EHC

Question 1

what interacts with oral contraceptive

Answer 1

enzyme inducers (scrap GP)- reduce effectiveness
st john wort / sfu
carbamazepine
rifampicin/ rifambutin
alcohol
phenytoin
griseofulvin
phenobrabitol

Question 2

contraception you can use when on enzyme inducers

Answer 2

COPPER IUD
progestogen only injection
use up until 4 weeks after stopping interacting drug

Question 3

type of emergency contraception

Answer 3

copper IUD
up to 3mg levonorgestrel (unlincenced)
ulipristal 30mg (reduced efficacy antacids, h2 , ppi )

Question 4

Emergency contraception who makes clinical guideline

Answer 4

FSRH

Question 5

1ST line EHC

Answer 5

copper IUD
most effective
insert up to 120hrs (5days) after UPSI or up to 5 days after earliest calc ovulation

Question 6

second line EHC: hormonal

Answer 6

copper IUD not acceptable/ appropriate
oral ehc : levonorgestrel or ulipristal (more effective)
offer asap to increase efficacy

Question 7

what Hormonal EHC to give if bmi>26 or> 70kg

Answer 7

ulipristal is fine but have to double dose of levonorgestrel to 3mg as high bw decrease efficacy

Question 8

levonorgestrel moa and dose

Answer 8

-prevent ovultation and fertilisation
dose: 1500mg <72h (3 days) of uPSI
if vomiting <3hrs of taking = replace dose

Question 9

caution in giving levonorgestrel

Answer 9

crohns - malabsorption
past ectopic pregnancy
-ciclosporin( toxcicity)

Question 10

ulipristal MOA and dose

Answer 10

progestogen receptor modular inhibit delay ovulation (more effective than levonorgestrel)
-<120hrs of UPSI or if likely before the estimated 5 days of ovulation
dose: 30mg <120 hrs
if vomiting <3hrs = take another

Question 11

cautions in ulipristal

Answer 11

-severe asthma tx oral steroid
- severe liver impairment

Question 12

c/I ulipristal

Answer 12

repeat use in same cycle

Question 13

can you repeat use of levonorgestrel same cycle

Answer 13

manufacturer advise avoid due to menstrual irregularities but it can be done

Question 14

patient counselling on ulipristal;
reduces effectiveness of regular contraceptive so how long barrier method

Answer 14

COC= 14days (16 if qlaira)
progestogen only= 9 days (14 if parenteral)

Question 15

how long to wait after using Levenorgestrol before starting normal contraceptive pill

Answer 15

5 days, use condom reliably or abstain from sex during this period as contraceptive effect of ulipristal reduced

Question 16

EHC s/e

Answer 16

menstrual irregularity