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The Pharmacist Year 3 > EHC COPY > Flashcards

EHC COPY 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
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?
Leveonelle is cheaper
27
ellaOne product advice
* 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
Levonelle product advice
* 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
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
- >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
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 EHC 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 EHC 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 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

The Pharmacist Year 3 (5 decks)

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