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OSCE Year 3 > EHC > Flashcards

EHC Flashcards

1
Q

API in Levonelle

A

Levonorgestrel 1.5mg

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2
Q

API in ellaOne

A

Ulipristal acetate 30mg

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3
Q

What are the 3 forms of emergency contraception?

A

Leveonelle
ellaOne
Coppier-bearing IUD (Non-hormonal)

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4
Q

List the 3 types of hormonal contraception from most effective to least effective

A

Copper-bearing IUD
ellaOne
Levonelle

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5
Q

When is pregnancy most likely in a woman’s cycle?

A

Pregnancy is possible at any point in the month, and most likely around the ovulation period.
Ovulation may occur between days 6-21 in cycles, but not all women have 28 day cycles.

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6
Q

Indications for Levonelle and ellaOne

A

-After UPSI
Hours since UPSI must be established
Episodes of UPSI in current cycle must be established
-after ejaculation on to external genitalia
-after contraceptive failure

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7
Q

Give example of contraceptive failure

A
  • split condom (male/female)
  • missed pills
  • DDI with hormonal contraception
  • Delayed contraceptive implant or injection
  • detached contraceptive patch
  • dislodged IUD
  • dislodged/early removal of diaphragm
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8
Q

Levonelle mechanism of action

A

Prevents ovulation and fertilisation

Discourages implantation

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9
Q

ellaOne mechanism of action

A

Delays ovulation

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10
Q

Age for Levonelle

A

Licensed OTC for ages 16 and over

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11
Q

Age for ellaOne

A

Licensed OTC for all women of childbearing age

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12
Q

Levonelle hours since UPSI licence

A

Licensed up to 72 hours after UPSI

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13
Q

ellaOne hours since UPSI licence

A

Licensed up to 120 hours after UPSI

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14
Q

Efficacy of UPA in ellaOne reduced when?

A

Efficacy of UPA reduced if any progesterone is taken in the 5 days post UPA (or before)
- offer Levonelle (LNG) instead

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15
Q

Sources of progesterone

A

COC, POP, HRT, LARCs

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16
Q

Side effects of Levonelle

A 
Headache 
Nausea
Breast tenderness
Lower abdominal pain 
Irregular bleeding
Fatigue 
Dizziness 
Increased risk of ectopic pregnancy
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17
Q

Side effects of ellaOne

A 
Headache 
Nausea
Abdominal Pain 
Dysmenorrhoea 
Mild to moderate dizziness
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18
Q

Contraindications of Levonelle

A

Pregnancy
Bowel disease
Hepatic impairment
Enzyme inducers e.g. St John’s Wort, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbituates

19
Q

What to do if a patient is on an enzyme inducer drug and you must give them leveonelle?

A

2nd dose levonelle 12 hours after

not licensed but is conservative practice - GP, PGD

20
Q

Contraindications of ellaOne

A

pregnancy/suspected pregnancy
severe hepatic impairment
severe asthma uncontrolled by oral steroids
breastfeeding (36hr/1 week abstention)
drug interactions (CYP3A4 inducers, ritonavir (long term), levonorgesterel, hormonal contraception, progestogen-containing drugs)

21
Q

How does progestogen affect ellaOne action?

A

Progestogen reduces the ability of UPA to delay ovulation. It is unknown whether this reduces the effectiveness of UPA in preventing pregnancy.
Progestogen or progesterone-containing drugs taken before UPA may theoretically affect effectiveness

22
Q

What action does a lady need to take if vomiting occurs after she takes EHC?

A

Take another dose/come back to pharmacy

23
Q

What should you warn a woman about what may happen after she has EHC?

A
  • pregnancy MAY occur but unlikely
  • if you vomit, come back to the pharmacy for another dose
  • your next period may be late, heavy or light
  • spotting may occur
  • if next period is different or >5 days late (LNG) or >7 days late (UPA) perform a pregnancy test 3-4 weeks after UPSI
  • seek medical advice if lower abdominal pain occurs
24
Q

Late periods after EHC - how late and what to do?

A

-If period >5 days late after taking Leveonelle , or
-if period >7 days late after taking ellaOne
Perform pregnancy test 3-4 weeks after UPSI

25
Q

Advice regarding continuing contraception after EHC

A
  • EHC is only for current pregnancy risk, continuing contraception may be required
  • use a barrier method until next period
  • oral EHC doesn’t provide protection against sexually-transmitted infections or further contraceptive cover
  • discuss risk/screening for STIs etc.(ask if regular partner, sensitively)
26
Q

Which EHC is cheaper?

A

Leveonelle is cheaper

27
Q

ellaOne product advice

A
  • take one stat
  • delays ovulation
  • 2% pregnancy rate in the 5 days
  • Nausea, headache or dizziness
  • 2nd dose required if vomit within 3 hours
  • NMP may appear different
28
Q

Levonelle product advice

A
  • Take one stat
  • Delays ovulation
  • Pregnancy risk increases from day 1 (2%) to day 3 (5%)
  • Nausea, headache, refer abdominal pain
  • 2nd dose required if vomit within 3 hours
  • NMP may appear different
29
Q

Continuing contraception after ellaOne

A
  • Omit normal pill today – 5 days if containing progesterone
  • use barrier contraception until NMP
  • STIs – establish relationship status and signpost
30
Q

Continuing contraception after Levonelle

A
  • Omit normal pill today
  • use barrier contraception for 7 days (2 for POP, 9 for Qlaira)
  • STIs – establish relationship status and signpost
31
Q

How does regular contraception work?

A

Works by making ovaries dormant

32
Q

What is the effect of missed contraceptive pills on protection from pregnancy?

A

Missed pills stop dormancy and trigger ovulation

After missed pills and EHC, the aim is to make the ovaries dormant again

33
Q

BNF advice on starting a COC when previously on a POP

A
  • Ensure previous contraception taken effectively/exclude pregnancy
  • If starting a COC on day 6 or later, add precautions for 7 days
  • First 7 and last 7 (active pills) important
34
Q

BNF advice on starting a POP when previously on a COC

A
  • POP (Qlaira) - additional precautions for 9 days

- POP (other brand) - add precautions for 7 days

35
Q

Advice on starting a POP for the first time - advice?

A
  • Start at any point and no additional precautions if on Micronor/Noriday
  • If starting Cerazette POP start within days 1-5 (period) and no additional precautions needed
  • If starting Cerazette from day 6 onwards, use additional precautions for 2 days
36
Q

Changing to a POP from a COC (ED)

A

If ED/placebo pills taken, use additional precautions for 2 days

37
Q

COC (not ED) to POP

A

Omit pill-free period, start POP immediately for immediate cover

38
Q

COC to POP (Cerazette)

A

Omit pill-free period for immediate cover

If pill-free period was taken, use additional precautions for 2 days

39
Q

Missed pill advice - COC

A
  • > 24 hours late
  • If starting on day 6 or later, add precautions for 7 days
  • critical at end or start of cycles as pill-free period elongated
  • EHC indicated if 2 or more COC pill missed (>24 hours late)
  • takes 7 days to build cover back up
40
Q

Missed pill advice - POP Cerrelle

A

If >3 hours late:
Continue pills with 2 days extra precautions
EHC indicated if 1 or more pills missed (>3 hours late) and UPSI occurs before 2 tablets are taken correctly.
-takes 2 days to build cover back up

41
Q

Continuing contraception advice after EHC taken (LNG)

A

Today - omit regular dose of contraception
Tomorrow onwards:
-additional contraception precautions for 7 days (CHC) or 2 days (POP) or 9 days (Qlaira COC)
In future correct/effective contraception use to avoid further risk of pregnancy

42
Q

Continuing contraception advice after EHC taken (UPA)

A

Today - omit regular dose of contraception
Tomorrow onwards:
Omit COC/POP for 5 days and use additional precautions until next menstrual period
In future correct/effective contraception use to avoid further risk of pregnancy

43
Q

Missed pill advice - POP Cerazette

A

If >12 hours late
continue pills with 2 days extra precautions
EHC indicatedi if 1 or more pills missed (>3hrs late) and UPSI occurs before 2 tablets are taken correctly
-takes 2 days to build contraceptive cover back up

OSCE Year 3 (25 decks)

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