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5: Y5 - ESA 5 - Pharmacology > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the broad categories of contraception?

A
  • Medical
  • Social
  • Societal
  • Religious
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2
Q

What are the types of oral contraceptive pills?

A
  • COCP (oestrogen and progestin)
  • POP (progestin only
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3
Q

What are the different formulations of the COCP?

A
  • Monophasic
  • Biphasic
  • Triphasic
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4
Q

What is the monophasic formulation of the COCP?

A

Each tablet contains a fixed amount of oestrogen and progestin

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5
Q

What is the biphasic formulation of the COCP?

A

Each tablet contains a fixed amount of oestogen, whilst the amount of progestin increases in the second half of the cycle

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6
Q

What is the triphasic formulation of the COCP?

A

The amonnt of oestrogen may be fixed or variable, whilst the amount of progestin increases in 3 equal phases

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7
Q

What are the different doses of oestrogen found in the COCP?

A

50, 35, 30, or 20mg/day

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8
Q

What does of oestrogen does NICE recommend in the COCP?

A

The lowest dose possible

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9
Q

Give two examples of forms of oestrogen found in the COCP

A
  • Ethinylestradiol
  • Mestranol
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10
Q

What is the half life of ethinylestradiol?

A

15 hours

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11
Q

What is the half life of mestranol?

A

8-24 hours

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12
Q

What are the routes of administration of COCP?

A
  • Oral
  • Transdermal patch
  • Implants
  • Nasal
  • Vaginal
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13
Q

What kind of oestrogens can be administered orally?

A

Synthetic derivatives; ethinylestradiol, mestranol, valerate

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14
Q

What kind of progestins can be administered orally?

A

Synthetical derivavtives

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15
Q

What are the types of synthetic derivatives of progestins?

A
  • Progesterone derivatives, e.g. medroxyprogesterone, dyhydrogesterone
  • Testosterone derivatives, e.g. norethisterone, norgestrel, ethynodiol
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16
Q

What is the mechanism of action of the COCP?

A
  • Suppression of ovulation
  • Adverse effects on the cervical mucus
  • Adverse effect on the endometrium
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17
Q

How does the COCP suppress ovulation?

A

Oestrogen inhibits the secretion of FSH via negative feedback on the anteiror pituitary, and progesterone inhibits the secretion of LH

18
Q

What effect does the COCP have on cervical mucus?

A

Progesterone makes it more viscious, and therefore much less suitable for the passage of sperm

19
Q

What effect does the COCP have on the endometrium?

A

It prevents the secretory phase and so the endometrium remains atrophic - this discourages implantation

20
Q

What are the other ways that the COCP may prevent pregnancy?

A

May interfere with the cooridinated contractions of the cervix, uterus, and fallopian tubes that facilitates fertilisation and implantation

21
Q

What effect does the COCP have on the hypothalamus and gonadotroph?

A

It holds it in a ‘ready to go’ state

22
Q

What effect does the COCP have on the ovary?

A

It holds it in the ‘non-dominant follicular’ state

23
Q

What effect does the COCP have on the endometrium?

A

It holds it an the atrophic state

24
Q

What are the adverse effects of the COCP?

A
  • Venous thromboembolism
  • Myocardial infarction
  • Hypertension
  • Decrease glucose tolerance
  • Increased risk of stroke in women with focal migraines
  • Headaches
  • Mood swings
  • Cholestatic jaundice
  • Increased incidence of gallstones
  • Precipitate porphyria
25
Q

What is the COCP metabolised by?

A

Hepatic cytochrome P450

26
Q

What is the result of the COCP being metabolised by cytochrome P450?

A

Its efficacy can therefore be reduced by enzyme inducing drugs

27
Q

Give three examples of types of drugs that may reduce the efficacy of the COCP?

A
  • Anti-epileptics
  • Some antibiotics
  • Some natural products
28
Q

Give two anti-epileptics that reduce the efficacy of the COCP?

A
  • Carbamazepine
  • Phenytoin
29
Q

Give two antibiotics that affect the efficacy of the COCP

A
  • Rifampicin
  • Rifabutin
30
Q

Give an example of a natural product that reduces the efficacy of the COCP

A

St. Johns Wort

31
Q

What affect do soya proteins have on oestrogen?

A

It enhances its absorption, and reduces its storage and adipose on muscle, therefore reducing the half life from 15 to 7 hours

32
Q

Why are soya proteins beneficial in post-menopausal women?

A

Because it can replace natural oestrogen

33
Q

Give 4 examples of POPs

A
  • Levonorgestral
  • Norethisterone
  • Ethynodiol diacetate
  • Desogestrel
34
Q

Give an example of a drug used in the progesterone depot

A

Medroxy Progesterone Acetate (MPA)

35
Q

How often is MPA given in the progesterone depot?

A

Every 12 weeks

36
Q

How can the progestin etonogestrel be administered?

A
  • Female implants
  • Male implants
  • Vaginal ring
37
Q

Give an example of a drug that can be used as emergency contraception up to 72 hours post coitus

A

Levonorgestrel

38
Q

Give two examples of drugs that can be used as an emergency contraception up to 120 hours after coitus

A
  • Ullipristal acetate
  • Cu2+ IUD
39
Q

What is ullipristal acetate?

A

A selective progesterone receptor modulator

40
Q

How does the Cu2+ IUD work?

A

It prevents blastocyst attachment to the endometrium

5: Y5 - ESA 5 - Pharmacology (28 decks)

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