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OSPE > EHC > Flashcards

EHC Flashcards

1
Q

What do combined oral contraceptives contain?

A

ethinylestradiol as the oestrogen component; mestranol and estradiol are also used. The ethinylestradiol content of COCs range from 20–40 micrograms

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2
Q

What is Gedarel?

A

COC

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3
Q

What is Femodette?

A

COC

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4
Q

What is Yasmin?

A

COC

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5
Q

What is Levest?

A

COC

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6
Q

What is Microgynon ED?

A

COC

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7
Q

What is Zoely?

A

COC

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8
Q

What is Logynon ED?

A

COC

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9
Q

What is Qlaira?

A

COC

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10
Q

What is the contraceptive injection?

A

PO

Depo-Provera or Noristerat

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11
Q

What is the implant?

A

PO

Nexplanon

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12
Q

What is the hormonal IUD?

A

PO
Mirena
Jaydess
Levosert

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13
Q

What is the non-hormonal IUD?

A

Copper IUD

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14
Q

What is Micronor?

A

POP

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15
Q

What is Noriday?

A

POP

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16
Q

What is Norgeston?

A

POP

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17
Q

What is Cerazette?

A

POP

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18
Q

What is Cerelle?

A

POP

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19
Q

What is the active ingredient in Levonelle?

A

Levonorgestrel 1.5mg

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20
Q

What is the active ingredient in EllaOne?

A

Ulipristal Acetate

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21
Q

What is a non-hormonal form of EHC?

A

Copper IUD

More effective than EllaOne and Levonelle but not available OTC

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22
Q

When does ovulation most commonly occur?

A

Supposed to happen at day 14 but it can happen any time between 6-21 days. Very hard to predict and rely upon (possible to get pregnant at any part of the cycle)

23
Q

How does EHC work?

A

Delays ovulation

24
Q

When is EHC indicated? (7)

A
  • After UPSI
  • UPSI in the 28 days following the use of enzyme-inducing drugs
  • UPSI from 21 days post-partum
  • UPSI from 5 days post abortion/miscarriage/ectopic pregnancy
  • After ejaculation onto external genitalia
  • UPSI before new contraception is effective
  • After contraceptive failure
25
Q

What counts as contraceptive failure? (7)

A
  • split condom
  • missed pills
  • DDI with hormonal contraception
  • delayed contraceptive implant or injection
  • detached contraceptive patch
  • 7 days prior to IUD/IUI being dislodged/removed
  • dislodged/early removal of diaphragm
26
Q

Is copper IUD effected by enzyme-inducing drugs?

A

NO

27
Q

What is the mechanism of action for levonelle?

A

(progestogen)

(preovulation) - prevents ovulation and fertilisation and discourages implantation

28
Q

What is the mechanism of action for EllaOne?

A

(progesterone receptor modulator) - delays ovulation and alters the endometrium

29
Q

Who is levonelle licensed for ?

A

Licensed for OTC for ages 16 and over up to 72 hours after UPSI

30
Q

Who is EllaOne licensed for ?

A

OTC for all women of childbearing age (use professional judgement) up to 120 hours after UPSI

31
Q

What is the licensed framework for copper IUD?

A

10 days after UPSI

32
Q

What is Levonelle’s efficacy ?

A

95% (<24 hrs)
85% (25-48 hrs)
58% (49-72 hrs)
OVERALL EFFICACY 84%

33
Q

What is EllaOne’s efficacy?

A
  • 1st line - slightly higher efficacy than levonelle
  • lower pregnancy rate than levonelle within 72 hrs
  • 48-120 hrs 2% pregnancy rate
  • 98% effective
  • efficacy of UPA reduced if any progesterone is taken i the 5 days post UPA
34
Q

What is the weight restriction for Levonelle?

A

If BMI > 26 or >70kg, this may reduce efficacy

35
Q

What are the adverse effects for Levonelle?

A 
Headache 
Nausea 
Breast tenderness
Lower abdominal pain 
Irregular bleeding 
Fatigue 
Increased risk of ectopic pregnancy 
Dizziness
36
Q

What are the adverse effects for EllaOne?

A 
Headache 
Nausea
Abdominal pain 
Dysmenorrhea
Mild-moderate dizziness
37
Q

Why is lower abdominal pain a red flag with taking Levonelle?

A
  • Levonelle can cause ectopic pregnancy and lower abdominal pain is indicative of this (must be referred immediately)
38
Q

What are the contraindications and interactions for Levonelle?

A

Pregnancy
Bowel disease
Hepatic impairment
Enzyme inducers* - rifampicin, St John’s Wort, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbiturates

39
Q

What are the contraindications and interactions for EllaOne?

A 
Pregnancy/suspected pregnancy 
Severe hepatic impairment 
Severe asthma uncontrolled by oral steroids
Breastfeeding (express and discard for 1 week)*
Drug interactions 
CYP3A4 inducers*
Ritonavir (long term)
Levonorgestrel 
Hormonal contraception
Progestogen containing drugs
Option to REFER -  Cu-IUD
40
Q

What action is needed if the next menstrual period after EHC is lighter/unusual?

A

If next menstrual period is lighter, shorter or more than 5 (levonelle)/7 (ella one) days late pregnancy test is needed at least 3 weeks after UPSI

41
Q

What advice can you give for continuing contraception post UPSI and EHC?

A

Use a barrier method (condoms) for at least 14 days or until the next menstrual period

42
Q

Do EHCs protect against STIs?

A

NO - STI screening may be needed

43
Q

Which is the cheapest EHC?

A

Levonelle

44
Q

Can you use multiple EHCs per cycle?

A

YES as long as its the same type

45
Q

How long do extra precautions need to be carried out after EHC?

A

7 day rule – takes 7 days for contraception to be re-established for COC (2 days for POP) with the exception being COC Qlaira which takes 9 days

POCs can be implant or injection – tends to be 7 days (slightly different rule)

46
Q

Advice for starting a COC?

A
  • First and last 7 important (active pills)
  • Starting COC – day 6 or later? Add precautions for 7 days (ideally start on day 1-5 of natural cycle)
    QS – quick start method starting on different day of cycle (barrier method needed)
47
Q

Changing COC to POP advice ?

A
  • COC-POP- ensure previous contraception taken effectively or exclude pregnancy; use additional precautions for 2/7, if pill-free period
  • COC(ED) to POP – use addition precaution for 2/7, if ED/placebo pills taken
  • COC(non-ED) to POP – for immediate cover, omit pill-free period, start POP immediately
  • COC to Cerazette (POP) – for immediate cover, omit pill-free period.
  • For immediate cover: when they reach last COC pill, they do not have 7 day break and immediately start taking POP )no withdrawal bleed) (no barrier method needed)
48
Q

Starting a POP advice?

A
  • (Cerazette) start within days 1-5 & no additional precautions needed (day 6 onwards, use additional precautions for 2/7 (Quick-start)
  • (Micronor/Noriday) – no add precautions days 1-5**
  • POP needs to be taken every day at same time
49
Q

Changing POP to COC?

A

POP – Qlaira (COC) (additional precautions for 9 days)
POP – Zoely (additional precautions for 7 days)
POP-COC (add precautions for 7/7)

50
Q

Missed pill advice for COC?

A
  • > 24 hrs LATE
  • If starting on day 6 or later, add precautions for 7 days
    Critical at end or start of cycles as PF period elongated
  • EHC indicated if 2 or more missed (>24 hrs)*
  • except Zoely24+4 and Qlaira26+2 – where EHC indicated if 1 or more missed (>12 hrs)*

Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7/9 or 2 days

51
Q

Missed pill advice for POP?

A
  • > 3 hrs late [Micronor/Noriday]
  • > 12hrs late [*Cerazette Cerrelle]
  • Continue pills with 2 days extra precautions
  • EHC indicated if 1 or more pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly]

Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7/9 or 2 days

52
Q

Continuing contraception advice after EHC?

A

TODAY
Omit regular dose of usual hormonal contraception
TOMORROW ONWARDS
Following LNG,
additional contraceptive precautions for 7 days [COC] OR (2 days for POP, 9 days for Qlaira®)- see BNF
Following ellaOne® Omit for COC/POP FOR 5 days and use additional precautions until next menstrual period or for at least the next 14 days

In future, correct/effective contraceptive use or abstinence to avoid further risk of pregnancy.

53
Q

How to exclude pregnancy in an EHC consultation?

A
  • ask about last menstrual period (was it normal?)

- ask if there has been any other occasions of UPSI in between

OSPE (1 decks)

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