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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
Advice regarding continuing contraception after EHC
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
Which EHC is cheaper?
Levonelle is cheaper
27
ellaOne product advice
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
Levonelle product advice
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
Continuing contraception after ellaOne
Omit normal pill today – 5 days if containing progesterone Use barrier contraception until NMP STIs – establish relationship status and signpost
30
Continuing contraception after Levonelle
Omit normal pill today Use barrier contraception for 7 days (2 for POP, 9 for Qlaira) STIs – establish relationship status and signpost
31
How does regular contraception work?
Works by making ovaries dormant
32
What is the effect of missed contraceptive pills on protection from pregnancy?
Missed pills stop dormancy and trigger ovulation | After missed pills and EHC, the aim is to make the ovaries dormant again
33
BNF advice on starting a COC when previously on a POP
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
BNF advice on starting a POP when previously on a COC
POP (Qlaira) - additional precautions for 9 days | POP (other brand) - add precautions for 7 days
35
Advice on starting a POP for the first time - advice?
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
Changing to a POP from a COC (ED)
If ED/placebo pills taken, use additional precautions for 2 days
37
COC (not ED) to POP
Omit pill-free period, start POP immediately for immediate cover
38
COC to POP (Cerazette)
Omit pill-free period for immediate cover | If pill-free period was taken, use additional precautions for 2 days
39
Missed pill advice - COC
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
Missed pill advice - POP Cerrelle
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
Continuing contraception advice after Levonelle taken (LNG)
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
Continuing contraception advice after ellaOne taken (UPA)
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
Missed pill advice - POP Cerazette
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
When is EHC indicated with a COCP?
2 or more missed pills within 7 days
45
When is EHC indicated with a POP?
If 1 or more pills are missed within 7 days
46
When is EHC indicated with Zoely or Qlaira?
If a pill is taken over 12 hours late
47
When is EHC indicated with Micronor or Noriday?
If a pill is taken over 3 hours late
48
When is EHC indicated in GI illness?
If vomiting occurs within 3 hours of taking a POP | If the patient has persistent diarrhoea for >24 hours
49
What is the advice for regular contraception if EHC is given in the 3rd week?
Omit 7 day break and run the next pack through | Extra precautions until next bleed
50
What advice should be given after EHC regarding NMP?
May be lighter, heavier, earlier or later | If over 5 days late, take a pregnancy test
51
What physical factor may reduce efficacy of levonelle?
BMI >26>70kg

EHC Y4 (2 decks)

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