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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
Q

What is ulipristal?

A

selective progesterone receptor modulator

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26
Q

indications of ulipristal

A

UPSI up to 120hrs ago

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27
Q

What is 1st choice EC?

A

Cu-IUD

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28
Q

ulipristal and LH surge

A

ulipristal can prevent ovulation after the LH surge has started
it delays folicular rupture for up to 5 days

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29
Q

When can you start hormonal contrapeption after taking ulipristal?

A

5 days after

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30
Q

When may ulipristal be less effective?

A

if the patient had progestogen in the previous 7 days

if they’re on oral contraceptives

31
Q

What’s the only method of EC that is effective after ovulation?

A

copper IUD

32
Q

Is copper IUD affected by BMI/weight/other drugs?

A

no

33
Q

age of Levonelle on PGD

A

from 13 years provided they are Fraser competent

34
Q

age and cost of Ulipristal OTC

A

no minimum age for supply

cost £35

35
Q

age for ulipristal on PGD

A

from 13 years provided thay are Fraser competent

36
Q

What must be assessed when supplying to U16? (OTC & PGD)

A

Fraser competency

37
Q

Efficacy of levonogestrel over time

A

up to 12hrs - 95%
25-48hrs - 85%
49-72hrs - 58%

38
Q

effectiveness of ulipristal over time

A

95% effective up to 120 hours

39
Q

questions to consider when suppling EC with natural menstrual cycle (3)

A
  1. date of last menstrual period
  2. usual cycle length
  3. is ovulation likely to have taken place yet this cycle
40
Q

When to use EC after POP late (traditional and desogestrel)?

A

traditional POP - > 3hrs late (last pill > 27hrs ago)

desogestrel POP - > 12hrs late (last pill > 36hrs ago)

41
Q

When is EC needed while getting the depo injection?

A

> 14 weeks ago

42
Q

When to get EC while using the transdermal patch?

A

off for 48hrs of unknown length of time

43
Q

When to get EC while on CHC? (general)

A

2 or more pills missed

44
Q

Taking COC and missed 2 or more pills in the first week. Is EC required? (pills 1-7)

A

EC required if UPSI occurred in HFI or 1st week

45
Q

Taking COC and 2 or more pills missed in the 2nd week (days 8-14)

A

EC not required if pills taken correctly in past 7 days

advise to finish the pack and take the usual 7 day break

46
Q

Taking COC and missed 2 or more pills in the 3rd week (days 15-21)

A

omit pill free interval by finishing current pack and starting next pack the next day
EC not required if HFI omitted

47
Q

What to do if >7 active pills were missed?

A

restart COC like they’ve never used it before

48
Q

pregnancy/suspected pregnancy and EC

A
  • levongestrel won’t harm the foetus if already pregnant

- ulipristal - pregnancy/suspected should be excluded before giving ulipristal

49
Q

Can you take EC if already taken in the same cycle?

A

yes for levonogestrel and ulipristal

50
Q

breastfeeding and levongestrel

A

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
Q

ulipristal and breast feeding

A

don’t breastfeed

express and discard milk for 7 days after taking ulipristal

52
Q

BMI and levonogestrel

A

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
Q

BMI and ulipristal

A

unaffected by BMI

54
Q

What to do if giving levonorgestrel and patient overweight?

A

give a double dose (3mg) of levonorgestrel

55
Q

problem with giving a double dose of Levonelle?

A

it is off label - refer

most PGDs allow supply of 2 pills for these cases

56
Q

What conditions is levonogestrel not recommended in?

A 
severe liver dysfunction
acute porphyria
patients at risk of ectopic pregnancy
suffered inflammation of the fallopian tubes
severe malabsorption syndrome
57
Q

What medical conditions is ulipristal not recommended in?

A
  • severe liver impairement

- severe asthma who are on oral glucocorticoid treatment

58
Q

What drugs can effect the efficacy of EC?

A

enzyme inducing drugs

59
Q

What is the guidance for EC and taking enzyme inducing drugs?

A

use a Cu-IUD

60
Q

If unable to give Cu-IUD and taking enzyme inducers and need EC, what can be given?

A

a double dose (300mcg) of levonogestrel can be used

61
Q

ulipristal and enzyme inducing drugs

A

ulipristal not recommended for those who have taken enzme inducing drugs in the past 4 weeks

62
Q

What can reduce the ability of ulipristal to delay ovulation?

A

if progestogen is taken in the following 120hrs

63
Q

When to continue hormonal contraception after taking ulipristal?

A

don’t start until 5 days after taking ulipristal

64
Q

How long after taking ulipristal will COC work?

A

12 days

65
Q

When will hormonal contraception work after taking levonogestrel?

A

immediately

66
Q

ulipristal and have taken progestogen recently, how long?

A

don’t give ulipristal if they have taken progestogen in the last 7 days

67
Q

dosage of Levonelle

A

1.5 mg tab

68
Q

antibiotics that are potent enzyme inducers

A

rifabutin

rifampicin

69
Q

dosage of Ulipristal (EllaOne)

A

30mg tab

70
Q

Can EllaOne be given more than once in the same menstrual cycle?

A

yes

71
Q

vomiting after taking EC

A

vomiting within 3hrs another EC should be taken asap

72
Q

Do EC need to be taken with food?

A

no

73
Q

cycle disruption after taking EC

A

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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