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patient: OSPE > EHC 1 > Flashcards

EHC 1 Flashcards

1
Q

where can EHC be supplied?

A 
GP
community pharmacy
A&E
GUM clinics
out of hour clinics
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2
Q

what is the biggest UK provider of EHC?

A

community pharmacy

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3
Q

active ingredient in levonnele?

A

levonorgestrel 1.5mg

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4
Q

active ingredient in ellaone

A

Ulipristal acetate 30mg

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5
Q

non hormonal EHC? where can you get it?

A

copper bearing IUD

from GP or GUM clinic

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6
Q

what type of EHC is most effective?

A

IUD

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7
Q

what part of the cycle do you ovulat

A

MIDDLE

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8
Q

why do you ovulate

A

due to a hormone surge

increasing levels of LH and FSH

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9
Q

how does EHC work?

A

stops ovulation

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10
Q

when is day 1 of the natural cycle

A

first day of period or first pill in the pill pack

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11
Q

how many people actually ovulate at day 14?

A

25% women

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12
Q

what days can ovulation occur in

A

6-21

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13
Q

7 indications for EHC?

A

UPSI on any day
IPSI in the 28 days following enzyme inducing drugs
UPSI from 21 days post partum
UPSI 5 days post abortion/ miscarriage/ ectopic pregnancy
ejaculation onto external genitalia
UPSI before new contraception is effective
contraceptive failure

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14
Q

how long does a diaphragm need to stay in place for?

A

6 hours after intercourse

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15
Q

what can you give if a patient has UPSI within 28 days following use of liver enzyme inducing drugs

A

offer Cu-IUD

or a double dose 3mg LNG

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16
Q

levonelle mechanism of action and what is it

A

type of progestogen

prevents ovulation and discourage implantation

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17
Q

what is levonelle licensed for (age?)

A

16 years and older

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18
Q

ellaone what is it? how does it work?

A

progesterone receptor modulator

delays ovulation and alters endometrium to prevent implantation

19
Q

who is ella one licensed for?

A

all women of childbearing age
aka if a young girl has started period
must use professional judgement and that the child is gillick competence

20
Q

levonelle timeframe?

A

72 hours

21
Q

ellaone timeframe?

A

5 days

22
Q

IUD timeframe?

A

10 days roughly

23
Q

how effective is levonelle at:
<24 hours after UPSI
25-48 hours after UPSI
48-72 hours after UPSI

A

<24: 95%
25-48: 85%
49-72: 58%

24
Q

levonelle overalll efficacy? why should we be cautious about telling patients this?

A

84%

wrong to say this if theyre getting it on the third day

25
Q

effect of BMI on levonelle?

A

if BMI >26 they may find the efficacy is reduced

important to make patient aware

26
Q

ella one efficacy? pregnancy rate in 48-120 hour time window?

A

higher than LNG

48-120 hours theres 2% pregnancy rate

27
Q

what reduces the efficacy of ellaone?

A

if any progesterone is taken in 5 days post taking ellaone aka all forms of contraception

28
Q 
1000 women have sex, how many will get pregnant with: 
no contraception?
those who use ellaone?
those who use levonelle?
those who use IUD
A

NONE: 80
EllaOne: 5
LNG: 10
IUD: 1

29
Q

adverse effects of levonelle:

A 
headache
nausea
breast tenderness 
lower abdo pain 
irregular bleeding: mensural changes 
fatigue 
increased risk of ectopic pregnancy- REFER ABDO PAIN 
dizziness
30
Q

ellaone adverse effects?

A 
headache 
nausea 
abdo pain 
dysmenorrhea 
mild dizziness
31
Q

what side effect must women be counselled on?

A

nausea: if occurs within 3 hours come back for another dose

32
Q

is pregnancy a C/I for EHC?

A

YES, cannot take this as an abortion product

33
Q

would EHC affect an unborn child?

A

no

34
Q

C/I of levonelle?

A

pregnancy
bowel disease- reduces absorption
hepatic impairment- metabolism
enzyme inducers (CYP3A4 inducing drugs

35
Q

examples of enzyme inducers which can effect Levonelle

A

St john wort, rifampicin, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbituates

36
Q

what to do if patient is on enzyme inducers? what will happen?

A

refer to GUM clinic or GP: will be given 2 doses 12 hours apart

37
Q

is a second dose licensed?

A

no

38
Q

ellaone contraindications?

A

pregnancy
hepatic impairment
asthma uncontrolled by oral steroids (oral not inhalsed)
breastfeeding- discard for 1 week

39
Q

ellaone drug interactions?

A 
CYPA43 inhibitors
ritonavir 
levonorgestrel 
hormonal contraception 
progestogen containing drugs
40
Q

what must you do if you want to give ellaone to someone who is breastfeeding?

A

advise that it passes into milk so they need to pump and discard for 1 week

41
Q

how does progesterones impact ellaone. so what do we advise?

A

prevents the ability of UPA to delay ovulation

dont take hormonal contraception for 5 days after ellaone

42
Q

checklist for OTC consultation if NOT on contraception

A 
introduction 
indicated? 
exclude pregnancy? 
Other medications? 
Is cost/ efficacy an issue?
choose correct EHC
administration counselling 
MOA counselling 
efficacy counselling 
side effects explained
VOMITING advice 
advise to do a pregnancy test if next period is more than 5 days late for LNG or 7 days if taken ellaone 
contraception must be used going forward- doesnt protect against future pregnancy 
continuing contraception? 
seek medical advice if lower abdominal pain 
STI?
conclude
43
Q

when to take a pregnancy test?

A

if period if 5 days late for LNG or 7 days in the case of ella one
3 weeks after UPSI

patient: OSPE (2 decks)

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