q

CHC surgery rules

A
  • stop 4 weeks before major elective, any surgery to legs/pelvis, if prolonged immobilising of lower limbs
  • use alternative method of contraception
  • restart 2 weeks after full remobilisation
  • if discontinuation not possible (trauma)/still on CHC - consider thromboprophylaxis
17
Q

CHC side effects

A
  • headache
  • unscheduled bleeding (breakthrough bleeding)
  • mood change
  • weight gain
  • libido change
18
Q

Switching from CHC to a different CHC

A

no additional contraception needed

19
Q

Switching from POP to CHC

A

7 days extra precaution

20
Q

Switching from levenorgesterel IUD to CHC

A

7 days extra precaution

21
Q

Switching from Cu-IUD and other non-hormonal methods to CHC

A
  • if CHC started in first 5 days of cycle - no extra precaution needed
  • if started after day 5 - 7 days extra precaution
22
Q

Switching from CHC to others during week 1 of cycle or day 3-7 of HFI and NO UPSI since start of HFI

A
  • to Cu-IUD - no precaution
  • to POP - 2 days precaution
  • to others - 7 day precaution
23
Q

Switching from CHC to others during week 1 of cycle or day 3-7 of HFI and UPSI since start of HFI

A
  • carry on with CHC until 7 consecutive days of other method taken then stop
24
Q

Switching from CHC to other methods in week 2 or 3 of cycle

A

No extra precaution required

25
Q

Oral contraceptives vomit/diarrhoea

A

if vomit/diarrhoea within 2 hours of COC/POP - take another ASAP

26
Q

POP misses doses and protection

A
  • missed if >12 hours desogesterel, >3 hours other, take ASAP, next pill at usual time
  • protection until 48 hours taken right (7 days desogesterel)
  • emergency contraception if UPSI between missed pill and 2 days after restarting
27
Q

COC missed doses and protection

A
  • late start after HFI (>9 days since last active pill) = emergency contraception if UPSI, take ASAP and use condoms 7 days
  • 1 missed pill = take ASAP - no further action if consistent use in last 7 pills
  • 2 + missed pills:
    week 1 = emergency contraception if UPSI within HFI + week 1, take ASAP and use condom 7 days
    week 2-3 = no emergency contraception, take ASAP, 7 days condom
    if 2+ missed pills in 7 days before HFI - carry on taking pill through HFI
28
Q

Name the different emergency contraceptions

A

Cu-IUD, ulipristal 30mg, levonorgestrel 1.5mg - taken ASAP

29
Q

Cu-IUD emergency contraception details

A
  • first line
  • within 120 hours
  • can be inserted up to 5 days after the earliest estimated date of ovulation
30
Q

Levonorgestrel emergency contraception details

A
  • within 72 hours - 2nd dose if DV in 3 hours
  • BMI > 26 or weight > 70kg = ulipristal or 2 x levonorgestrel
  • can be used more than once in same cycle but increases risk of side effects
31
Q

Ulipristal emergency contraception details

A
  • within 120 hours - 2nd dose if DV in 3 hours
  • ulipristal more effective than levonorgestrel
  • BMI > 26 or weight > 70kg = ulipristal or 2 x levenorgestrel
  • can be used more than once in same cycle
32
Q

Reinitiating regular contraception after levenorgestrel

A

start hormonal contraception immediately - condoms until effective

33
Q

Reinitiating regular contraception after ulipristal

A
  • wait 5 days before starting regular hormones again - use condoms in those 5 days
  • if during week 1 in females taking regular CHC - can restart immediately but use condom for 7 days
34
Q

Levonorgestrel 1.5mg side effects and cautions

A
  • breastfeeding: no delay
  • caution if malabsorption
  • cause breast tenderness, DV, fatigue and haemorrhage
  • avoid in severe liver impairment
  • interaction: CYP inducers e.g. rifampicin
35
Q

Ulipristal 30mg side effects and cautions

A
  • Breastfeeding: 1 week delay
  • caution in severe asthmatics controlled by glucocorticoids
  • cause cycle irregularities, DV, altered mood, dizziness
  • avoid in severe liver impairment
  • interaction: CYP inducers e.g. rifampicin
36
Q

Cu-IUD MHRA warning

A

risk of uterine perforation (severe pelvic pain after insertion, sudden change in period, pain during intercourse, unable to feel threads- check up if can’t feel)

37
Q

Cu-IUD replacement requirements

A
  • replace every 5-10 years
  • remove in first trimester of pregnancy if not worked
38
Q

Levenorgestrel IUD (not emergency contraception) details

A
  • risk of uterine perforation
  • remove in first trimester of pregnancy if not worked
  • reduced pain/bleeding side effects
  • replace every 3-10 years

GPhC Exam (22 decks)

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