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MO1 > contraception > Flashcards

contraception Flashcards

1
Q

what are the various types of contraception available?

A
  • Combined oral contraceptives
  • Combined patch
  • Progesterone only contraceptives
  • Long-acting reversible contraception:
  • Injections
  • Implants
  • IUDs
  • Emergency Contraception
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2
Q

what are the hormone changes in the menstrual cycle?

A

peaks in FSH/LH/Oestrogen around day 14…
in line with ovulation!!

The progesterone levels risein line with thickening of theuterus and then drop if
fertilisation doesn’t occur to allow shedding of the lining ie menstruation

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3
Q

how does the COC work?

A

COC’s overide the production of LH/FSH and therefore prevent ovulation

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4
Q

why are oestrogen and progesterone used together?

A

they are needed together to prevent overthickening- hyperplasia

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5
Q

what is the purpose of a 7 day pill free interval?

A

causes concentration of hormones to fall which causes a withdrawal bleed that mimics menstruation

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6
Q

what is in the COC?

A

both an oestrogen (usually ethinylestradiol) and a progestogen (eg. Levonorgestrel

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7
Q

what is the difference between monophasic COC and phasic coc?

A

Monophasic COCs — the amount of oestrogen and progestogen in each active tablet is constant throughout the cycle (most commonly prescribed)
* Phasic COCs — the amounts of oestrogen and progestogen vary over the 21 day cycle……..used in women who cannot be
stabilised on monophasic preparations

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8
Q

what is a low and a standard strength of COC?

A

low is 20mcg - for people at risk of circulatory diseases
standard strength 30-35mcg

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9
Q

how could you encourage a patient to increase compliance?

A

reduced menstrual pain
normal fertility returns after taking them

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10
Q

what side effects do the COC have?

A

Temporary ADR’s; eg. headaches, nausea, breast tenderness, and mood changes, Breakthrough bleeding ……likely to be
transient….. If these do not stop within a few months, changing the type of OC may help

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11
Q

why do we monitor BP with COC?

A

as bp may increase

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12
Q

how/ when should you start the pill?

A

start on first day of
menstruation…Any later than day four use
further contraception for seven days

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13
Q

how should you counsel on how to take a COC?

A
  • Take once daily at approximately the same
    time each day
  • Take for 21 days then take a seven day break
  • REMEMBER!!!
  • ED take inactive seven tablets
  • Breakthrough bleed will occur during break or
    when inactive pills are taken
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14
Q

does consultations about EHC need to be in person?

A

Consultations about CHC do not necessarily
have to be face-to-face; online CHC provision
is possible

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15
Q

what counts as a COC missed pill?

A

A missed pill is one that is taken > 24 hours
late!

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16
Q

what questions should you ask about a missed pill?

A

when did you miss it? ie the timing around it

17
Q

what are the missed pill rules for COC?

A
  • 1 missed pill <24 hours late: Take pill as soon as remember then revert back to your usual timing
  • 1 missed pill >24 hours late:
  • Take a pill as soon as possible even if it means taking 2 pills at the same time. Then revert back to normal pill taking. No additional contraception is needed. Take the 7-day break as normal.
  • 2 + missed pills:
  • Take the most recent missed pill as soon as possible (even if it means taking two pills in one day). Extra contraceptive measures must be used for the next 7 days
18
Q

when should you give EHC with a pill?

A

first week yes
second week no as long as first week taken correctly
last week- omit the pill-free internal EHC not req

19
Q

what is the missed pill window for Qlaira and Zoely?

A
  • Smaller missed pill window of 12 hours!!!
  • Extra precautions should be used for 9 days
    as opposed to 7
20
Q

what is the consequence of sickness/ diarrhoea ?

A
  • Vomiting < 2 hours of taking a COC….take another pill ASAP
  • If vomiting or severe diarrhoea persists >24 hrs follow the instructions for missed pills
  • Use alternative precautions during the illness period and
    for 7 days afterwards.
  • If the illness occurs while taking the last 7 tablets???
  • Omit any pill-free period
21
Q

what precautions should be used with enzyme inducing antibiotics?

A
  • Enzyme inducing antibiotics
  • Advice dependant on length of treatment
  • Efficacy of CHC will be compromised and so
    extra precautions are necessary throughout
    treatment and for up to 4 weeks after course
    has finished
    short- extra precaution
    long- alt such as depo that doesnt interact
22
Q

what enzyme inducers reduce the efficacy of COC?

A
  • Antiepileptic drugs - carbamazepine, phenobarbital, phenytoin, topiramate
  • Herbal remedies — St John’s wort
23
Q

how does lamotrogine affect COC?

A

Lamotrigine is not an enzyme-inducer, but may be increased clearance by CHC (pill, patch, or vaginal ring) leading to poor seizure control

24
Q

what be the risks with COC?

A
  • MI and stroke – higher risk if other risk factors present
  • Venous thromboembolism
  • Breast cancer
  • CSM advice small increased risk should be weighed against
    the evidence of the protective effect against cancers of the
    ovaries and endometrium
  • Cervical cancer
  • Age over 35yrs (avoid >50yrs)
  • Obesity
  • Family history of VT
25
Q

what advice should you give for someone who is travelling who is on a COC / patch?

A
  • Increased risk of DVT
  • Immobility for long periods > 5 hours
  • Exercise during the flight
  • Wear graduated compression hoisery
26
Q

who should POPs be given to?

A
  • Older women
  • Smokers
  • Hypertension
  • Valvular heart disease
  • Diabetics
  • Migraine sufferers
  • Breast feeding
27
Q

how do POPs work?

A

various mechanisms

28
Q

what are some common menstrual irregularities with POPs?

A
  • 20% women will become amenorrhoeic.
  • 40% women will have regular bleeding.
  • 40% women will have irregular bleeding
29
Q

how should you take the POP?

A

take one pill continuously at the same time each day

30
Q

what are the missed pill rules in regards to POP?

A

if taken more than 3 hours eg cereazette then take when you remember + use a barrier method for 2 days affter
if you have have UPSI in these two day EHC required

31
Q

what is drovelis?

A
  • Drosperinone is now licensed to be uses as a POP and has a missed pill window of 24 hours!
  • Brand name - Drovelis
  • Consists of 28 tablets per pack….24 active (pink) tablets and 4 inactive (white) placebo tablets.
  • The advice on missed pills is similar to that for COCs
32
Q

what are the features of a depo injection?

A
  • No known interactions with any medications (including antibiotics and liver enzyme-inducing drugs)!!!
  • Can be used by women with a BMI > 35 kg/m2
  • Is not rapidly reversible!!
  • There could be a delay of up to 1 year in the return of normal fertility
  • The most common reason for discontinuation = altered bleeding pattern
  • Loss of bone mineral density with long-term use
33
Q

what are the features of the implant?

A
  • Subdermal implantation by fully trained person into inner arm
  • Rapidly reversed on removal
  • Protection lasts 3 years
  • BMI >35 effective contraception not provided
    during the third year
34
Q

what are the features of IUD?

A
  • Used more commonly in parous women
  • Inserted by a trained healthcare professional
  • Effects last 5-10 years
  • Generally well tolerated
  • Can be used as emergency contraception up to 5 days after intercourse

MO1 (50 decks)

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