EHC 1 Flashcards
where can EHC be supplied?
GP community pharmacy A&E GUM clinics out of hour clinics
what is the biggest UK provider of EHC?
community pharmacy
active ingredient in levonnele?
levonorgestrel 1.5mg
active ingredient in ellaone
Ulipristal acetate 30mg
non hormonal EHC? where can you get it?
copper bearing IUD
from GP or GUM clinic
what type of EHC is most effective?
IUD
what part of the cycle do you ovulat
MIDDLE
why do you ovulate
due to a hormone surge
increasing levels of LH and FSH
how does EHC work?
stops ovulation
when is day 1 of the natural cycle
first day of period or first pill in the pill pack
how many people actually ovulate at day 14?
25% women
what days can ovulation occur in
6-21
7 indications for EHC?
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
how long does a diaphragm need to stay in place for?
6 hours after intercourse
what can you give if a patient has UPSI within 28 days following use of liver enzyme inducing drugs
offer Cu-IUD
or a double dose 3mg LNG
levonelle mechanism of action and what is it
type of progestogen
prevents ovulation and discourage implantation
what is levonelle licensed for (age?)
16 years and older
ellaone what is it? how does it work?
progesterone receptor modulator
delays ovulation and alters endometrium to prevent implantation
who is ella one licensed for?
all women of childbearing age
aka if a young girl has started period
must use professional judgement and that the child is gillick competence
levonelle timeframe?
72 hours
ellaone timeframe?
5 days
IUD timeframe?
10 days roughly
how effective is levonelle at:
<24 hours after UPSI
25-48 hours after UPSI
48-72 hours after UPSI
<24: 95%
25-48: 85%
49-72: 58%
levonelle overalll efficacy? why should we be cautious about telling patients this?
84%
wrong to say this if theyre getting it on the third day
effect of BMI on levonelle?
if BMI >26 they may find the efficacy is reduced
important to make patient aware
ella one efficacy? pregnancy rate in 48-120 hour time window?
higher than LNG
48-120 hours theres 2% pregnancy rate
what reduces the efficacy of ellaone?
if any progesterone is taken in 5 days post taking ellaone aka all forms of contraception
1000 women have sex, how many will get pregnant with: no contraception? those who use ellaone? those who use levonelle? those who use IUD
NONE: 80
EllaOne: 5
LNG: 10
IUD: 1
adverse effects of levonelle:
headache nausea breast tenderness lower abdo pain irregular bleeding: mensural changes fatigue increased risk of ectopic pregnancy- REFER ABDO PAIN dizziness
ellaone adverse effects?
headache nausea abdo pain dysmenorrhea mild dizziness
what side effect must women be counselled on?
nausea: if occurs within 3 hours come back for another dose
is pregnancy a C/I for EHC?
YES, cannot take this as an abortion product
would EHC affect an unborn child?
no
C/I of levonelle?
pregnancy
bowel disease- reduces absorption
hepatic impairment- metabolism
enzyme inducers (CYP3A4 inducing drugs
examples of enzyme inducers which can effect Levonelle
St john wort, rifampicin, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbituates
what to do if patient is on enzyme inducers? what will happen?
refer to GUM clinic or GP: will be given 2 doses 12 hours apart
is a second dose licensed?
no
ellaone contraindications?
pregnancy
hepatic impairment
asthma uncontrolled by oral steroids (oral not inhalsed)
breastfeeding- discard for 1 week
ellaone drug interactions?
CYPA43 inhibitors ritonavir levonorgestrel hormonal contraception progestogen containing drugs
what must you do if you want to give ellaone to someone who is breastfeeding?
advise that it passes into milk so they need to pump and discard for 1 week
how does progesterones impact ellaone. so what do we advise?
prevents the ability of UPA to delay ovulation
dont take hormonal contraception for 5 days after ellaone
checklist for OTC consultation if NOT on contraception
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
when to take a pregnancy test?
if period if 5 days late for LNG or 7 days in the case of ella one
3 weeks after UPSI
