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EHC Y4 > EHC COMPLETE > Flashcards

EHC COMPLETE 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

Levonelle
ellaOne
Copper-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 or 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

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19
Q

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

A

2nd dose levonelle 12 hours after (not licensed but is conservative practice - GP, PGD)

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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)

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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

Levonelle is cheaper

27
Q

ellaOne product advice

A

Take one stat
Delays ovulation
2% pregnancy rate in the 5 days

Side effects:
Nausea, headache or dizziness

2nd dose required if vomit within 3 hours
NMP may appear different

28
Q

Levonelle product advice

A

Take one today
Delays ovulation
Pregnancy risk increases from day 1 (2%) to day 3 (5%)

Side effects:
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

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 Levonelle 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 ellaOne 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 indicated 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

44
Q

When is EHC indicated with a COCP?

A

2 or more missed pills within 7 days

45
Q

When is EHC indicated with a POP?

A

If 1 or more pills are missed within 7 days

46
Q

When is EHC indicated with Zoely or Qlaira?

A

If a pill is taken over 12 hours late

47
Q

When is EHC indicated with Micronor or Noriday?

A

If a pill is taken over 3 hours late

48
Q

When is EHC indicated in GI illness?

A

If vomiting occurs within 3 hours of taking a POP

If the patient has persistent diarrhoea for >24 hours

49
Q

What is the advice for regular contraception if EHC is given in the 3rd week?

A

Omit 7 day break and run the next pack through

Extra precautions until next bleed

50
Q

What advice should be given after EHC regarding NMP?

A

May be lighter, heavier, earlier or later

If over 5 days late, take a pregnancy test

51
Q

What physical factor may reduce efficacy of levonelle?

A

BMI >26>70kg

EHC Y4 (2 decks)

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