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PY7020 REVISION > EHC & Progesterone Pill > Flashcards

EHC & Progesterone Pill Flashcards

1
Q

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

A

Levonorgestrel 1.5mg
Ulipristal acetate 30mg

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2
Q

How long after unprotected sexual intercourse can levonorgestrel be given?

A

Within 3 days (72h) after sexual intercourse.

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3
Q

What age is levonorgestrel licensed as a P medicine?

A

> 16 years old

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4
Q

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

A

Within 5 days (120h) after sexual intercourse

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5
Q

What are the brands for levonorgestrel and ulipristal acetate?

A

Levonelle - levonorgestrel
ellaOne - ulipristal acetate

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6
Q

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

A

5 days after sexual intercourse

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7
Q

What should a patient do if they vomit within 2h of taking levonorgestrel?

A

Take another tablet immediately.

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8
Q

What should a patient do if they vomit within 3h of taking ulipristal acetate?

A

Take another tablet immediately.

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9
Q

What class of drugs reduce the efficacy of emergency contraception?

A

Enzyme inducers, e.g. rifampicin, phenytoin, carbamazepine, ritonavir

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10
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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11
Q

What should you do if a woman is taking an enzyme inducing drug, and requests emergency contraception?

A

Give double dose levonorgestrel, or refer to get a C-IUD fitted.

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12
Q

Which emergency contraception do you give if a person has a BMI of >26kg/m^2, or is >70kg?

A

Either ulipristal acetate, or double dose levonorgestrel

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13
Q

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

A

Ciclosporin - its metabolism is inhibited.

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14
Q

What are the benefits of fitting a copper IUD?

A

Provides immediate effective contraception
Does not affect BMI/weight, or with other drugs

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15
Q

Which EHC should asthmatic women taking glucocorticoids NOT be given?

A

Ulipristal acetate

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16
Q

Which medical conditions should levonorgestrel be avoided in?

A

Severe liver dysfunction
Crohns disease
Inflammation of fallopian tubes

17
Q

What could lower abdominal pain after taking EHC signify?

A

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

18
Q

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

A

Progesterone & oestrogen.

19
Q

What classifies as a missed pill if a woman is taking a COC?

A

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

20
Q

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

A

7 days, after that the pill is at its max. efficacy

21
Q

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

A

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.

22
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/extra precaution/refrain from sex:

Levonorgestrel: 7 days, then restart COC immediately

Ulipristal acetate: 12 days, restart COC 5 days after taking EHC

23
Q

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

A

If she has missed <2 pills in the first week
If she has missed 2-7 pills in any other week during contraceptive therapy

24
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 after her previous one.

This is why POP’s should be taken at the same time everyday

25
Q

How many days do POPs reach max. efficacy?

A

2 days

26
Q

When is EHC given if the woman uses POP?

A

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)

27
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/extra precaution/refrain from sex:

Levonorgestrel: 2 days, restart POP immediately

Ulipristal acetate: 7 days, restart POP 2 days after taking EHC

28
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.

29
Q

How long after taking ulipristal can a woman not breastfeed for?

A

1 week because it would be present in the breast milk

30
Q

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

A

Lovima 75mcg tablets
Hana 75mcg tablets

31
Q

What type of progesterone is present in the mini pill?

A

Desogestrel.

32
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.

33
Q

How are mini pills usually taken?

A

At the same time everyday (like POPs)

34
Q

What conditions contraindicate the use of the mini pill?

A

Active thrombosis
Active/history of liver disease/cancer
Active/suspected sex-steroid sensitive cancer
Undiagnosed vaginal bleeding
Hypertension/uncontrolled diabetes

35
Q

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

A

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

36
Q

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

A

Lamotrigine because the mini pill reduces its efficacy

37
Q

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

A

Follow the missed pill rule.

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

PY7020 REVISION (42 decks)

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