Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LMCC Part II > OCP Counselling > Flashcards

OCP Counselling Flashcards

1
Q

what to ask on sexual history for OCP

A

previous and present use of contraception, compliance and SEs experienced

sexual orientation and practices

present and past number of partners, concurrent partners

current relationship–> monogamous, health and age of partner

STIs now and in the past (consider screening for current symptoms)

possibility of current pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what to ask on OB/GYN history when counselling about contraception

A

age of menarche

menstrual cycle length, regularity, total days, amount of bleeding

PMS, other menstrual sx

dysmenorrhea, pelvic pain, dysfunctional uterine bleeding

date of last pap and pelvic exam, past abnormal paps and gynecological procedures

GTPAL

current breastfeeding

childbearing goals and attitude towards accidental pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what to ask specifically on PMHx for OCP counselling

A

HTN
liver disease
thromboembolic disease–> IHD, CVA, DVT/PE
cancer–breast, uterine, ovarian
migraines with aura or focal neuro findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what other meds might interact with the OCP

A

anticonvulsants

antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what to ask about on family history when counselling contraception

A

clotting disorders/VTE/PE

breast, uterine, ovarian, liver cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

is a gyne exam necessary to prescribe contraception

A

no–only do if suspect STI or if gyne exam is due

pap test if due

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what investigations should be done if planning to prescribe contraception

A

beta hcg if suspect pregnancy or if planning IUD

STI testing if high suspicion, patient requests or planning IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

absolute contraindications to the IUD

A

pregnancy

unexplained abnormal vaginal bleeding

cervical, uterine or salpingeal infection, current or recurrent PID or STIs in last 3 months

immediately post septic abortion

malignant trophoblastic disease

copper allergy or wilsons disease (for copper IUD)

current breast cancer (for hormonal IUD)

severely distorted uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how effective is the IUD

A

99.9%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the pros of the IUD

A

most effective reversible form of contraception

lasts 5 or more years

copper IUDs can be emergency contraception within 7 days

hormonal IUD improves menorrhagia and dysmenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cons of IUD

A

small risk of uterine perforation (0.6-1.6/1000), pain or dysmenorrhea

irregular bleeding is common in first few months and decreases over time

possible risk of PID around month of insertion

small risk of expulsion (more during first year)

r/o ectopic pregnancy if becomes pregnant with IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

absolute contraindications of OCP, ring and patch

A

previous PE, DVT, CVA, CAD

smoker older than 35 (more than 5 cigs/day)

current breast, endometrial, cervical ca

unexplained abnormal vaginal bleeding

cirrhosis, other liver disease

pregnancy

less than 6 weeks post partum if breastfeeding

uncontrolled HTN about 160/100

migraines with aura

complicated valvular disease

DM with retinopathy, neuropathy, nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how effective are the OCP, ring, patch

A

99.9% if used perfectly–user failure rates are 3-8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

pros of OCP, ring, patch

A

improved cycle regulation, decreased menstrual flow, improved acne and hirsutism, improved dysmenorrhea and PMS

decreased risk of ovarian, endometrial and colon cancer

decreased risk of benign breast disease, fibroids and ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cons of OCP, ring, patch

A

must take pill daily and at same time

irergular bleeding common for first few cycles and tends to improve with time

slight increase in VTE risk compared to non users, highest in first year of use

common SEs: nausea, breast tenderness, headache

increased risk of weight and mood changes–not supported by evidence but anecdotally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

absolute contraindications to progesterone only pill

A

pregnancy

current breast ca

relative are viral hep and liver tumours

17
Q

efficacy of progesterone only pill

A

99.5% with perfect use; 5-10% failure rate

18
Q

pro of progesterone only pill

A

can be used in breastfeeding women or in patients with contraindication to combined OCP

19
Q

what vital sign must be normal before starting OCP

A

blood pressure

20
Q

when should you follow up new OCP start

A

3 months

21
Q

when should you follow up new IUD insertion

A

4-6 weeks to check strings

22
Q

do minors need parental consent for contraception

A

no

23
Q

why do you have to confirm the purpose of contraception is to prevent pregnancy

A

may want it to treat acne

*must tell them it doesnt protect against STDs

24
Q

are any OCPs more effective than another

A

no

25
Q

how do cardiovascular risks compare between pregnant women and those on OCP

A

the cardiovascular risk of pregnancy is significantly higher than for OCP

26
Q

what increases risk of ischemic stroke in those on OCP

A

smoking and HTN

27
Q

how do VTE risks compare between pregnant women and those on OCP

A

much higher in pregnancy than in those on OCP (but those on OCP have higher risk than general population)

28
Q

what other patient consideration puts them at even higher risk of VTE while on the OCP

A

obesity

29
Q

how does OCP change breast cancer risk

A

only slightly higher in OCP use–3/1000 vs 2/1000 but the risk is significantly higher if there is family history of breast ca

30
Q

how long does it take normal ovulatory menstruation to occur again after stopping OCP

A

1-3 months but can be sooner or later

31
Q

what does the patient do if they missed:

1 pill

A

take it as soon as you remember and take next pill at usual time

32
Q

what does the patient do if they missed:

2 pills in a row

A

in the first two weeks–> take two pills on the day you remember and two pills the next day; finish rest of pack as usual.
**use backup for 1 week

in the third week–> keep taking one pill every day until Sunday; on Sunday, set aside rest of pack, including spacers, and start taking a new pack of pills.
**use backup for one week

33
Q

what does the patient do if they missed:

3 or more pills in a row at any time

A

keep taking one pill every day until Sunday. On sunday, set aside the rest of the pack and start taking a new pack of pills.
**use backup for TWO weeks

34
Q

if the patient starts birth control pills right away (without waiting for menses) how long must they use backup

A

1 week

35
Q

what risk factors must be screened per the example LMCC case

A 
DVT
active liver disease
undiagnosed vaginal bleeding
HTN
migraines
pregnancy
36
Q

how to ask about the risk factors mentioned in the LMCC case

A 
history of clots?
history of abdominal pain?
history of jaundice?
history of abnormal periods?
history of HTN?
history of migraines?
history of mood changes or depression?
37
Q

what does the LMCC case definitely want us to do for young people coming in?

A

HEEADSS

38
Q

what is HEEADSS

A 
Home and environment
Education
Employment
Activities
Drugs
Sexuality
Suicide/depression

LMCC Part II (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions