pre-IC16 & IC16

Question 1

How does progestin and estrogen prevent ovulation?

Answer 1

Progestin block LH surge + estrogen suppress FSH release

Question 2

Which substance provide most contraceptive effect?

Answer 2

Progestin

Question 3

Which substance stabilize the endometrial lining and provide cycle control?

Answer 3

Estrogen

Question 4

Will there be period for progestin only contraceptive?

Answer 4

No

Question 5

Most commonly used estrogen

Answer 5

Ethinyl estradiol

Question 6

Androgenic SE examples

Answer 6

Acne, oily skin, hirsutism

Question 7

Usually, lower or higher estrogen dose is used?

Answer 7

Lower

Question 8

Factors favoring higher doses of EE (30-35 mcg)

Answer 8

• Obesity or weight > 70.5 kg
• Early to mid cycle breakthrough bleeding/spotting
• Tendency to be non-adherent

Question 9

Which is the ONLY progestin agent that does not have androgenic effects?

Answer 9

Drospirenone

Question 10

Adverse effects of Drospirenone

Answer 10

hyperkalemia, thromboembolism and bone loss

Question 11

Monophasic vs multiphasic COC

Answer 11

Mono: Same amounts of estrogen & progestin in every pill
Multi: Variable amounts of estrogen and progestin

Question 12

Benefit of monophasic COC

Answer 12

Less confusing, less complicated miss-dosed instructions

Question 13

Benefit of multiphasic COC

Answer 13

Tend to have lower progestin overall -> lesser side effects

Question 14

Regimen for Conventional cycle COC

Answer 14

21 days active pill + 7 day placebo = 28 days

Question 15

Which COC leads to lesser periods?

Answer 15

Extended-cycle / continuous COC

Question 16

Regimen for Extended-cycle / continuous COC

Answer 16

84 days followed by 7 days placebo (no placebo at all for continuous)

Question 17

Which method does not need backup contraceptive?

Answer 17

First Day Method

Question 18

When to avoid/stop COC to prevent breast cancer?

Answer 18

Avoid: Age > 40; Family history/ risk factors of breast CA
Stop: Current/ recent PMH of breast CA (within 5 years)

Question 19

Which substances could contribute to venous thromboembolism?

Answer 19

Estrogens & New generation progestins (esp Drosperinone, Cyproterone & Desogestrel)

Question 20

Alternative contraceptive methods to avoid VTE

Answer 20

• Low dose estrogen with older progestins
• Progestin-only contraceptive
• Barrier methods

Question 21

What to do if one COC pill is missed < 48h?

Answer 21

• Take the missed dose immediately and continue the rest as usual
• This may mean 2 pills on the same day

Question 22

What to do if two or more consecutive COC dose missed (more than 48 hours)?

Answer 22

• Take the missed dose immediate and discard the rest of the missed doses
• Continue the rest as usual (may have 2 pills on the same day)
• Backup contraceptive required for at least 1 week

Question 23

What to do If the COC pills were missed during last week of hormonal tablets (e.g. day 15-21)

Answer 23

• Finish remaining active pills
• SKIP hormone-free interval and start a new pack the next day
• Backup contraceptive for at least 1 wk

Question 23

Contraindication with progestin only pill

Answer 23

current/ recent history of breast cancer

Question 24

What to do If late POP dose by > 3 hours?

Answer 24

back up for 2 days

Question 25

How to use transdermal contraceptives?

Answer 25

Applied once weekly for 3 weeks followed by 1 patch-free week

Question 26

How long is vaginal ring used?

Answer 26

Used for 3 weeks then discarded

Question 27

Transdermal patch/ vaginal ring has the highest risk of ____ compared to other methods

Answer 27

VTE

Question 28

Regimen for progestin injections

Answer 28

IM injection every 12 weeks

Question 29

SE for progestin injection

Answer 29

- Variable breakthrough bleeding esp the first 9 months - Weight gain - Short term bone loss

Question 30

Limit use of progestin injection to no more than ____

Answer 30

2 years

Question 31

Which IUD results in Heavier menses/bleeding ?

Answer 31

Copper IUD (compared to levonorgestrel)

Question 32

MOA of IUDs

Answer 32

inhibition of sperm migration, damage ovum, disrupt transport of fertilized ovum. If with progestin -> endometrial suppression, thicken mucus

Question 33

3 categories of Long acting reversible contraception (LARC)

Answer 33

- Hormone releasing implant (Subdermal Progestin Implants) - Levonorgestrel IUD (hormone releasing) - Copper IUD

Question 34

Proteinuria: 24h-urinary protein (UTP)

Answer 34

≥ 300 mg

Question 35

Proteinuria: Dipstick protein

Answer 35

≥ 2+

Question 36

Proteinuria: Urine protein: creatinine ratio (uPCR)

Answer 36

> 0.3 mg/dL

Question 37

Signs of end- organ damage

Answer 37

* Platelet count < 100 * Neurological complications * LFTs > 2X ULN * Doubling of SCr in absence of other renal disease * Pulmonary edema

Question 38

Treatment for HTN in pregnancy

Answer 38

Nifedipine ER/ labetalol

Question 39

Prevention of preeclampsia

Answer 39

Low dose aspirin (100mg or more daily)

Question 40

Who should take aspirin for prevention of preeclampsia? and When??

Answer 40

HTN on previous pregnancy, multifetal gestation, autoimmune diseases, DM, CKD, etc To be started after 12 weeks, ideally before 16 weeks, and continued till delivery

Question 41

When does headache (For COC) usually occur?

Answer 41

During pill-free interval