30 - Drugs that May Reduce Combined Hormonal Contraceptive Efficacy

Interacting Drug Documentation Antituberculous     Rifampin Established; reduced efficacy if 50 microg EE Antifungals     Griseofulvin Strongly suspected Anticonvulsants and sedatives     Phenytoin, mephenytoin, phenobarbital, primidone, carbamzepine, ethosuximide Strongly suspected; reduced efficacy if 50 microg EE; trials lacking Antibiotics     Tetracycline, doxycycline Two small studies find no association   Penicillins No association documented   Ciprofloxacin No effect on efficacy of a 30 microg EE + desogestrel pill   Ofloxacin No effect on efficacy of a 30 microg EE + levonorgestrel pill Antiretrovirals Variable effects; see manufacturer or other

EE = ethinyl estradiol.

29 - Drugs Whose Effectiveness Is Influenced by Combination Oral Contraceptives

Interacting Drug Documentation Management Analgesics       Acetaminophen Adequate Larger doses of analgesic may be required   Aspirin Probable Larger doses of analgesic may be required   Meperidine Suspected Smaller doses of analgesic may be required   Morphine Probable Larger doses of analgesic may be required Anticoagulants       Dicumarol, warfarin Controversial   Antidepressants       Imipramine Suspected Decrease dosage about a third Tranquilizers       Diazepam, alprazolam Suspected Decrease dose   Temazepam Possible May need to increase dose   Other benzodiazepines Suspected Observe for increased effect Anti-inflammatories       Corticosteroids Adequate Watch for potentiation of effects, decrease dose accordingly Bronchodilators       Aminophylline, theophylline, caffeine Adequate Reduce starting dose by a third Antihypertensives       Cyclopenthiazide Adequate Increase dose   Metoprolol Suspected May need to lower dose Other       Troleandomycin Suspected liver damage Avoid   Cyclosporine Possible May use smaller dose   Antiretrovirals Variable See manufacturer or other

28 - Endometrial Cancer Risk Factors

Proliferation of the endometrium is under the control of estrogen, and prolonged exposure to unopposed estrogen from either endogenous or exogenous sources plays a central etiologic role. Risk factors for endometrial cancer include obesity, low fertility index, early menarche, late menopause, and chronic anovulation. Granulosa cell tumors of the ovary that secrete estrogen may present with synchronous endometrial cancers. Chronic unapposed estrogen replacement increases the risk, and women taking tamoxifen for breast cancer treatment or prevention have a twofold increased risk.

The Lynch syndrome occurs in families with an autosomal dominant mutation of mismatch repair genes MLH1, MSH2, MSH6, and PMS2, which predispose to nonpolyposis colon cancer as well as endometrial and ovarian cancer. The estimated lifetime risk for endometrial cancer is 40–60%, with a mean age around 50 years. Unlike colorectal cancer, endometrial cancer risk is not lower in MSH6 mutation carriers. Most women present with stage I disease, and the survival rate is generally good (5-year survival 88%). No unique endometrial screening strategies have been established for Lynch family gene carriers.

• Obesity

• Impaired carbohydrate tolerance

• Nulliparity

• Late menopause

• Unopposed oestrogen therapy

• Functioning ovarian tumours

• Previous pelvic irradiation

• Family history of carcinoma of breast, ovary

or colon

27 - Oral Contraceptive Pills Mcqs

1q: oral contraceptives ( OCPs ) give protection against all of the following except ?


a. endometrial carcinoma
b. osteoporosis
c. benign breast disease
d. hepatic adenoma

answer d . hepatic adenoma

OCPs – Oral contraceptive pills give protection against the following conditions :


1. T = Thyroid autoimmune disorders
2. H = Hirsutism
3. E = Endometrial carcinoma


4. C = Colorectal cancer
5. O = Ovarian cancer
6. B = Benign Breast diseases ( fibroadenosis )
7. R = Rheumatoid arthritis
8. A = Anemia and Acne
9. S = Salpingitis ( PID )


10. U = Uterine cancer
11. F = Fibroids ( exception is submucous variety )
12. O = Ovarian cysts


13. P = Pelvic inflammatory disease
14. O = Osteoporosis and Osteopenia
15. E = Ectopic pregnancy
16. M = Mittelschmerz , Menorrhagia , Dysmenorrhea , Premenstrual Tension , Polymenorrhea .




Other important points to be remembered about OCPs is that their extensive use leads to a few diseases like :


1. Cancer cervix
2. Breast cancer
3. Pituitary adenoma
4. Hepatic adenoma

26 - total laparascopic hysterectomy video

this is a beautiful video of total laparoscopic hysterectomy. it is beautifully done and beautifully explained . absolutely bloodless . observe the steps carefully

25 - hormone therapy in gynaecology mcqs - 1

1q: HRT is helpful in all of the following except ?

 

1. vaginal atrophy
2. flushing
3. osteoporosis
4. coronary heart disease

 

answer: d . coronary heart disease .

 

2q: estrogen replacement for post-menopausal symptoms cause an increase in ?

 

1. LDL
2. Cholesterol
3. VLDL
4. Triglycerides

 

Answer: d . triglycerides . estrogen replacement causes an increase in HDL and triglycerides and decreases LDL levels .

 

3q: estrogen administration in a post menopausal woman increases the ?

 

1. gonadotropin secretion
2. LDL – cholesterol
3. Bone mass
4. Muscle mass

 

Answer: c . bone mass .

 

4q: all of the following appear to decrease hot flushes in menopausal women except ?

 

1. androgens
2. raloxifene
3. isoflavones
4. tibolone

 

answer: b . raloxifene .

 

5q: absolute contraindication of hormone replacement therapy is ?

 

1. thrombosis
2. fibrocystic disease
3. fibroadenoma
4. hemorrhage

 

answer: a . thrombosis .

 

6q: GnRH analogues may be given in all of the following except ?

 

1. prostate carcinoma
2. endometrial carcinoma
3. fibromyoma of uterus
4. precocious puberty

 

answer: b . endometrial carcinoma .

 

here is a list of all the conditions in which GnRH analogues are used :

 

1. adenomyosis
2. irritable bowel syndrome
3. carcinoma breast
4. DUB
5. endometriosis
6. fibromyoma uterus
7. hirsutism
8. infertility
9. precocious puberty

24 - absolute contraindications of oral contraceptive pills

1. carcinoma of breast and genitals
2. congenital hyperlipidemia
3. porphyria
4. cardiac abnormalities
5. moderate to severe hypertension
6. previous or present history of thromboembolism
7. undiagnosed abnormal uterine bleeding
8. impending major surgery to avoid post operative thromboembolism
9. liver diseases , hepatoma or history of jaundice during past pregnancy