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PY6020 > EHC & Progesterone Pill > Flashcards

EHC & Progesterone Pill Flashcards

1
Q

What are some examples of issues that you could suspect when supplying an emergency contraceptive?

A
  1. Non-consensual intercourse
  2. Child protection
  3. Vulnerable adults
  4. Consent/confidentiality
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2
Q

Which 2 drugs are currently used as emergency contraceptives (give their doses too)?

A
  1. Levonorgestrel 1500mcg (1.5mg) tablets

2. Ulipristal acetate 30mg tablet

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3
Q

Can you provide contraception/sexual health advice to a child <16 years old?

A

Yes, as it may be consensual in their case.

Use your judgement and assess the situation.

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4
Q

How long after unprotected sexual intercourse can levonorgestrel be given, & at what age is it licensed as a P medicine?

A

It must be taken within 72h (3 days) after unprotected sexual intercourse.

It is licensed as a P medicine >16years old.

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5
Q

How is levonorgestrel given to <16 year olds?

A

As a POM under a PGD

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6
Q

How long after unprotected sexual intercourse can ulipristal acetate be given?

A

It must be taken within 120h (5 days) after unprotected sexual intercourse.

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7
Q

What brand contains ulipristal acetate?

A

ellaOne.

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8
Q

What is the mechanism of action of ulipristal acetate?

A

It is a selective progesterone receptor modulator (SPRM) & inhibits/delays ovulation of the female.
This hence alters the endometrial environment and inhibiting implantation from occurring.

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9
Q

When should an intra-uterine device (IUD) be fitted after unprotected sexual intercourse?

A

An IUD should be fitted 5 days after unprotected sex (or within 5 days of expected ovulation).

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10
Q

What information should you need before supplying EHC?

A
  1. When the sexual intercourse happened.
  2. Age

______________________
3 days: Levonorgestrel 1500mcg
5 days: ellaOne (ulipristal acetate) 30mg, or IUD

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11
Q

When should you refer a patient who wishes to purchase an EHC?

A
  1. If her last period was late
  2. If her last period was lighter/shorter than normal
  3. If her last period was unusual in any way
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12
Q

What class of drugs reduce the efficacy of levonorgestrel?

A

Anti-epileptic drugs, e.g. phenytoin, carbamazapine.
They are enzyme inducers.

  • Others can include rifampicin, ritonavir, St. johns wort, and rifabutin.
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13
Q

Why do EHC’s have a long half life?

A

Because it gets circulated in the portal vein, which constantly gets reabsorbed & circulated in the body.

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14
Q

Which immunosuppressive drug can increase in toxicity when given with levonorgestrel?

A

Ciclosporin - its metabolism is inhibited.

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15
Q

What are some examples of some drugs that interact with ulipristal acetate, & should be avoided?

A
  1. Carbamazepine
  2. Phenobarbital
  3. St. johns wort
  4. Rifampicin
  5. Nevirapine
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16
Q

What should you offer to women who plan on purchasing an EHC, but are taking enzyme-inducing drugs?

A

Either:
1. Encourage to fit a copper IUD (Cu-IUD)

OR

  1. Consider double dose of levonorgestrel (3mg), although may be ineffective
    - Do not give double dose of ulipristal acetate
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17
Q

How could the effectiveness of ulipristal acetate be reduced?

A

If she has taken progesterone-only pills 7 days before, or 5 days after taking ulipristal acetate.

  • E.G. she is on regular progesterone-only contraceptives, but has missed a dose & needs EHC.
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18
Q

Which EHC is given if the patient has a BMI >26Kg/m^2, (or weighing >70kg)?

A

Ulipristal acetate

  • Double dose of levonorgestrel can alternatively be given (3mg)
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19
Q

What are the benefits of fitting a copper IUD?

A
  1. Provides immediate effective ongoing contraception

2. Does not affect BMI/weight or with other drugs

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20
Q

Which bodily system does EHC increase the risk of?

A

Blood clotting - consultation is needed if the person is overweight.

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21
Q

Which EHC should asthmatic women taking glucocorticoids NOT be given?

A

Ulipristal acetate

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22
Q

Which medical conditions should levonorgestrel be avoided in?

A
  1. Severe liver dysfunction
  2. Crohns disease
  3. Inflammation of fallopian tubes
23
Q

What should the patient do if she vomits 2h after taking levonorgestrel?

A

She must take another dose of 1.5mg levonorgestrel immediately.

24
Q

What should the patient do if she vomits 3h after taking ulipristal acetate?

A

Another 30mg tablet should be taken immediately.

25
Q

What are some common side effects of EHC?

A
  1. Headache
  2. Nausea
  3. Altered bleeding patterns (next period being late/early)
26
Q

What could lower abdominal pain after taking EHC signify?

A

It could signify an ectopic pregnancy & she must be referred immediately.

27
Q

What should the patient do if her next period is light/heavy/unusual in any way after taking EHC?

A

She should do a pregnancy test 3 weeks after unprotected sex

28
Q

What is contained in a combined oral contraceptive pill (COC)?

A

Progesterone & oestrogen.

29
Q

How many COC pills can be missed for it to be considered missed pills?

A

2 pills or more

30
Q

How many days does it take for COCs to reach maximum efficacy?

A

7 days (due to hepatic metabolism)

After week 1 of taking COCs, the pill is at its max. efficacy

31
Q

If a woman is taking COC pills, and they miss 2 or more pills in their first week (or barrier failure/unprotected sex), what is given?

A

EHC, as the pill hasn’t reached its max. efficacy within the 1st week.

32
Q

Why is the last week of the contraceptive pack considered a placebo week?

A

The last 7 days contain placebo pills which are there to help the woman make a habit of taking the pill regularly, until she starts a new pack the next month.

  • This week is also known as the ‘pill-free’ week.

This is why some packs contain 21, or 28 tablets.

33
Q

If a woman is taking COCs, when will EHC be needed?

A
  1. If her ‘pill-free’ week (placebo week) is extended
  2. If >2 pills are missed in the 1st week - reduced efficacy
  3. If >7 pills are missed in any week during contraceptive therapy
34
Q

What precautions must be taken if a woman is on COCs, and has taken either levonorgestrel or uripristal (and for how long)?

A
  • Use barrier methods/refrain from sex
    1. For levonorgestrel: 7 days (to reach efficacy) - restart COC immediately
    2. For uripristal: 12 days - restart COC 5 days after taking uriprisal
35
Q

When is EHC not given to a woman who is taking COCs?

A
  1. If she has only missed 1 pill during the 1st week

2. 2-7 pills are missed 2-3 weeks during contraceptive therapy

36
Q

What is considered a late/missed pill if the woman is taking progesterone only pills (POP)?

A

If she has taken her next dose >12h from her previous dose.

This is why POPs should be taken at the same time everyday.

37
Q

How many days do POPs reach max. efficacy?

A

2 days.

38
Q

When is EHC given if the woman uses POP?

A
  1. If she has taken her pill late or missed a pill

2. She has had unprotected sex/failed barrier method before max. efficacy of the POP has been established (2 days)

39
Q

What precautions must be taken if a woman is on POPs, and has taken either levonorgestrel, or uripristal (and for how long)?

A
  • Use barrier methods/refrain from sex
    1. For levonorgestrel: 2 days (to react efficacy) - restart POP immediately
  1. For uripristal: 7 days - restart POP 5 days after uripristal given
40
Q

Which EHC is given if a woman has missed her POP for >12h?

A

Levonorgestrel.

41
Q

If a woman is breastfeeding, when should she take levonorgestrel?

A

After breastfeeding, to avoid the amount of levonorgestrel in breast milk in the next feed.

42
Q

When can you not breast feed after taking ulipristal acetate?

A

After using uripristal, you cannot breast feed for 1 week because it would be present in breast milk.

43
Q

What is the mini pill?

A

It is a POP licensed as P in pharmacies, so women can buy them.

44
Q

What are the 2 mini-pills available in pharmacies to buy (including doses)?

A
  1. Lovima 75mcg tablets

2. Hana 75mcg tablets

45
Q

What type of progesterone is present in the mini pill?

A

Desogestrel.

46
Q

How does desogestrel prevent pregnancy?

A

It inhibits ovulation by thinning the lining of the uterus & preventing implantation of the fertilised egg.
Cervical mucus also thickens & prevents the sperm from penetrating the egg.

47
Q

How are mini pills usually taken (remember they are POPs)?

A

One tablet at the same time everyday.

You must start it on day 1 of period.

48
Q

What conditions contraindicate the use of the mini pill?

A
  1. Active thrombosis - blood clotting
  2. Active/history of liver disease/cancer
  3. Active/suspected sex-steroid sensitive cancer - breast/uterine/ovarian
  4. Undiagnosed vaginal bleeding
  5. Hypertension/uncontrolled diabetes
49
Q

What happens if a woman has missed her mini pill for >12h?

A

She should take the pill as soon as she remembers, & carry on with the next pill at the right time.

Since she is now unprotected, she should also use a barrier method for the next 2 days.

If she had unprotected sex after her missed pill, give EHC.

50
Q

If a woman is on enzyme-inducing drugs (e.g. phenytoin/rifampicin/St. johns wort/carbamazepine), what extra precaution should she do if she is already taking mini pills?

A

She should use a temporary barrier method during the time she is taking the enzyme inducing drugs.

51
Q

Which specific anti-epileptic drug should not be given with Lovima & why?

A

Lamotrigine.

The mini pill reduces lamotrigine’s efficacy.

52
Q

What are some side effects of the mini pill?

A
  1. Acne
  2. Mood changes
  3. Breast pain
  4. Weight gain
  5. Nausea
53
Q

What should happen if a woman vomits 3-4h after taking her mini pill?

A

Follow the missed pill rule.

  • Take pill, and next dose as normal
  • Protection for 2 days

PY6020 (22 decks)

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