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PHA223 > emergency contraception > Flashcards

emergency contraception Flashcards

1
Q

menstrual cycle definition

A

time from the first day of menstruation up to the day before the next menstruation

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2
Q

How does oral EC work?

A

by delaying ovulation

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3
Q

When does ovulation occur?

A

14 days before menstruation starts

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4
Q

How to calculate estimated ovulation date?

A

determining the length of the patients cycle and subtracting 14

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5
Q

How to calculate expected ovulation from an irregular cycle?

A

calculate the earliest likely ovulation date using the shortest cycle in the past 12 months

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6
Q

When is the fertile peroid?

A

5 days leading up to and including the estimated ovulation day - 6 days

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7
Q

How long are sperm viable in the genital tract for?

A

5 days after UPSI

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8
Q

How long does an egg survive for?

A

12 - 24hrs

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9
Q

What is the pregnancy risk from 1 UPSI during 6 fertile days?

A

30%

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10
Q

drug in EllaOne?

A

Ulipristal

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11
Q

Where can you get EllaOne?

A

in a pharmacy

  • OTC (charged)
  • supplied by PGD (free)
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12
Q

drug in Levonelle

A

levonogestrel

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13
Q

Where can you get Levonelle?

A

in a pharmacy

  • OTC (charged)
  • PGD (free)
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14
Q

Where can you get a copper IUD?

A

GP or GUM clinic

inserted by a specially trained practitioner

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15
Q

effectiveness of copper IUD

A

> 99%

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16
Q

How does copper IUD work?

A

spermicidal and toxic to ovum

prevents fertilisation

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17
Q

When can Cu-IUD be fitted after UPSI?

A

120hrs (5 days) after

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18
Q

Is Cu-IUD effective after ovulation?

A

yes

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19
Q

When can Cu-IUD be inserted after earliest estimated ovulation?

A

up to 5 days of estimated ovulation

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20
Q

c/i for Cu-IUD

A 
pregnancy
> 48hrs or < 4 weeks postpartum
undiagnosed vaginal bleeding
gynaecological cancers (cervical, endometrial, ovarian)
acute pelvic infection
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21
Q

When can Levonelle be taken after UPSI?

A

up to 72 hrs after

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22
Q

Levonelle and the LH surge

A

If taken before the LH surge can result in ovulatory dysfunction in the subsequent 5 days
it’s less effective if taken once LH has started to rise

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23
Q

What to give if LH has risen and can’t take Levonelle?

A

ulipristal

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24
Q

indications for Levonelle

A
  1. had UPSI/compromised contraception within last 72hrs

2. has levonogestrel but vomited within 3hrs of taking it and still within 72hrs of UPSI

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25
What is ulipristal?
selective progesterone receptor modulator
26
indications of ulipristal
UPSI up to 120hrs ago
27
What is 1st choice EC?
Cu-IUD
28
ulipristal and LH surge
ulipristal can prevent ovulation after the LH surge has started it delays folicular rupture for up to 5 days
29
When can you start hormonal contrapeption after taking ulipristal?
5 days after
30
When may ulipristal be less effective?
if the patient had progestogen in the previous 7 days | if they're on oral contraceptives
31
What's the only method of EC that is effective after ovulation?
copper IUD
32
Is copper IUD affected by BMI/weight/other drugs?
no
33
age of Levonelle on PGD
from 13 years provided they are Fraser competent
34
age and cost of Ulipristal OTC
no minimum age for supply | cost £35
35
age for ulipristal on PGD
from 13 years provided thay are Fraser competent
36
What must be assessed when supplying to U16? (OTC & PGD)
Fraser competency
37
Efficacy of levonogestrel over time
up to 12hrs - 95% 25-48hrs - 85% 49-72hrs - 58%
38
effectiveness of ulipristal over time
95% effective up to 120 hours
39
questions to consider when suppling EC with natural menstrual cycle (3)
1. date of last menstrual period 2. usual cycle length 3. is ovulation likely to have taken place yet this cycle
40
When to use EC after POP late (traditional and desogestrel)?
traditional POP - > 3hrs late (last pill > 27hrs ago) | desogestrel POP - > 12hrs late (last pill > 36hrs ago)
41
When is EC needed while getting the depo injection?
> 14 weeks ago
42
When to get EC while using the transdermal patch?
off for 48hrs of unknown length of time
43
When to get EC while on CHC? (general)
2 or more pills missed
44
Taking COC and missed 2 or more pills in the first week. Is EC required? (pills 1-7)
EC required if UPSI occurred in HFI or 1st week
45
Taking COC and 2 or more pills missed in the 2nd week (days 8-14)
EC not required if pills taken correctly in past 7 days | advise to finish the pack and take the usual 7 day break
46
Taking COC and missed 2 or more pills in the 3rd week (days 15-21)
omit pill free interval by finishing current pack and starting next pack the next day EC not required if HFI omitted
47
What to do if >7 active pills were missed?
restart COC like they've never used it before
48
pregnancy/suspected pregnancy and EC
- levongestrel won't harm the foetus if already pregnant | - ulipristal - pregnancy/suspected should be excluded before giving ulipristal
49
Can you take EC if already taken in the same cycle?
yes for levonogestrel and ulipristal
50
breastfeeding and levongestrel
levongestrel has no adverse effects on breastfeeding or infant avoid nursing at least 8hrs after to reduce amount of levongestrel the baby will take in
51
ulipristal and breast feeding
don't breastfeed | express and discard milk for 7 days after taking ulipristal
52
BMI and levonogestrel
effectiveness of levonogestrel can be reduced in women who weigh > 70kg (BMI > 26) can take a double dose of levonorgestrel (3mg) - off licence or take ulipristal
53
BMI and ulipristal
unaffected by BMI
54
What to do if giving levonorgestrel and patient overweight?
give a double dose (3mg) of levonorgestrel
55
problem with giving a double dose of Levonelle?
it is off label - refer | most PGDs allow supply of 2 pills for these cases
56
What conditions is levonogestrel not recommended in?
``` severe liver dysfunction acute porphyria patients at risk of ectopic pregnancy suffered inflammation of the fallopian tubes severe malabsorption syndrome ```
57
What medical conditions is ulipristal not recommended in?
- severe liver impairement | - severe asthma who are on oral glucocorticoid treatment
58
What drugs can effect the efficacy of EC?
enzyme inducing drugs
59
What is the guidance for EC and taking enzyme inducing drugs?
use a Cu-IUD
60
If unable to give Cu-IUD and taking enzyme inducers and need EC, what can be given?
a double dose (300mcg) of levonogestrel can be used
61
ulipristal and enzyme inducing drugs
ulipristal not recommended for those who have taken enzme inducing drugs in the past 4 weeks
62
What can reduce the ability of ulipristal to delay ovulation?
if progestogen is taken in the following 120hrs
63
When to continue hormonal contraception after taking ulipristal?
don't start until 5 days after taking ulipristal
64
How long after taking ulipristal will COC work?
12 days
65
When will hormonal contraception work after taking levonogestrel?
immediately
66
ulipristal and have taken progestogen recently, how long?
don't give ulipristal if they have taken progestogen in the last 7 days
67
dosage of Levonelle
1.5 mg tab
68
antibiotics that are potent enzyme inducers
rifabutin | rifampicin
69
dosage of Ulipristal (EllaOne)
30mg tab
70
Can EllaOne be given more than once in the same menstrual cycle?
yes
71
vomiting after taking EC
vomiting within 3hrs another EC should be taken asap
72
Do EC need to be taken with food?
no
73
cycle disruption after taking EC
menstrual cycle may be altered next period may be early/late esp. if > 1 dose given pregnancy test recommended if peroid if delayed by >7 days after EC

PHA223 (43 decks)

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