E2 Emergency contraception Flashcards
what are the 3 options for emergency contraception?
- IUD
- levonorgestrel (Levonelle One Step)
- ulipristal acetate (EllaOne)
mode of action of IUD when it comes to emergency contraception
- affects motility and viability of sperm
- affects viability and transport of the ova
- local endometrial inflammatory reaction prevents implantation
- needs to be inserted before the fertilised egg is implanted otherwise it can’t stop it
mode of action of levonorgestrel in emergency contraception
inhibits ovulation
mode of action of ulipristal acetate in emergency contraception
selective progesterone receptor modulator
describe the IUD as a method of emergency contraception
- most effective and is ongoing afterwards
- inserted by GP or Sexual and Reproductive Health Clinic
- inserted up to 5 days after unprotected sex or 5 days after expected date of ovulation
- free
- refer for insertion but also give hormonal contraception unless it is contraindicated
licensing requirements for OTC supply of Levonelle (levonorgestrel)
- unprotected sexual intercourse within previous 72 hours
- only those over 16
- must rule out possibility of pregnancy
- bowel / liver disease (hormones rely on liver enzymes functioning)
- concurrent medicines including herbal (eg. St John’s Wort)
- hypersensitivity
- history of ectopic pregnancy
- history of salpingitis (inflammation of the fallopian tubes)
counselling for Levonelle
- take as soon as possible to maximise potential effectiveness
- will need second dose if vomits within 3 hours
licensing requirements for OTC supply of ellaOne (ulipristal acetate)
- unprotected sex within previous 120 hours
- women of reproductive age
- must rule out possibility of pregnancy
- bowel / liver disease
- severe asthma
- concurrent medicines
- hypersensitivity
how does ellaOne prevent pregnancy?
inhibits ovulation so egg can’t meet sperm
counselling for OTC supply of ellaOne
- take as soon as possible to maximise effectiveness
- if vomits within 3 hours, second dose needed
side effects of ellaOne
nausea
vomiting
headache
dizziness
fatigue
low abdominal pain
diarrhoea
breast tenderness
painful periods
mood swings
muscle pain
side effects of Levonelle
nausea
vomiting
headache
dizziness
fatigue
low abdominal pain
diarrhoea
breast tenderness
what should pharmacists do following EHC?
- establish and support the patient with any ongoing contraceptive needs
- establish and support the patient with any potential STI issue
- pregnancy advice
- bare in mind safeguarding risks
what does PGD stand for and what does it mean?
- Patient Group Direction
- it is a legal document that allows certain health professionals to give medicine to a group of patients without a prescription
describe the PGD supply of EHC
- usually a POM product is supplied as it is often cheaper and has a wider license
- 16 year old restriction is often lowered for Levonelle but varies across different PGDs
- more extensive records required
- doses may need to be supervised
- action in case of vomiting may differ
- free at point of supply
in an EHC consultation, what questions should be asked to determine the risk of pregnancy?
- how old are you?
- did you have sex?
- when did you have sex?
- are you using any other forms of contraception?
in an EHC consultation, what questions should be asked to exclude the possibility of pregnancy?
- was your last period later than normal?
- was your last period lighter or shorter than normal?
- was your last period unusual in any way?
- have you had any other UPSI in this cycle?
in an EHC consultation, what questions should be asked to determine allergies and current conditions?
- do you have any allergies?
- do you have liver disease?
- do you have any problems with absorption eg. Crohn’s disease?
- do you have porphyria?
- do you have any unexplained / unusual vaginal bleeding?
- are you breastfeeding?
in an EHC consultation, what questions should be asked to determine drug interactions?
- do you take any other medicines?
prescription
OTC
herbal
what are the lines of action for EHC?
first line
- copper IUD
second line
- ulipristal acetate (ellaOne)
third line
- levonorgestrel (Levonelle)
aftercare advice for EHC
- take pregnancy test if menses delayed by more than 7 days, is lighter than normal or is associated with abdominal pain that is not typical of the woman’s usual dysmenorrhoea
- pregnancy test if quick start hormonal contraception as they have bleeding as not true menses
- if conception occurs, oral hormonal contraception has no harmful effect on pregnancy outcomes and no increased risk of congenital abnormality
- as a pharmacist you can do the pregnancy test with them in the pharmacy
discuss advanced supply of EHC
- does not reduce pregnancy rate
- used more frequently and sooner if supplied in advance
- does not lead to increased frequency of UPSI, change in contraceptive method or increased risk of STI
- not cost effective
- consider LARC
