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Practice exam 4: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Three disadvantages of LARC include the possibility of irregular bleeding with Mirena (in the first six months) and Implanon; persistent bleeding may occur with Depo-Provera and heavier menstrual blood loss is common with CulUDs (1). A second disadvantage of LARC is that some, e.g. Mirena, Implanon and CulUDs, require a small operation or outpatient procedure to insert and remove them (1). A third disadvantage specific to Depo-Provera is the potential long ‘carry-over’ effect following discontinuation – resumption of ovulation may take up to a year (1). [There is no delay in return of fertility with CulUDs, Mirena or Implanon.]
Medical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
Intramuscular Depo-Provera® is an alternative to oral medroxyprogesterone acetate. It is more often used for contraception, but has been shown to be effective in inducing amenorrhoea and improving endometriosis-associated pelvic pain. Depo-Provera is as effective as low-dose danazol combined with an oral contraceptive pill, but has far fewer side-effects11. The major side-effects of Depo-Provera include weight gain, breast tenderness. There may be prolonged amenorrhoea following termination of treatment. It is this last side-effect that limits use for women wishing to seek fertility in the short term.
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
Depo-Provera, like other progestin-only contraception methods, alters the endometrial lining, thickens the cervical mucus, and blocks the luteinizing hormone surge to prevent ovulation. A backup form of contraception should be used if DMPA is given more than seven days from the start of menstrual bleeding.7 After discontinuation, ovulation resumes at 14 weeks, but it can take up to 18 months. In comparison with combined hormonal methods, Depo-Provera does not impact follicle-stimulating hormone levels as consistently or as intensely. Thus, for one-third of users, estradiol levels remain unchanged from early to mid-follicular phase levels.25
Can behaviour support interventions successfully treat inappropriate sexual behaviour after acquired brain injury in community settings? A case series (N = 24)
Published in Neuropsychological Rehabilitation, 2022
Glenn Kelly, Suzanne Brown, Lauren Gillett, Joseph Descallar, Grahame K. Simpson
No medication was prescribed to target the ISX behaviours, and a minority of the sample were prescribed other classes of medication, limiting the likelihood that medication played a role in the reductions of ISX behaviours. Depo-Provera (medroxyprogesterone acetate) is a common agent employed by forensic services to treat sex offenders in general (Nair, 2016). The treatment of sexual aggression using Depo-Provera among an uncontrolled case series of clients with ABI (n = 8) has been reported (Emory et al., 1995). Those behaviours included instances of paedophilia or rape, whereas the behaviours in the current case series were not as severe. The results of the current case series suggest that behaviour support interventions can be considered as an alternative to medication as a treatment option for most ISX behaviours after ABI.
Preparation of sterile long-acting injectable medroxyprogesterone acetate microcrystals based on anti-solvent precipitation and crystal habit control
Published in Expert Opinion on Drug Delivery, 2019
Rong Sun, Yuting Guo, Na Yin, Jiaojiao Yin, Tian Yin, Haibing He, Jingxin Gou, Yu Zhang, Xing Tang
Medroxyprogesterone acetate (MPA), also known as depot medroxyprogesterone acetate (DMPA) and sold under the brand name Depo-Provera®, is a form of progesterone. It is used as contraception to prevent pregnancy in women by decreasing the release of gonadotropins and suppressing sex hormone levels in body [15]. High-dose MPA inhibits follicular development and prevents ovulation as its primary mechanism of action [16]. It is also used to reduce pain caused by endometriosis, and to ease pain and symptoms in women with metastatic uterine or kidney cancer in low dose [15,17]. The Depo-Provera® (MPA-DP) is prepared by wet milling and available in vials and prefilled syringes for intramuscular (IM) injection. Each dose contains 1 mL MPA sterile aqueous suspension consisting of MPA 150 mg, PEG-3350 28.9 mg, polysorbate-80 2.41 mg, sodium chloride 8.68 mg, methylparaben 1.37 mg, propylparaben 0.150 mg and water for injection. It should be shaken vigorously before intramuscular injection and administered 1 mL every 3 months [18].
Phase 1 study to investigate the pharmacokinetic properties of dacomitinib in healthy adult Chinese subjects genotyped for CYP2D6
Published in Xenobiotica, 2018
Xia Chen, Ji Jiang, Nagdeep Giri, Pei Hu
Eligible subjects had no evidence or history of clinically significant dermatologic, haematologic, renal, endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, neurologic, or allergic disease. Subjects were excluded if they had any condition possibly affecting drug absorption (e.g. gastrectomy), a history or evidence of drug dependency, a positive urine cotinine test at screening, a history of or regular alcohol consumption exceeding seven drinks/week for women or 14 drinks/week for men, or were unwilling to avoid beverages containing caffeine and/or alcohol or abstain from smoking. Prior use of an investigational drug or biologic within the three months preceding the first dose of study medication was not allowed. Concomitant treatment with prescription or nonprescription drugs and dietary supplements within 14 days or five half-lives, whichever was longer, before the first dose of study medication was not allowed. Herbal medication and hormone replacement therapy had to be discontinued at least 28 days before the first dose of study medication. In addition, Depo-Provera® had to be discontinued at least six months before the first dose of study medication.