EHC & Progesterone Pill Flashcards
Which 2 drugs are currently used as emergency contraceptives (give their doses too)?
Levonorgestrel 1.5mg
Ulipristal acetate 30mg
How long after unprotected sexual intercourse can levonorgestrel be given?
Within 3 days (72h) after sexual intercourse.
What age is levonorgestrel licensed as a P medicine?
> 16 years old
How long after unprotected sexual intercourse can ulipristal acetate be given?
Within 5 days (120h) after sexual intercourse
What are the brands for levonorgestrel and ulipristal acetate?
Levonelle - levonorgestrel
ellaOne - ulipristal acetate
When can an intra-uterine device (IUD) be fitted after unprotected sexual intercourse?
5 days after sexual intercourse
What should a patient do if they vomit within 2h of taking levonorgestrel?
Take another tablet immediately.
What should a patient do if they vomit within 3h of taking ulipristal acetate?
Take another tablet immediately.
What class of drugs reduce the efficacy of emergency contraception?
Enzyme inducers, e.g. rifampicin, phenytoin, carbamazepine, ritonavir
Why do EHC’s have a long half life?
Because it gets circulated in the portal vein, which constantly gets reabsorbed & circulated in the body.
What should you do if a woman is taking an enzyme inducing drug, and requests emergency contraception?
Give double dose levonorgestrel, or refer to get a C-IUD fitted.
Which emergency contraception do you give if a person has a BMI of >26kg/m^2, or is >70kg?
Either ulipristal acetate, or double dose levonorgestrel
Which immunosuppressive drug can increase in toxicity when given with levonorgestrel?
Ciclosporin - its metabolism is inhibited.
What are the benefits of fitting a copper IUD?
Provides immediate effective contraception
Does not affect BMI/weight, or with other drugs
Which EHC should asthmatic women taking glucocorticoids NOT be given?
Ulipristal acetate
Which medical conditions should levonorgestrel be avoided in?
Severe liver dysfunction
Crohns disease
Inflammation of fallopian tubes
What could lower abdominal pain after taking EHC signify?
It could signify an ectopic pregnancy & she must be referred immediately.
What is contained in a combined oral contraceptive pill (COC)?
Progesterone & oestrogen.
What classifies as a missed pill if a woman is taking a COC?
If >2 pills are missed in the 1st week
If >7 pills are missed in any week during contraceptive therapy
If her pill free week is extended
How many days does it take for COCs to reach maximum efficacy?
7 days, after that the pill is at its max. efficacy
Why is the last week of the contraceptive pack considered a placebo week?
Because they are there to help the woman make a habit of taking the pill regularly until she starts a new pack the next month.
This is why some packs contain 21, or 28 tablets.
What precautions must be taken if a woman is on COCs, and has taken either levonorgestrel or uripristal (and for how long)?
Use barrier methods/extra precaution/refrain from sex:
Levonorgestrel: 7 days, then restart COC immediately
Ulipristal acetate: 12 days, restart COC 5 days after taking EHC
When is EHC not given to a woman who is taking COCs?
If she has missed <2 pills in the first week
If she has missed 2-7 pills in any other week during contraceptive therapy
What is considered a late/missed pill if the woman is taking progesterone only pills (POP)?
If she has taken her next dose >12h after her previous one.
This is why POP’s should be taken at the same time everyday
How many days do POPs reach max. efficacy?
2 days
When is EHC given if the woman uses POP?
If she has missed a pill, or taken it late
If she has unprotected sex before the max. efficacy of the POP has been established (2 days)
What precautions must be taken if a woman is on POPs, and has taken either levonorgestrel, or uripristal (and for how long)?
Use barrier methods/extra precaution/refrain from sex:
Levonorgestrel: 2 days, restart POP immediately
Ulipristal acetate: 7 days, restart POP 2 days after taking EHC
If a woman is breastfeeding, when should she take levonorgestrel?
After breastfeeding, to avoid the amount of levonorgestrel in breast milk in the next feed.
How long after taking ulipristal can a woman not breastfeed for?
1 week because it would be present in the breast milk
What are the 2 mini-pills available in pharmacies to buy (including doses)?
Lovima 75mcg tablets
Hana 75mcg tablets
What type of progesterone is present in the mini pill?
Desogestrel.
How does desogestrel prevent pregnancy?
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.
How are mini pills usually taken?
At the same time everyday (like POPs)
What conditions contraindicate the use of the mini pill?
Active thrombosis
Active/history of liver disease/cancer
Active/suspected sex-steroid sensitive cancer
Undiagnosed vaginal bleeding
Hypertension/uncontrolled diabetes
What happens if a woman has missed her mini pill for >12h?
She should take her next dose as soon as she remembers
She is now also unprotected, so should use barrier methods for 2 days
Supply EHC if she had unprotected sex after her missed pill
Which specific anti-epileptic drug should not be given with Lovima & why?
Lamotrigine because the mini pill reduces its efficacy
What should happen if a woman vomits 3-4h after taking her mini pill?
Follow the missed pill rule.
Take the pill, and next dose as normal
Protection for 2 days
