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BNF Genito-urinary system > Contraception > Flashcards

Contraception Flashcards

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1
Q

What are considered to be ‘highly effective’ contraception methods that should be recommeneded to patients on teratogenic drugs?

A

CU IUD
sterilisation
long acting reversible contraceptives
progesterone only implant

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2
Q

What formulations are COC availble as?

A

tablet, patches, vaginal rings

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3
Q

Health benefits associated with COC

A
  1. reduced risk of ovarian, endrometrial and colorectal cancer
  2. predictable bleeding
  3. reduced dysmenorrhea/menorrhagia
  4. management of PCOS, endometrosis
  5. improved acne
  6. reduced menopausal symptoms
  7. maintaining bone mineral density in peri-menpausa; females <50 yrs
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4
Q

What are monophasic COC pils?

A

Contain a fixed amount of oestrogen / progestrogen

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5
Q

What is normally the oestrogen component of COC?

A

Ethinylestradiol

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6
Q

What is generally contained in the first line option of a COC

A

ethinylestradiol + either levonorgestrol or norethisterone

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7
Q

If a patient is >90kg and wants a patch COC - what is the issue?

A

Absorption may be ineffective - needs additional precautions

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8
Q

Brand name for COC containing ethinylestradiol 20mch + desogestrol 150mcg

A

Gedarel

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9
Q

How long prior to surgery should COC be stopped?

A

4 weeks

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10
Q

What oral contraceptive has the MOA of altering cervical mucus and consistently inhibiting ovulation

A

Progesterone only contraceptives

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11
Q

What factors would influence a prescriber to choose POC over COC?

A

If the patient smokes, history of DVT, HTN (>160/95), valvular heart disease, diabetes with complications, migraine with aura

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12
Q

What hormone is contained in medroxyprogesterone acetate (Depo - provera)

A

Progesterone

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13
Q

What do patients need to be counselled on when starting a Progesterone depo injection?

A

Risk of fertility return being delayed

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14
Q

Norethisterone enantate (Noristerat) is an oily injection - how long does it last for?

A

8 weeks

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15
Q

What drug does Nexplanon contain?

A

Etonogestrel

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16
Q

how long does a nexplanon implant last for?

A

3 years

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17
Q

mirena, Jaydesd and Levosert are all types of what?

A

IUD containing progesterone

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18
Q

What is a benefit of hormone containing IUD over CU IUD?

A

They can help with heavy bleeding an period pain

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19
Q

examples of barrier methods

A

Condoms,diaphragms, cervical caps

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20
Q

How long after UPSI can a cu IUD be inserted?

A

5 days (120 hours)

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21
Q

How long after UPSI is levonorgestrol effective?

A

72 hours ( 3 days)

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22
Q

How lng after UPSI is ulipristal effective?

A

5 days (120hours)

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23
Q

If a patient has high body weight (>26, or >70kg) what emergency contraceptive should be used?

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A

Uilpristal acetate or double dose of levonorgestrol

24
Q

How many days after having emergency ulipristal can a patient start regular contraception?

25
What is the general advice for contraception use in women who are on enzyme inducing drugs
should start alternative contraception e.g. PO depo injection, IUD for duration of treatment and for 4 weeks on stopping
26
If a women is to start an enzyme inducer for < 2 months, whast advice should be given regarding her contraception
can continue on COC + another barrier methd
27
If a women is to start an enzyme inducer for > 2 months (except rifampicin or rifabutin), whast advice should be given regarding her contraception
Use monphasic COC at a dose of >50mcg of ethinylestraidiol and use an extended/tricycling regime. If breakthrough bleeding occurs, increase dose of ethinylestradiol by increments of 10mcg (max 70mcg)
28
If a women is to start an enzyme inducer for > 2 months (including rifampicin or rifabutin), whast advice should be given regarding her contraception
alternative methods e.g. IUD must be used
29
If a patient is using medication that increases gastric pH, what emergency contracpetion should e given?
Levonorgestrol or IUD as use of ulipristal has not yet been studied
30
Can ulipristal be used more than once in the same cycle?
No - only to be used once per cycle. Levonorgestrol can be given > 1 per cycle
31
Can levonorgestrol be used more than once in the same cycle?
Yes but EllaOne cannot
32
A patient has severe asthma treated with corticosteroids can she has ulipristal?
No - antiglucocorticoid effect of ulipristal
33
What are some risks associated wiht COC
1. VTE + arterial thrombus 2. increased risk of breast cancer 3. Migraine - need to stop and refer 4. cervical cancer
34
If a patient starts her COC on day 6 of her cycle what needs to be advised?
additional precautions required for first 7 days
35
What are Every Day (ED) tablets?
21 days of active + 7 days of placebo
36
Additional precautions for Qlairia pils (ED) are needed for howmany days?
9 days
37
If a patient vomits within 3 hours of taking her pill or has diarrhoea for >24 hours what should be advised?
Following instrctions for a missed pill - if persists >24 hours consider additional non oral contraception
38
What happens if a women forgets to take a pill?
1. take as soon as remember and take next pill at normal time 2. no additional precautions required
39
When is a pill classed as being 'missed'?
> 24 hours
40
If a patient has 2 or more missed pills what should she do?
extra contraception or abstain for 7 days, continue with normal regime. If the missed days run at the end of the packet, move onto new packet and skip the pill free intervalWha
41
If a vaginal ring is expelled for < 3 hours what should the user be advised?
Rinse with cool water, reinsert no additional contraceptvie measures needed
42
If a vaginal ring is expelled > 3 hours duringg week 1 or 2 of cycle what should the user be advised?
rinse with cool water, reinsert, use barrier methods for 7 days
43
If a vaginal ring is expelled > 3 hours during week 3 of cycle what should the user be advised?
Insert a new ring or allow for withdrawl bleed and insert new ring after no more than 7 days
44
How should a contraceptive patch e.g. Evra be applied?
Apply on day 1 of cycle, remove on day 8 and 15 to apply a new patch. Remove on day 22 for HFI
45
If ap atinet forgets to reapply their new patch for > 48 hours what should be done?
apply a new patch (chaginging the new day 1) + additional measures for 7 days
46
What contraception has the MHRA warning associated with uterine perforation
copper IUD
47
If a IUD is removed after day 3 of menstrual cycle, what should be advised?
Additional contraception for at least 7 days
48
If a patient has a IUD inserted but has a pre-exisiting STI what is a risk?
Development of pelvic inflammatory disease
49
What is the MHRA warning associated with Esmya ( form of ulipristal) ?
Severe liver impairment - suspended of license
50
What is the issue is a POC pil is delayed by 12 hours
contraceptive effect is lost
51
If a POC pil is started on day 5 of cycle are additional measures requried?
No but if >5 days, needs 2 days of additional measures
52
If vomiting or diarhorea occurs within 2 hours of taking a POC what advice should be given?
Take next pill asap, if this is > 3 hours then the additonal precautions needed for 2 days
53
What age range is nexplanon licensed for use in?
18 - 40 year olds
54
What is the MHRA warning associated with Nexplanon?
Risk of migration and neurovascualr injury
55
What cancer risks are associated with HRT?
1. endometrial cancer risk | 2. ovarian cancer
56
What are some of the cautions associated wiht HRT?
endometrial + ovarian cancer risk increased increased stroke + CHD risk VTE risk

BNF Genito-urinary system (3 decks)

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