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PBL PY2 Fall > Medical Abortifacients > Flashcards

Medical Abortifacients Flashcards

1
Q

legal definition of abortion

A

termination of pregnancy by various means such as surgery before the fetus is able to sustain independent life

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2
Q

World Health Organization definition of abortion

A

various clinical conditions such as spontaneous and induced abortion (both viable and non-viable pregnancies), incomplete abortion and intrauterine fetal demise

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3
Q

what is the 2nd most common reproductive health procedure?

A

abortion

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4
Q

1 in __ women have an abortion

A

3

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5
Q

has the number of abortions been increasing or decreasing since 2005?

A

decreasing

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6
Q

what % of abortions are reported as medical abortions?

A

4%

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7
Q

definition of induced abortion

A

voluntary ending of a pregnancy

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8
Q

surgical abortion definition

A

removal of a pregnancy with teh use of instruments or aspiration of uterine cavity

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9
Q

medical abortion definition

A

use of one or more medications to interrupt a pregnancy

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10
Q

definition of abortifacients

A

drugs used to induce a medical abortion

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11
Q

induced abortions occur most often in the ___ trimester. Up to ____ days gestation

A

1st; 12 weeks or 84 datys gestation

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12
Q

what are the 4 options for medical abortion?

A
  1. Mifegymiso (mifepristone 200mg and 800mcg misoprostol) as 1 pill
  2. Mifepristone 600mg and misoprostol 400mcg as 2 pills
  3. methotrexate 50mg IM or vaginally & misoprostol 800mcg vaginally 3-7 days later
  4. misoprostol 800mcg PO or vaginally Q3H for 12H
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13
Q

effectiveness of mifegymiso for medical abortion

A

~95-98% up to 49 days and 95-99% up to 63 days

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14
Q

effectiveness of individual mifepristone and misoprostol

A

92% up to 49 days

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15
Q

effectiveness of methotrexate and misoprostol

A

> 90% up to 49 days

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16
Q

effectiveness of misoprostol vaginally

A

85% up to 49 days

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17
Q

what medical abortion option is approved and available in Canada for this indication?

A

Mifegymiso

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18
Q

is mifepristine available as a single entity in Canada?

A

no

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19
Q

is misoprostol approved for the indication of medical abortion in Canada?

A

no

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20
Q

what comes in the Mifegymiso box?

A

Green box: 1 tab of mifepristone 200mg

Orange box: 4 tabs misoprostol 200mg

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21
Q

what is the indication for Mifegymiso?

A

medical termination of a pregnancy within 63 days (9 weeks) gestation as measured from last period

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22
Q

what is the MOA of mifepristone in abortion? (two main parts)

A

blocks progesterone receptors (w/o activating them). Lack of progesterone causes the endometrial lining to break down and bleeding starts 9so endometrium can no longer support a growing embryo)

Also increases prostaglandin levels and dilates the cervix

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23
Q

what is the MOA of misoprostol in medical abortion?

A

induces cervical ripening (cervical thins, soften, relaxes and dilates) and uterine contractions to facilitate evacuation of contents

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24
Q

misoprostol is a synthetic form of _____ (E1)

A

prostaglandin

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25
Q

what are 6 important contraindications to medical abortion?

A
  1. ambivalence
  2. severe uncontrolled asthma
  3. hypersensitivity to ingredients
  4. IUD
  5. longterm corticosteroid use
  6. anemia w/ hemoglobin <95g/L
26
Q

why is medical abortion c/i in severe uncontrolled asthma?

A

MIFE is an anti-glucocorticoid and can compromise control of severe asthma attacks

27
Q

why are medical abortions c/i in patients with a current IUD?

A

more likely to be ectopic pregnancy and a missed diagnosis can be life-threatening

28
Q

why is longterm corticosteroid use a relative c/i for medical abortion?

A

steroid effectiveness can be reduced for 3-4 days after MIFE

29
Q

explain the SIG for Mifegymiso

A
  1. mifepristone pill is taken with a glass of water (either at clinic or at home)
  2. 24-48hrs later, 2 misoprostol tablets are placed on either side of the mouth between the cheek and gums for 30min. Any remaining fragments are swallowed with water

plan to rest for 3 hours after taking miso pills

30
Q

is there an interaction between NSAIDs and mifegymiso?

A

No, bc the mechanism of NSAIDs is to decrease the making of new prostaglandins, so it does not have any action on pre-existing prostaglandins (which the MIFE would act on)

31
Q

what day of the week is it suggested to take the medical abortion pills to avoid symptoms on weekdays?

A

take MIFE on friday and MISO on saturday

32
Q

vaginal bleeding starts ____hrs after MISO

A

1-48hrs

33
Q

t/f the bleeding with medical abortion is heavier than menstrual period

A

yes

34
Q

the heavy bleeding of medical abortion lasts ____hrs and light spotting can last until ____

A

2-4hrs; next menstrual period

35
Q

t/f the blood released after medical abortion contains blood clots

A

t

36
Q

how should a patient be advised to manage bleeding after medical abortion?

A

sanitary pads (DO NOT USE TAMPONS), can use panty liners for the light bleeding that may last 30 days of tx

37
Q

how much blood is alarming after a medical abortion?

A

saturating 2 or more pads/hour for 2 consecutive hours

38
Q

heavy bleeding after MA should not last more than ___days (red flag)

A

16

39
Q

what are 4 red flags for bleeding after MA?

A
  1. excessive bleeding
  2. dizziness or racing heart
  3. heavy bleeding >16 days
  4. foul-smelling vaginal discharge
40
Q

pain and cramping with MA starts within __hours of taking MISO

A

4

41
Q

the increased pain after an MA may last up to ___hours

A

24

42
Q

how can the pain of MA be managed?

A

ibuprofen, naproxen (acetaminophen is less effective), heating pad, rest

43
Q

what are the 2 red flags for pain after MA?

A
  1. cramping lasting >16 days

2. cramping/pain not improving with pain medications

44
Q

what is a common GI sx after MA?

A

diarrhea (may also have N/v, headache, fever, chills)

45
Q

the GI side effects of MISO can be minimized by ___

A

taking MISO after a snack

46
Q

when is a fever a red flag after MA?

A

if its >38C for >6hrs and malaise (weakness, nausea, vomiting, diarrhea)

47
Q

when is feeling sick a red flag after MA?

A

feeling sick with/without fever for >24hrs after MISO

48
Q

what are some things on a supportive care checklist a PhC should go over w/ patient before a MA?

A
  1. do they have pad and liners
  2. do they have a contraceptive plan
  3. do they have pain meds
  4. do they have support
  5. do they have a follow-up appointment and know the red flags and what to do?
49
Q

t/f 24 hour phone coverage must be available to patients using mifegymiso

A

t

50
Q

conformation of completion of MA should be done ___ weeks after taking MA

A

1-2 weeks

51
Q

PhC can follow up with patient ___days after MA to ask about appropriate admin and any side effects

A

2-3 days

52
Q

how can confirmation of MA be done?

A
  1. transvaginal ultrasonography (TVUS)

2. HCG blood test

53
Q

when after MA can hormonal contraception (POC or CHC) be started?

A

on the day of or day after MISO

54
Q

when after MA can an IUD/IUS be inserted?

A

after a follow-up visit that confirms completion of abortion

55
Q

is an ultrasound needed prior to Rx for MA?

A

no

56
Q

health Canada recommends MA be used how late into pregnancy?

A

9 weeks or less

57
Q

the SOGC guidelines recommends MA can be used how far into pregnancy?

A

10 weeks or less

58
Q

Can NPs prescribe for MA?

A

no

59
Q

Do PhCs need to stock a limited quantity of mifegymiso?

A

no, they should be stocked as much as any other med based on patient demand

60
Q

does the first dose of MA need to be a witnessed dose?

A

no

61
Q

t/f mifegymiso is universally covered in canada at no cost to patients

A

t

PBL PY2 Fall (21 decks)

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