Session 4

Question 1

How are sex hormones transported around the body?

Answer 1

Bound to sex hormone binding globulin (SHBG) and albumin

Question 2

Why are enzyme inducing drugs (e.g. rifampicin and carbamazepine) contraindicated for the COCP?

Answer 2

Increases activity of cytochrome P450 enzymes which increases the COCP clearance leading to contraceptive failure (used at a minimum does so quite sensitive to changes anyway)

Question 3

Outline the options for emergency contraception

Answer 3

Levonorgestrel up to 72 hours
Up to 120 hours - ulliprisal acetate (progesterone receptor modulator) or Cu2+ IUD (prevents blastocyst attachment to endometrium)

Question 4

What are the indications to commence HRT?

Answer 4

Hot flushes/sweats, vaginal dryness, osteoporosis

Question 5

What are the risks of HRT?

Answer 5

Oestrogen replacement therapy (ERT) - increases endometrial and ovarian cancer risk.
HRT - increases breast cancer risk
Increases risk of VTE and stroke (but beneficial effect on IHD risk)

Question 6

How does mifepristone induce labour or medically terminate pregnancy?

Answer 6

Partial agonist to progesterone, inhibiting its action

Sensitises the uterus to prostaglandins

Question 7

What is the mechanism of action and indications for raloxifene?

Answer 7

Selective oestrogen receptor modulator (SERM)

Protects against osteoporosis, prevention of breast cancer

Question 8

What is the desired level of cholesterol?

Answer 8

<5mmol/L

Question 9

What are the main different classes of lipid lowering drugs?

Answer 9

Statins, cholesterol lipase inhibitors, nicotinic acid and fibrates

Question 10

When should statins be used for primary prevention?

Answer 10

Adults who have a 20% or greater 10-year risk of developing CVD

Question 11

How do fibrates work and when are they used?

Answer 11

E.g.fenofibrate
Decreases serum triglycerides by increasing lipoprotein. Used for those whose serum-TAG concentration is greater than 10 mmol/L or in those who cannot tolerate a statin.

Question 12

What advice should be given so someone who has missed an COCP or POP?

Answer 12

COCP - if just one pill, no precaution. If two or more, additional contraception methods required. Emergency contraception if in the first week
POP - if more than 3 hours late, other contraception methods required for 48 hours. Emergancy contraception if sex in past 2-3days.