Block Six Flashcards
(168 cards)
1
Q
What are the insulin drugs?
A
Rapid/short-acting bolus insulins: - Novorapid Short-acting bolus insulins: - Actrapid - Humulin R Intermediate-acting basal insulins: - Protaphane - Humulin NPH Long-acting basal insulins: - Lantus - Biphasic insulins Biphasic insulins (mixtures providing for both immediate and prolonged action) - Humulin 30/70
2
Q
What is insulin used for?
A
- Lower and control blood glucose levels in diabetics (type 1 and type 2)
- Lower and control blood glucose levels in the person with diabetes (type 1 and type 2) who has developed a DKA or HONK syndrome (hyperosmolar nonketotic)
- In association with IV dextrose administration.
- With glucose as an emergency intervention for hyperkalemia
- To treat gestational diabetes mellitus
3
Q
What is the main aim of treating gestational diabetes?
A
To provide adequate treatment for the mother while minimising adverse effects on the foetus, both short term and long term
4
Q
What is currently the only oral hypoglycaemic that is used for treating gestational diabetes?
A
Metformin
5
Q
What is the mode of action of insulin?
A
Binds to insulin receptors in target tissue, promoting uptake of glucose into the target tissue from the blood
6
Q
What is the effect of insulin and what can excess effect do?
A
- Lower blood glucose levels
- Can result in a ‘hypo’
7
Q
What is the main adverse effects of insulin?
A
- A ‘hypo’
- Also allergies, ‘resistance’, weight gain and lipodystrophy
8
Q
Why should injection sites of insulin be rotated?
A
To prevent lipodystrophy
9
Q
What are insulin antagonists and how to they affect insulin requirements?
A
- Drug interactions which oppose the physiological action of insulin
- Increase insulin requirements
10
Q
What are the three main types of insulin regimen?
A
- Basal-bolus
- Continuous sub-cutaneous infusion
- Biphasic
11
Q
What is the basal-bolus regimen?
A
Use long-acting (basal) insulin injected once or twice daily to mimic normal basal insulin secretion, and a short-acting (bolus) insulin injected before or with meals and snacks
12
Q
What is the continuous sub-cutaneous infusion regimen?
A
A short-acting insulin is delivered by a pump. Small doses are given over 24 hours, i.e. a basal rate, with boluses delivered at mealtimes
13
Q
What is the biphasic regimen?
A
An intermediate-acting insulin mixed with a short-acting insulin is injected twice daily, i.e. before breakfast and dinner
14
Q
What is the glucagon and its effect?
A
- A hormone
- Raises blood glucose levels
15
Q
What are symptoms of hypoglycaemia?
A
- Paleness
- Sweating
- Confusion
- Tachycardia
- Headache
- Hunger
- Weakness
- Motor and/or emotional disturbances
- Coma
- Death
16
Q
What is treatment for mild hypoglycaemia?
A
Food source such as glucose containing drink
17
Q
What is treatment for severe hypoglycaemia?
A
- IV glucose-in- dextrose solution or administration of glucagon via IV, IM or SC routes is used and a result (increase in BGL) should be observed within 20 minutes
- Oral source of carbohydrate after glucagon injection
18
Q
What are common adverse effects of hypokalaemia?
A
- Nausea
- Vomiting
19
Q
What are oral hypoglycaemics drugs?
A
- Metformin (class - Biguanide)
- Vidagliptin (class - DPP-4 inhibitors)
- Gliclazide (class - Sulphonyureas)
- Pioglitazone (class - Thiazolidinedione)
- Dapagliflozin (class - SGLT2 inhibitor)
20
Q
What is the therapeutic use for oral hypoglycaemics?
A
To lower and control blood glucose in the person with type 2 diabetes mellitus
21
Q
For which diabetes are oral hypoglycaemics not effective?
A
Type 1
22
Q
Which oral hypoglycaemic is the preferred first-line treatment?
A
- Metformin
- WhIt is not only effective in reducing HbA1c levels, but is safe with a low risk hypoglycaemia, does not cause weight gain, and may provide patients with additional cardiovascular benefits
23
Q
Why is metformin the preferred first-line oral hypoglycaemic treatment?
A
- Effective in reducing HbA1c levels
- Safe with a low risk hypoglycaemia
- Does not cause weight gain
- May provide patients with additional cardiovascular benefits
24
Q
What combination of oral hypoglycaemic is given if patients who do not meet their HbA1c (glycemic control) target?
A
Metformin with vidagliptin (Galvumet)
25
What is the mode of action of metformin (Biguanide)?
- Decrease hepatic glucose production (gluconeogenesis)
| - Also, increases peripheral utilisation, slows glucose absorption from GI tract
26
What are advantages of metformin?
- Low risk hypoglycaemia
- Weight loss
- Preferred oral med in pregnant (gestational or T2D) or breastfeeding women (T2D); prediabetics
- Extensive history of use
- Low cost
27
What is the mode of action of vidagliptin?
- Inhibits enzyme that normally breaks down incretin
| - This results in increased insulin synthesis and secretion, and decreased glucagon secretion
28
What are advantages of vidagliptin?
- Low risk hypoglycaemia
- Weight neutral
- Well tolerated
29
What is the mode of action of gliclazide?
- Primarily stimulates release of insulin from pancreas
| - May also inhibit gluconeogenesis and increase insulin receptor numbers on target cells
30
What are advantages of gliclazide?
Extensive history of use
31
What is the mode of action of pioglitazone?
Increases insulin sensitivity in adipose tissue, skeletal muscle, decreases gluconeogenesis
32
What are advantages of pioglitazone?
- Low risk hypoglycaemia
- Increased HDL-C
- Decreased TGs
33
What is the mode of action of dapagliflozin?
Reversibly inhibits sodium-glucose co-transporter 2 (SGLT2) in the renal tubules decreases glucose reabsorption, increasing glycosuria
34
What are advantages of dapagliflozin?
- No hypoglycaemia
- Decreased Weight
- Decreased blood pressure
35
What are the reproductive drugs?
- Ethinyloestradiol
- Levonorgestrel
- Norethisterone
- Desogestrel
- Tamoxifen
- Mifepristone
36
What is a drug that is oestrogen and oestrogen derivatives?
Ethinyloestradiol
37
What are drugs that are progesterone and progesterone derivatives?
- Levonorgestrel
- Norethisterone
- Desogestrel
38
What is a drug that is a oestrogen antagonist?
Tamoxifen
39
What is a drug that is a progesterone antagonist?
Mifepristone
40
What are the hormones produced in the body for normal sexual development and functioning?
- Gonadotrophin releasing hormone (GnRH)
- The gonadotrophins FSH (follicle stimulating hormone)
- LH (luteinizing hormone)
- Steroidal hormones (oestrogens, androgens, progesterone)
41
Where is the gonadotrophin releasing hormone produced and what is its effect?
- Produced by the hypothalamus
| - Stimulates the secretion of FSH and LH
42
Where are FSH (follicle stimulating hormone) and LH (luteinizing hormone) produced and what is their effect?
- Produced by the pituitary
| - Act on the gonads to produce sperm and testosterone in males and mature ova and oestrogens and progesterone in females
43
Why are steroidal hormones and their synthetic versions more widely used compared to gonadotrophins?
Since gonadotrophins are more expensive and need to be given by injection
44
What are oestrogens?
All steroids that bind to oestrogen receptors and act as agonists
45
What is an example of an agonist of oestrogen and what is it used for?
- Ethinyloestradiol (Synthetic Oestrogens)
| - Used in hormonal contraceptives and HRT for menopause
46
What is an example of an antagonist of oestrogen and what is it used for?
- Tamoxifen (Clomiphene - infertility drug)
| - Breast cancer (opposes the effects of oestrogen)
47
What are progestogens?
All steroids that bind to progesterone receptors and act as agonists
48
What is an example of an agonist of progestogen and what is it used for?
- Levonorgestrel norethisterone (Synthetic progestogens)
| - Used in hormonal contraceptives
49
What is an example of an antagonist of progestogen and what is it used for?
- Mifepristone
- Antagonises the endometrial and myometrial effects of progesterone. It is an abortifacient. In pregnancy it sensitises the myometrium to the contraction-inducing action of prostaglandin
50
Where are oestrogens synthesised?
- In the ovaries in the pre-menopausal woman
- In the placenta during pregnancy
- In small amounts by the adrenal glands in both sexes
- In a woman after menopause they are produced only by the adrenal glands
51
What is the effect of oestrogens?
Influence the growth and development of female reproductive organs
52
What and how do oestrogens protect against?
- Protect against osteoporosis by making tissues less responsive to PTH (parathyroid hormone)
- PTH promotes the movement of calcium from bone into blood as part of normal body function. In the premenopausal women this action of PTH is partially opposed by oestrogens. Therefore, when oestrogen levels drop after menopause increased loss of calcium from bone occurs
53
What are preparations for oestrogens?
Synthetic or semisynthetic since natural oestrogens are rapidly removed by first pass metabolism
54
What are therapeutic uses of oestrogens?
- Menopause – As a Replacement Therapy – ‘HRT’
- Osteoporosis
- Primary Amenorrhoea
- Postpartum Lactation
- Control of Height
- Dermatological problems
55
How are oestrogens used for menopause – as a replacement therapy – ‘HRT’?
- Minimise calcium loss from bone and ‘hot flushes’
| - Also, minimises vaginal mucosal atrophy and maintaining mucous secretions
56
How are oestrogens used for osteoporosis?
Oestrogens increase bone density post-menopausal woman
57
How are oestrogens used for primary amenorrhoea?
- Cause is often osteoporosis, therefore oestrogens may be used as part of treatment
- When there is ovarian or pituitary failure, oestrogens may can maintain breast development, correct vaginal mucosal atrophy and minimise calcium loss from bone
- Oestrogens ‘regularise’ the menstrual cycle and stop excessive bleeding
58
How are oestrogens used for postpartum lactation?
- Oestrogens relieves postpartum painful breast engorgement and prevents postpartum lactation
59
How are oestrogens used for control of height?
Oestrogens cause closure of the epiphyseal plates of the long bones, preventing further growth
60
How are oestrogens used for dermatological problems?
Helps acne
61
What are adverse effects of oestrogen treatment?
- Breakthrough bleeding
- Breast tenderness
- GI upsets
- Thromboembolic disorders
- Hypertension
- Promote growth of some breast cancers
62
Where is progesterone synthesised?
- By the corpus luteum in the ovaries in the second half of the menstrual cycle
- In large amounts by the placenta in the pregnant woman
- Small amounts are produced in the adrenal glands in both sexes
63
What is the plasma half-life of progesterone?
5 minutes
64
Where and how fast is progesterone metabolised?
Is cleared completely during first pass passage through the liver
65
Why is progesterone chemically modified?
Absorbs to quickly otherwise when given orally
66
What are therapeutic uses of progesterone and progestogens?
- Contraceptive agents
- Menstrual irregularities
- Endometriosis
67
How is progesterone and progestogens used as contraceptive agents?
Used in combined oral contraceptive
68
How is progesterone and progestogens used for menstrual irregularities?
A combination oral contraceptive:
- Control excessive bleeding
- Control painful periods
- Control erratic or absent periods (amenorrhoea).
69
How is progesterone and progestogens used for endometriosis?
Higher doses progestogens inhibit endometrial growth
70
What are adverse effects of progesterone?
- Weight gain
- Depression
- Breast tenderness
- Androgenic adverse effects associated with the synthetic progestogens such as hirsutism, acne and hair loss, and salt and water retention associated more with aldosterone
71
What are trophic hormones affecting gonadal function used for?
Infertility
72
What does the treatment for infertility with trophic hormones entail?
Initial treatment/priming with menotrophins (source of FSH and LH) to stimulate follicular development followed by HCG to mimic the LH surge that causes ovulation
73
What are the main fertility drugs?
- Clomiphene
| - Bromocriptine
74
What is the mode of action of fertility drugs (Clomiphene, Bromocriptine)?
Inhibits prolactin production, since elevated levels of prolactin inhibit FSH and LH production and therefore ovulation
75
What is a example of a pituitary gonadotrophin inhibitor?
Danazol
76
What is the mode of action of danazol?
Inhibition of FSH and LH secretion, reducing production of progesterone by the ovaries
77
What is danazol used to treat?
Endometriosis
78
What are examples of contraceptives?
Combined Oral Contraceptive (contain synthetic oestrogen and synthetic progesterone)
- Levlen®
- Norimon®
- Mercilon®)
Progestogen only pill (contain synthetic progesterone)
- POP or Minipill
- Noriday®
Depo Provera® (contains medroxyprogesterone)
Subdermal implant Jadelle® (contains levonorgestrel)
LNG IUS Mirena® (contains levonorgestrel)
79
What are hormonal contraceptives?
Female contraceptives that contain synthetic oestrogen and/or progestogen
80
What is the mode of action of oestrogens and progestogens in preventing conception?
- Prevention of ovulation by the actions of oestrogen and progestogen on the hypothalamic-pituitary axis to suppress the synthesis and secretion of FSH and the mid-cycle surge of LH
- Progestogen produces of cervical mucous that is hostile to sperm survival
- Progestogen causes endometrial changes discouraging implantation and decreasing fallopian tube motility which can impair the normal transport of sperm and ova
81
What are risks of using combined oral contraceptive pill (COC)?
- Blood clots
| - Venous thrombosis
82
What are first choice oral contraceptives?
Monophasic pills
83
How to take the COC Pill?
- Start on first day on menstrual cycle
| - Take pill every day, around the same time each day, according to the day on the packet
84
What are the three different ways to take the COC Pill?
- Period option - take 21 days of active hormone pills, followed by 7 days of inactive non-hormonal (placebo) pills
- No period option/or continuous pill taking - skip out the inactive pills and take only active pills continuously
- Less frequent period option - miss out inactive pills and don’t have a break most months. Just take the inactive pills when want a bleed
85
What are oestrogen related adverse effects of the COC Pill?
- Nausea
- Breast tenderness/swelling
- Fluid retention (causes increased BP and migraines)
86
What are progestogen related adverse effects of the COC Pill?
- Nausea
- Headache
- Dizziness
- Breast discomfort
- Mood swings
- Depression
- Changes in libido
- Changes in appetite
- Possible weight gain
- Skin disorders
87
What are serious adverse effects of the COC Pill?
- Increase risk of venous thrombosis
| - Very small increase risk in stroke and MI
88
What are possible problems with oral contraceptive pills?
- Not universally suitable due to pt's medical history
- Possible links with some cancers: breast and cervical cancer
- Increased risk of blood clots, heart attack and stroke in some women
- Breakthrough bleeding and recurrent thrush infections
- Headaches
89
What are potential drug interactions with the COC Pill?
- Enzyme inducers can increase the clearance of COCs and may increase breakthrough bleeding and decrease contraceptive efficacy
- Enzyme inhibitors can decrease the clearance of COCs, possibly increasing adverse effects
- Oral contraceptives can increase or decrease the effectiveness of other medications
90
What are specific risk factors for venous thromboembolism?
- Family history of venous thromboembolism
- Obesity
- Long-term immobilisation
- History of superficial thrombophlebitis
- Over 35 years
- Smoking
91
What are specific risk factors for arterial disease?
- Family history of arterial disease
- Diabetes mellitus
- Hypertension
- Smoking
- Over 35 years
- Obesity
- Migraine
92
What are potential benefits of COC Pill?
- Very efficient
- Acceptable form, particularly for woman low risk for adverse effects
- Reduction in menstrual cramps
- Reduction in heavy irregular bleeding
- Reduced risk of developing cancer of the ovaries and the endometrium
93
What is pill failure?
- Forgetting to take it or gastrointestinal upset (vomiting or/and diarrhoea)
- Drug interactions
94
What do you do if you have missed out one combined oral contraceptive pill?
- Take the missed pill as soon as it is remembered and take the pill that day at the usual time
- Take the rest of the packet at usual
- No additional contraception is needed
95
What do you do if you have missed out two or more combined oral contraceptive pills?
- Take only one active pill as soon as it is remembered and then resume normal pill-taking
- Use the 7-day rule
96
What is the 7-day rule?
- Take an active pill and abstain from sex or use another form of contraception for 7 days (may mean omitting the pill-free interval of the 7 inactive pills)
97
When is emergency contraception is recommended?
If 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred since finishing the last packet
98
What is the main mechanism of the progestogen only pill?
Make cervical mucous impenetrable to sperm
99
What are requirements when taking the progestogen only pill?
- Pills need to be taken within 3 hours of a set time
| - Preferable intercourse occurs four hours after taking the pill
100
What do you do if you missed a POC?
- Should be taken as soon as remembered and the next pill should be taken at the right time
- Use the 2-day rule - abstain from sex or use another form of contraception for 2 days
- Use the emergency contraceptive pill if intercourse has occurred
101
What is the emergency contraceptive pill?
A pill with a high dose of levonorgestrel
102
When should the emergency contraceptive pill be taken?
One tablet taken as a single dose as soon as possible (and no later than 72 hours) after unprotected sexual intercourse
103
What are adverse effects of the emergency contraceptive pill?
- Nausea
- Lower abdominal pain
- Headache
- Fatigue
- Vomiting
- Diarrhoea
- Dizziness
- Breast tenderness
- Delay of menses
104
How to alleviate side effects of the emergency contraceptive pill?
Take with food
105
What are recommendations for contraceptives when breastfeeding?
If breast-feeding is well established and there are no concerns with the infant’s growth, COCs or any of the available forms of contraception can be started six weeks after birth
106
What is the mode of action of Depo-Provera contraceptives?
- Stop release of egg
- Thickens mucous
- Thin endometrial lining
107
What drug is in Depo-Provera contraceptives?
Long-acting progestogen
108
What is an advantage of Depo-Provera contraceptives?
The risk of endometrial cancer is reduced
109
What are the disadvantages of Depo-Provera contraceptives?
- Periods may be affected
- Bone density loss
- Takes approximately 6 months to return to fertility
- Weight changes
- Increased risk of breast cancer
- Depression
- Withdrawal takes time
110
What are long-acting reversible contraceptives (LARC)?
- Copper and hormonal intra-uterine devices and hormonal implants
- Provide effective contraceptive cover for several years with little ongoing input from the user
111
What are adverse effects of the levonorgestrel implant?
Multiple or long incisions and pain
112
How does the Jadelle subcutaneous levonorgestrel implant work?
Two implants which contains 75mg of levonorgestrel released slowly over 5 years
113
How does the intra-uterine progestogen-only device work?
- Device inserted into the uterine cavity which releases levonorgestrel over a 5 year period
- Endometrial suppression occurs and the endometrial cells become resistant to oestrogen stimulation
- Sperm migration through the uterus is affected and ovulation in some women is inhibited
114
When is the intra-uterine progestogen-only device used?
When women experience unacceptable adverse effects from other contraceptive methods
115
What can intra-uterine progestogen-only devices treat?
Menorrhagia
116
What hypoglycaemic drugs are parenterally administered?
- Insulin
| - GLP-1 analogue
117
How is high blood glucose regulated?
- There is a decrease in Alpha cells, which decreases glucagon
- There is an increase in Beta cells, which increases insulin
- These both decrease blood glucose
118
How is low blood glucose regulated?
- There is an increase in Alpha cells, which increases glucagon
- There is a decrease in Beta cells, which decrease insulin
119
What are factors affecting insulin secretion?
- Parasympathetic stimulation
- Sympathetic stimulation
- Gastrointestinal hormones
- Carbohydrate and protein intake
120
What are the physiological affects of diabetes on the body?
- Hyperglycaemia
- Glucosuria
- Polyphagia
- Polyuria
- Polydipsia
- Muscle wasting
- Weight loss
121
What is the pathophysiology of Type 1 diabetes?
No insulin produced
122
What is the pathophysiology of Type 2 diabetes?
Not enough insulin or ineffective insulin
123
What is the treatment of Type 1 diabetes?
Insulin
124
What is the treatment of Type 2 diabetes?
- Exercise and diet
- Oral hypoglycemics and GLP-1 analogue
- Insulin
125
What is the pathophysiology of gestational diabetes?
Ineffective insulin
126
What is the treatment of gestational diabetes?
- Exercise/diet/weight management
| - Metformin/insulin
127
Why are some medications for insulin ineffective for some diabetics?
They some production of insulin in the body in order to be effective
128
Why does insulin need to be handled carefully?
Since it is a protein and therefore can denature
129
Why are there no oral formulations for insulin?
Since it is a protein and will be deaminated in the digestive system
130
What is a rapid short acting insulin?
Novorapid
131
What is are short acting insulins?
- Actrapid
| - Humulin R
132
What is a intermediate acting insulin?
- Protaphane
| - Humulin NPH
133
What is a long acting insulin?
Lantus
134
How to look after a insulin pen to ensure it does not denature?
- Store unopened insulin in the fridge
- Kept at room temperature
- Discarded after 4 weeks
135
How to administer a insulin pen?
- Invert the pen at least 10 times to gently mix (avoid shaking)
- Prime the pen – dial up 2 units and perform an ‘air shot’
- Dial up dose and inject – hold for 10 secs before removing
- Rotate injection sites to prevent lipodystrophy
- Avoid hot showers or baths within 30 mins of an injection to decrease the risk of a sudden drop in BGL
- Regularly test BGL – at least 4 times a day (before each main meal and bed)
136
What are advantages of insulin pumps?
- Remove need for multiple daily injections
- More closely mimics normal endogenous basal-bolus
insulin release
- Improved HbA1c levels
- Less variable insulin levels;
- Convenient and flexible
137
What are disadvantages of insulin pumps?
- Risk of infection at cannula site
- Reliance on pump not to malfunction
- Need to be connected all day
- Requires high level of commitment for treatment to be successful
- Cost - have to meet specific criteria to be funded
138
What can affect insulin therapy?
Alcohol
139
What is a negative effect of using metformin?
Can increase blood lactate levels which can cause lactic acidosis
140
Why does lactic acidosis occur?
Due to an accumulation of metformin
141
What are positive aspects of metformin?
- No hypoglycaemia
- No weight gain
- Can be used during pregnancy for gestational DM and by pre-existing T2D patients
- Safe for use during breastfeeding by T2Ds
142
What are adverse effects of metformin?
- Increased stool frequency
- Diarrhoea
- Flatulence
- Vitamin B12 deficiency
143
What are symptoms of lactic acidosis?
- Anorexia
- Nausea
- Vomiting
- Cramps
- Abdominal pain
- Rare, but potentially fatal
144
What are warnings to be aware of when using metformin?
- Renal impairment
- Hepatic impairment – limits ability to clear lactate
- Other situations where renal function may be
affected/impaired such as dehydration, starting an NSAID or diuretic, severe trauma, acute heart failure
145
What are care considerations when using metformin?
Take with meals (half-life of 3hrs)
146
What are drug interactions with metformin?
```
Alcohol:
- Increased risk hypoglycaemia
- Increased risk of lactic acidosis (excessive consumption)
Beta-blocker and ACE inhibitors:
- Increased risk of hypoglycaemia
```
147
What are adverse reactions of gliclazide?
- Hypoglycaemia (take with food)
- Weight gain
- Gastrointestinal disturbances
- Allergic skin reactions
148
When is gliclazide contraindicated?
During pregnancy
149
What are factors to consider when using metformin?
- GI symptoms
- May cause vitamin B12 deficiency
- Determine renal function before treatment (Use in caution or reduce dose renal disease, CI significant renal impairment)
- Rare lactic acidosis
- Avoid severe hepatic disease
150
What are factors to consider when using vidagliptin?
- Dose adjustment/avoidance renal disease
- Avoid in patients with hepatic dysfunction
- Avoid use in patients with severe heart failure
151
What are factors to consider when using gliclazide?
- High risk hypoglycaemia
- Weight gain
- GI symptoms
- Allergic skin reaction
- Dose adjustment/avoidance for renal disease and hepatic impairment
- Effects on HbA1c may not persist as long as other oral options
152
What are factors to consider when using pioglitazone?
- Weight gain
- GI disturbances
- Avoid in patients with hepatic impairment
- Increased risk of oedema and heart failure, bone fractures and ?bladder cancer
153
What are factors to consider when using dapagliflozin?
- Genital infections and urinary tract infections, polyuria
- Volume depletion/hypotension
- Dose adjustment/avoidance for renal disease
154
Why is hypoglycaemia an potential adverse effect of sulfonylureas?
They stimulate insulin release and if you forget to eat this will still lower glucose levels causing hypoglycaemia
155
What are the steps of the menstrual cycle?
- 1-5 Menstruation
- 4-14 Proliferative
- 13-16 Fertile
- 14 Ovulation
- 15-25 Secretory
- 25-28 Changes depend on whether pregnant or not
156
What is in the first generation of COC pills?
- Progestogens norethisterone
| - Norethindrone acetate
157
Which generation of COC pills are more common and first line?
Second generation
158
What is in the second generation of COC pills?
- Levonorgestrel
| - Norgestimate
159
What is in the third generation of COC pills?
- Desogestrel
- Gestodene
- Cyproterone acetate
160
What is in the fourth generation of COC pills?
- Drosperinone
- Dienogest
- Nomestrol acetate
161
What are third and fourth generation COC pills more at risk of developing?
Venous thrombosis
162
When do you use the progestogen only pill POP?
When a COC is contraindicated
163
What is cerazette?
A newer progesterone only pill?
164
What are advantages of cerazette over other POPs?
- In addition to thickening the mucous in the cervix, it also inhibits ovulation
- Instead of taking it within 3 hours, it must be taken within 12 hours of the same time each day
- 99% efficacy with perfect taking
165
What are disadvantages of cerazette?
- Not funded
| - Contains desogestrel
166
What is the rule for when you miss cerazette?
7-day rule
167
What to do if POP pill is missed?
- Take the missed pill as soon as it is remembered and take the pill that day at the usual time
- Take the rest of the packet at usual
- Use contraception for 2 days
- Use emergency contraceptive
168
What is the effect of the Jadelle subcutaneous levonorgestrel implant?
- Inhibits ovulation
- Thickens of the cervical mucus
- Impedes sperm transport through cervix, uterus and tubes
