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Flashcards in Sexual Health Deck (59):
1

What are the two hormones in combined hormonal contraceptives? What three forms can they come in, can you think of the brand name of any of these?

Oestrogen and Progestogen

COC pill e.g. Microgynon (Ethinylestradiol + Levonorgestrel) Cilest (Ethinylestradiol + Norgestimate)

Combined transdermal patch (Evra)

Combined vaginal ring (NuvaRing)

2

What guidelines should be followed when providing contraception to under 16's?

Fraser Guidelines

3

IUD's are less appropriate for women with increased risk of _____?

Pelvic Inflammatory Disease
(an infection of the upper part of the female reproductive system- uterus, fallopian tubes, and ovaries, and inside of the pelvis)

4

COC's reduce the risk of what conditions?

PID
Ovarian + endometrial cancers (the progestogen reduces endometrial)
benign breast disease

5

What is the difference between monophasic and phasic COC's?

Monophasic contain the same amount of oestrogen and progestogen in each tablet. Most commonly used.

Phasic contain different amounts in each tablet- i.e. some of the tablets in the strip may contain 30 mcg of ethinylestradiol and some may contain 40 mcg. These are usually used for those that do not have a withdrawal bleed or have breakthrough bleeds on monophasic.

6

What oestrogen do the majority of COC's contain?

Ethinylestradiol

7

COC's and surgery?

Discontinue 4 weeks before major surgery/ leg surgery/ immobilisation
Re-start at next period at least 2 weeks after re-mobilised

POP's aren't an issue- can keep these going through surgery as no risk of clots with oestrogen-free

8

Above what BP should the COC be avoided in ?

Over 160/ 95 mmHg

9

What is the mechanism of action of COC's?

Stop follicles (containing an egg) developing in the ovary and prevent ovulation (release of an egg from the follicle to travel down the fallopian tube to the uterus) through suppression of Luteinising hormone and Follicle stimulating hormone.

10

What is the mechanism of action of POP's?

Alter cervical mucus to prevent sperm penetration (creates a hostile environment)
Some (desogestrel) inhibit ovulation- this has become a much more common MofA rather than just altering mucus

11

What kind of contraceptive is the contraceptive Injection? What do women need to be warned of with these?

Long- acting Progestogen only
Last around 3 months (12 weeks) at a time
Menstrual disturbance- troublesome bleeding reported

12

How long does the subdermal implant provide contraceptive cover for?

up to 3 years

Implant should be removed within 3 years of insertion

13

Two types of Intrauterine devices?

Copper- toxic to sperm
Progestogen only (levonorgestrel- called Intrauterine system)

14

In terms of cancers, which may the COC protect against, and which may it increase the risk of?

Protect against: Ovary and endometrial cancer
Progestogen reduces risk of endometrial

Small increased risk of: Breast and cervical cancer; risk diminishes after 10 years of stopping.

15

What are some of the side effects of the COC?

Abdominal cramps
Leg cramps
Nausea
breast changes
depression
hypertension
Headaches
irregular bleeding
(NB: does not appear to cause weight gain!)

16

Other than contraceptive purposes, what can COC's/ POP's be used for?

Reducing menstrual pain and bleeding- medical terms?
ACNE

17

If a woman has one of the risk factors for VTE/ CV disease (over 35, obese, FH, migraine with aura, heavy smoker) caution is advised. IF a COC is going to be used, what strength?
What about if they had 2 or more risk factors?

One risk factor- exercise caution, go for lower strength Oestrogen (ethinylestradiol 20 mcg. Usual strength= 30- 35 mcg)

2 or more: avoid use of a COC

18

What is the criteria used to assess whether a woman with pre-existing medical conditions would be suitable for a COC?

UKMEC scoring
(Medical Eligibility criteria for contraceptive use)
Risk benefit analysis for prescribing guidance

19

What assessments are needed prior to starting a COC/ POP?

Relevant History
BP
BMI
For COC's- reassess BP after 3 months, then yearly after that

20

What are the instructions for initiating the COC?

Can start it on any day of the cycle
Day 1 = first day of period
If starting on day 6 or later- contraceptive precautions needed for 7 days
Same applies if switching from a POP to a COC- use contraceptive precautions for 7 days

21

Name some Progestogens? Which can be used as Long acting progestogens?

Ulipristal acetate
Levonorgestrel
Desogestrel
Norethisterone

LARC's:
Norethisterone
Levonorgestrel
Medroxyprogesterone
Etonogestrel

22

In terms of cancer risk, what can progestogen only contraceptives do?

Small increased risk of breast cancers as with COC's, diminished after 10 years of use. Breast cancer is a contra-indication

Small increased risk of cervical cancer with Injectable progestogen use.
Progestogen protects against endometrial cancer

23

Side effects of POPs?

Oral use:
Nausea
Depression
Headaches
Breast discomfort
Appetite disturbance
Menstrual irregularities

24

What are the instructions for initiating the POP?

Start on day 1 of cycle (first day of period), no extra protection needed, as cannot start on any day of cycle like COC's.

Take continuously- no pill-free interval with POP's! A new blister is started directly the day after the previous one. Should get no withdrawal bleeds- however women who experience some irregular bleeding should possibly switch to a different method (bleeding irregularity has been reported in up to 50% of women using Cerazette)

After a couple of months of treatment, bleedings tend to become less frequent.

25

After how many years should copper IUD's usually be replaced?

5 years

26

What are the different types of Long acting reversible contraception?

Intrauterine contraceptive device (IUCD- copper releasing, non-hormonal)

Intrauterine system (IUS Mirena- Levornogestrol releasing)

Injectable Progestogen- oily based, released slowly over 12 weeks (IM injection) or 13 weeks (SC injection)
Sub-dermal progestogenic implant

27

Which progestogen injection has been associated with a reduction in bone mineral density and therefore increased osteoporosis risk?

Medroxyprogesterone

28

What is the only implant licensed in the UK?

Etonogestrel (nexplanon)

29

What is the main undesirable SE associated with Progestogen only contraceptive use (both POP's and long acting)?

Undesirable/ irregular vaginal bleeding patterns

30

How is erectile dysfunction treated?

With drugs improving the flow of blood to penis
Phosphodiesterase type- 5 inhibitors usually used (sildenafil, avanafil, tadalafil)

31

What drug, used for erectile dysfunction, may result in priapism (prolonged painful erection?)

Alprostadil

32

If men are to get certain erectile dysfunction meds such as sildenafil and tadalafil, on an NHS prescription, because they meet certain criteria, what must be endorsed?

SLS

33

Which erectile dysfunction drugs can also be prescribed for pulmonary arterial hypertension?

Tadalafil
Sildenafil

These relax muscles in the blood vessel walls in the lungs, dilating them and reducing BP

Should be used under specialist supervision

34

What are the common side effects of the Phosphodiesterase type- 5 inhibitors (sildenadil, tadalafil, avanafil) used in erectile dysfunction??

Flushing
Back pain
Dyspepsia (heart burn)
migraine
Blocked nose
VISUAL disturbance

35

What are the risk factors for erectile dysfunction?

Similar to those for CV disease:
Obesity
Sedentary lifestyle (blood isn't flowing much)
Smoking
High cholesterol

36

What is the new drug used for premature ejaculation?

Dapoxetine

37

What drug can be used to induce labour?

Oxytocin

38

What are Gemeprost, misoprostol and mifepristone used for?

Induction of ABORTION

Mifepristone can be used to facilitate the process: sensitises the uterus to administration of the abortion drugs Gemeprost and Misoprostol.

39

What is the treatment for bacterial vaginosis?

Metronidazole gel
Clindamycin cream

40

We know that clotrimazole cream can be used for fungal vaginal infection (thrush). What is the strength of each formulation used?

Internal vaginal cream: Clotrimazole 10% (Canesten internal cream)- insert one applicatorful into the vagina at night- can repeat dose once if needed.

External cream, to be applied to ano-genital area 2-3 times a day:
Clotrimazole 1% cream
Canesten 2% thrush cream

41

What are the instructions for use of clotrimazole vaginal pessaries for thrush?

200mg pessary insert at night for 3 nights (use at night as minimal movement)

Recurrent thrush:
500mg pessary weekly for 6 months after using clotrimazole cream for 10-14 days

42

Bar clotrimazole (Canesten), what other topical Imidazole cream can be used for thrush?

Ketoconazole cream (Nizoral)

Also used for dandruff/ seborrhoiec dermatitis/ Fungal skin condition called pityriasis versicolor as Nizoral shampoo

43

What class of medications is usually used for treating Urinary frequency/ Urinary Urgency?

Antimuscarinics (Anti-cholinergic's): one of their side effects is urinary retention!

Examples:
Fesoterodine
OXYBUTININ
Darifenacin
SOLIFENACIN
Tolterodine
Trospium

44

What is Beningn prostate Hyperplasia?

An enlarged prostate gland.
The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body.
As the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating-

trouble to start weeing
trouble to stop weeing (dribbling)
Weak stream
Often feeling you need a wee- gets you up at night

45

What are the alpha blockers used in BPH, and what do they do?

Relax smooth muscle and therefore increase urine flow

Examples:
Doxazosin
Alfuzosin
Indoramin
Tamsulosin (can get OTC- Flomax)
Prazosin

46

What are Finasteride and Dutasteride used for? What are the associated warnings?

Also used for BPH (these are not alpha blockers)

WOMEN of child bearing age should not handle crushed or broken tablets.

These are excreted in semen therefore used of a condom recommended

Cases of Male Breast Cancer reported: males to report any changes in breast tissue: lumps, pain, nipple discharge

47

What is the extra precaution needed before inserting an intra-uterine device into some women?

Risk of infection due to pre-existing STI's:
for women under 25 years, over 25 years with a new partner- perform an STI check before fitting the device
Risk of infection occurs in first 20 days after insertion- if woman has sustained pain attend emergency department ASAP as this could indicate Pelvic inflammatory disease

48

What is the first dose effect associated with the alpha blockers used for BPH?

Patients should be advised that their first dose may cause hypotension therefore there is risk of falling. They should take their first dose in bed- lie down if symptoms of sweating and dizziness develop and stay lying down.

49

What conditions and cancers does HRT increase the risk of?

Clots- Venous Thromboembolism (DVT and PE)
Stroke

Breast cancer- risk disappears within 5 years of stopping
Ovarian cancer
Endometrial cancer

Same as COC's as it is oestrogen that causes these.
HRT containing progestogen (for women with a uterus)provide some protection against endometrial cancer [but still increased risk of breast cancer].

50

What is the menopause?

Where a womans periods cease as her oestrogen levels decline. Results in hot flushes, night sweats, low mood (caused by vasomotor instability). Usually happens 44-55 years of age.

Treatment of symptoms usually involves HRT- small doses of oestrogen to soften the blow of the oestrogen decline. Also given progestogens if still has a uterus.

Tibolone: a drug that has oestrogenic, progestogenic and weak adrenergic activity used in HRT.

51

What condition can HRT be used to prevent?

OSTEOPOROSIS

52

How many days are the progestogen tablets used in HRT taken for each cycle? What about the oestrogen tablets? What is the prescription charge for the HRT packs containing oestrogen and progestogen tablets?

Progestogen tablets: for 12- 14 days of each cycle for women with a UTERUS

Oestrogen tablets: taken continuously

Usually a separate prescription charge for each of the tablets in the pack: e.g. Prempak- C renders 2 prescription charges.

53

Does HRT provide contraceptive cover, considering it comprises oestrogens and progestogens?

NO
A woman is still considered fertile for 2 years after her last menstrual period (if under 50- for 1 year if over 50 years). If any potentially fertile women are on HRT, non-hormonal contraceptive measures are advised such as Condoms.

54

What are the side effects of the alpha blockers used in BPH?

Dizziness (Most common)
Postural Hypotension
Back pain
Blurred vision
Dry mouth

55

How many weeks can Tamsulosin OTC be given for treatment of BPH before clinical assessment by a doctor?

Max 6 weeks treatment OTC

56

What is the treatment for Chlamydia, OTC?

Azithromycin
1g STAT (2 x 500mg tablets)
Need to have tested positive for chlamydia
Partner does not need to be tested to receive dose

57

What should patients report with treatment with Tamoxifen, a hormone used in treating Breast cancer?

Risk of VTE- report to hospital if there is any redness, swelling or pain in the leg.

Endometrial changes- report any abnormal vaginal bleeding, vaginal discharge and pelvic pain due to risk of cancer/ polyps

58

Which oral contraceptives offer everyday dosing- i.e. you don't need to take a pill free break as there are 7 inactive pills in there so can help with compliance as people don't have to remember to start a new pack?

Zoely: Estradiol and Nomogestrol (oestrogen + progestogen)

These are monophasic pills (i.e. the active pills contain the same amount of actives in each tablet)

59

Which oral contraceptive is a monophonic preparation i.e. each tablet contains a different amount of active so the patient has different levels of hormones throughout the month?

Qlaira (estradiol and dienogest)

pack also contains 2 inactive pills