COCP

Question 1

What is Qlaira?

Answer 1

Estradiol Valerate plus Dienogest
26/2 regime

1st two tablets and last 2 tablets are E only
2 other tablet types one with 3mg and one with 2mg of dienogest.

Question 2

Can you QS Qlaira?

Answer 2

Yes 9 days condoms

It is only effective immediately if D1

Question 3

What are missed pill rules Qlaira?

Answer 3

> 12 hours is missed pill
take it asap

D25-28 are only days no need extra contraception for 9 days

25 26 are E only 27 28 are placebo

If D18-24 discard pack and start new one

Question 4

What is point of Qlaira?

Answer 4

better lipid profile, less metabolic impact ? may be better for older/risk cvs

however cycle control is similar to low dose E pills, as is efficacy. 20% will not have withdrawal.

Question 5

What is the deal with lamotrigine and CHC?

Answer 5

HFI toxicity
CHC reduced seizure contro
Risks could outweigh benefits

Question 6

Which CHC may have reduced efficacy with increased weight?

Answer 6

Patch > 90kg

Question 7

Which Cancers does CHC reduce?

Answer 7

Ever use: Ovarian, Endometrial (persists many years) and colorectal

Question 8

CHC and arterial disease?

Answer 8

current users increased risk but still very uncommon

avoid in those with significant RF

Question 9

Breast cancer and CHC?

Answer 9

small increased risk reduces with time

Question 10

Cervical Ca and CHC?

Answer 10

5+ years use increased risk reduces with time and normal after 10 years

Question 11

What is first line COC and why?

Answer 11

< or = 30mcgEE with LNG or NET (VTE)

Question 12

Altitude rules?

Answer 12

> 7 days >4500m consider switch

Question 13

What does 50mcg mestranol equate to?

Answer 13

35mcg EE

Question 14

What is different about 17B-estradiol?

Answer 14

structure identical to that occurring naturally in humans ? better metabolic profile

Question 15

What are progestogens?

Answer 15

synthetic steroids designed to have some of properties of progesterone

allow for convenient dosing/potent suppression ovulation/ET

newer ones designed to be less androgenic less glucocorticoid but seem to have increased VTE

Question 16

What generation is NET?

Answer 16

1st

Question 17

What generation is LNG?

Answer 17

2nd

Question 18

What generation are desogestrel gestodene norgestimate

Answer 18

3rd

Etonogestrel is metabolite of desogestrel (ring)
Norelgestromin is metabolite of norgestimate (patch)

Question 19

What generation are drospirenone dienogest nomegestrol acetate?

Answer 19

4th

Question 20

What is in the patch?

Answer 20

Norelgestormin and EE
releases 33.9 mcg EE and 203mcg P over 24 hrs

one patch one week

Question 21

What is in the ring?

Answer 21

etonogestrel and EE
15mcg

one ring 21 days

Question 22

How do you advise women with very short of variable cycles when starting pill?

Answer 22

<20 days d1 only or 7 days condoms

Question 23

Switch one CHC to another when effective?

Answer 23

Immed

Question 24

Switch NET to CHC when effective?

Answer 24

7 days to suppress ovulation

Mucus effect may be maintained however no evidence

Question 25

DSG/injection/implant when cocp effective if switch?

Answer 25

All suppress ovulation so long as used properly CHC effective immediately as suppression maintained

Question 26

When is CHC effective if switch from IUS?

Answer 26

7 days. If sex last 7 days leave coil in for 7 days before remove.

Question 27

What to do if enzyme inducers and wants to continue COC?

Answer 27

20+30mcg
Continuous or extended with short HFI
Exceptionally 70mcg but ??dvt etc

Note not with rifampicin or rifabutin too potent

If short term could use condoms additionally to standard cocp

Question 28

How many hours within will pill not be absorbed if vomiting or diarrhoea?

Answer 28

Vomit < 3 hours after taking
Severe Diarrhoea > 24 hrs

Follow missed pill rules

Question 29

When is a coc a missed pill?

Answer 29

> 24 hrs
Most risk ovulation if extend HFI by missing pills either side HFI

Question 30

What is increase risk VTE with CHC?

Answer 30

3-3.5 times but absolute risk small and lower than preg or post natal

5-12/10,000 pill
2/10,000 no pill

Type of P affects as dose higher dose EE
Conflicting evidence re ctp/cvr…?? Cvr higher risk

Question 31

Dianette for contraception only?

Answer 31

No due to higher DVT risk

Question 32

What is Zoely?

Answer 32

24/4 estradiol nomegestrol

Question 33

How many days do you have to restart pill after HFI?

Answer 33

8 days since last active pill

If > or = 9 days and upsi consider EC

Question 34

If 1 missed pill anytime in cycle do you need EC?

Answer 34

No

As long as correct earlier pill use
If after HFI must have started pack on time

Question 35

If 2-7 pills missed week 1?

Answer 35

Consider EC if upsi

Question 36

If 2-7 pills week 2-3?

Answer 36

No need EC
But omit HFI if leading into
7 days condoms

Question 37

How many days to restart ring?

Answer 37

Up to 8 days. If 8 completed days or more it’s a late start. Ie 7 days condoms and consider EC if upsi

Question 38

If ring removed less than 48hrs do you need EC?

Answer 38

No-and no condoms needed (like one missed pill)

Question 39

If ring removed 48+ hours?

Answer 39

Same as if missed 2+ pills….
If in week 1 consider EC if upsi but any other time no need EC if correct use but 7/7 condoms

Question 40

If leave same ring in week 3-4 any action needed?

Answer 40

No-this is HFI

If leave same one in up to 5 weeks EC not needed

5+ weeks EC if sex during week 5+ omit HFI and PT/condoms

condoms 7 days if 4+ weeks

Question 41

What are rules re restarting patch? When is late? When do you need EC?

Answer 41

Same as ring. 8+ completed days consider EC if upsi

Question 42

What is rules if leave a patch on up to 48hrs post change day? Or detach up to 48hrs?

Answer 42

Like one missed pill. As long as restarted after HFI correct day no EC at any time in cycle needed no additional contraception

Question 43

If patch detatch or continued use more than 48 hrs what to advise?

Answer 43

Week 1- EC if UPSI
Any other week if correct use 7 days prior no EC
Condoms 7 days

Question 44

Why difference in days to restart after HFI?

Answer 44

Cocp is not late unless 9+ days
CVR/CTP is 8+days

Difference is due to fact with patch/ring HFI is considered to start immediately on removal

Eg mon 9am have until wed 9am to start by if pill but Tues 9am if ring or patch.