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15 Cards in this Set
- Front
- Back
- 3rd side (hint)
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List the types of contraceptives available |
1. IUCD (copper/mirena) 2. Implantable devices (Implanon/norplant) 3. OCP 4. Progestin only Pill 5. Barrier contraceptives (cap/condom) + spermicide 6. Natural methods (rhythm method/coitus interruptus) |
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What is the pearl index? how to calculate? what is the signifcance of the pearl index? |
Pearl Index = number of failures per 100 woman years of exposure PI = total no of accidental pregnancies x 12(mths) x 100 (woman), divided by the total number of months of usage Pearl index calculates the failure rate for a specific period of time |
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What are combined oral contraceptive pills? |
Combination of synthetic estrogen and progestins |
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describe the mode of action of COCs |
1. Inhibition of ovulation (by blocking LH surge, and FSH rise) 2. Affect tubular transport of ovum 3. Thickened cervical mucus (by effect of progestin) to block sperm 4. Induces endometrial thinning and atrophy (by effect of progestin) |
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what are the two types of COCs? List some examples |
1. Monophasic: fixed dose of estrogen and progestin (microgynon, nordiol, yasmin) 2. Multiphasic: bi/triphasic dose variations to mimic normal cycle (triquilar, trinordiol, qlaira) monophasic is used more commonly |
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How is COC administered? |
21 day pack: 21 combined E+P pills, followed by 7 day pill-free period 28 day pack: 21 combined E+P pills + 7 sugar pills Ortho Evra: Applied once a week, x3 weeks (on buttock) ; start on day 1 |
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what if pills are missed? |
missed 1 day = take asap, resume next dose at usual time missed 2 days or more = check that there's at least 7 more pills for this month. if >7 pills, continue taking rest of pills + barrier contraception for 7 days if <7 pills, throw away and begin a new pack + barrier contraception for 7 days |
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Efficacy of COCs? |
0.3-1% failure rate |
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benefits of COCs? |
1. Contraceptive benefits - quick on, quick off - efficient - removed from act of coitus - lower chances of ectopic pregnancy 2. Non-contraceptive benefits - Menstrual benefit (more regular, less bleed, less pain) - Cancer benefit (reduce epithelial ovarian CA and endometrial CA) - Other gynaecological benefits (reduced benign breast dz, protective against fibroid/endometriosis/osteoporosis/ovarian cysts) |
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Side effects of COCs? |
1. CVS = risk of DVT, CAD, Stroke (more risk of stroke in >35 y/o) 2. Liver disease = risk of hepatic adenoma (10-20x), cholestasis 3. Brease = increased risk of breast CA (no more risk after 10 years, higher risk below 20 y/o) 4. metabolic disease = increased peripheral insulin resistance and LDL 5. vitamin = decreased vitamin B2, B6, B12, folic acid ; but increase iron levels others: Estrogen SE: nausea, vomiting, headache, giddiness, depression, loss of libido Progestin SE: Weight gain, acne, hirsutism, E&P SE: breast fullness, tenderness Others: breakthrough bleeding |
effects of estrogen: increased clottingfactors, lower anti-coagulants, increased platelet aggregation) |
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drug interactions of COCs |
anti-coagulants (need increased dose) TCA need increased dose (COC aggravates depression) Insulin and oral hypoglycaemics (needs increased dose) Corticosteroids (need reduced dose) |
COCs are metabolized by liver enzymes
COCs increases risks of metabolic syndrome |
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Contraindications of COCs? |
Absolute CI: - CVS: Valvular disorders, IHD, high DVT risks, history of stroke - uncontrolled HTN, DM - SLE - Migraine with aura - Acute hepatitis/ hepatic adenoma/ cirrhosis - Estrogen dependent malignancies (Breast/Endometrium) - Pregnant/breast-feeding (impairs lactation, only give at post-partum >42 days) - smokers >35 y/o, 15 sticks a day - Any HMB - Solid organ transplantation patients Relative CI: - metabolic disease - migraine - gallbladder disease - cardiac disease - planned elective surgery (increased DVT) |
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What is this? |
combined contraceptives, 21 pills, followed by 7 pill free days |
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what is this? |
combined contraceptives, 28 days cycle |
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what is this? |
Ortho-vera combined contraceptive patches |
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