contraception & pregnancy C5 Flashcards
(20 cards)
MOA levongesterel (levonelle)
Inhibits ovulation by suppressing gonadotropins. Binds to progesterone and androgen receptors and slows the release of gonadotropin-releasing hormone from the hypothalamus, which suppresses the LH surge and therefore inhibits ovulation.
IUD: It can also thicken cervical mucus, interfering with the movement of sperm and therefore preventing fertilisation
when can levonelle be used
EHC up to 72 hours after unprotected sex
councelling points with EHC
EHC: can delay next period
General side effects :
Dizziness; gastrointestinal discomfort; haemorrhage; headaches; menstrual cycle irregularities; nausea; skin reactions
MOA uliporistal acetate
Debated
Binds to progesterone receptors and prevents progesterone binding. Suppresses the LH surge and consequently ovulation
when can ella one be used
EHC up to 5 days after unprotected sex
when should someone start their COC after revieveing EHC for both ella one and levonelle
E: Start COC after 5 days and use condoms for these 5 days, and then 7 days following this.
L: Can start COC straight away. Use barrier methods for 7 days
what do COC contain
estrogen + (levongetsterel or northehisterone)
how does COC Ethinylestradiol with levonorgestrel work
Suppression of gonadotropic hormone, thickens cervical mucus to prevent the travel of sperm, and prevents changes in the endometrium that would be required for implantation.
Ethinylestradiol decreases LH, which decreases vascularity in the endometrium, preventing implantation
what is the risk associated with migranies in someone taking a COC
potential sign of embolism - contraindicated. stop and refer them
what groups should caution be taken with the COC
Caution in women over 40, 6 weeks to 6 months post partum women, smokers under 35, BMI >30, previous venous embolism, heart abnormalities, long-term immobility
- These all increase the risk of developing a venous embolism whilst taking a COC
how does Noriday (northehisterne) work - POC
Progesterone analogue
Bind to progesterone receptors – changes on a genetic level.
Increases cervical mucus to interfere with sperm transport.
Suppresses the release of follicle-stimulating hormone and luteinizing hormone from the pituitary in the hypothalamus. This prevents follicular development, ovulation and corpus luteum development.
why is it important to take folic acid during pregnancy
Prevention of neural tube defects during pregnancy in the first trimester
role of folic acid
Converted to tetrahydrofolic acid and methyltetrahydrofolate by dihydrofolate reductase (med review to identify if pt is on any inhibitors of this enzyme, and this should be stopped/switched during pregnancy to mitigate the risk of neural tube defects caused by a lack of folic acid)
critical role in DNA synthesis, repair, and cell division
- Synthesis of nucleotides to build DNA and RNA
- Folic acid ensures proper closure of the neural tube, and normal cell division is essential for this
In the first 4 weeks of pregnancy, rapid cell division occurs; hence folic acid is essential in this stage
when should high dose (5mg) folic acid be considered preconception and during pregnancy
High dose should be taken in women where there is a high chance of developing neural tube defects. The risk is higher in women who:
* Have had a previous pregnancy affected by NTD.
* Have diabetes.
* Are obese (BMI ≥ 30).
* Are taking certain anti-epileptic or folate-antagonist medications (e.g., valproate, carbamazepine, methotrexate, trimethoprim).
* Have a family history of NTDS
name 5 antiemetics used in pregnancy
chlorpromazine hydrochloride, cyclizine, doxylamine with pyridoxine, metoclopramide hydrochloride, prochlorperazine, promethazine hydrochloride, promethazine teoclate, and ondansetron.
ondansetron class and MOA
5HT3 receptor antagonists: bind to 5ht3 receptors in the CTZ which surpress vomiting reflex
cyclizine MOA
Antihistamine
H1 antagonist
Binds to histamine receptors in the chemo trigger zone (vomiting centre)
Prevents neurotransmission of the emesis signal.
how does Chlorpromazine hydrochloride (antiemetic) and what needs to me monitored
Dopamine receptor antagonist on postsynaptic neurons
Can cause ESPE therefore
Also an antagonist at
- M1 (antimuscarinic = dizziness, dry mouth)
- H1 (sedation and weight gain)
- Alpha 1 (postural hypotension)
- D2 (EPSE, raised prolactin)
EPSE
prolactin levels prior to treatment
2 types of insulin used in gestational diabeties
aspart and lispro as they are fast acting
