Emergency contraception Flashcards
When does ovulation occur
Day 14
Which emergency contraceptives are available to buy over the counter and give their strength + dose
- levonorgestrel 1500mcg , Once
- ulipristal acetate 30 mg , Once
Give examples of levonorgestrel available to buy
- levonnele
- emmeres una
Give example of ulpristal acetate
Ella one
What questions should you ask a patient before giving it out
- If they have ovulated
how do emergency contraceptive pills work
prevent pregnancy by preventing or delaying ovulation (release of an egg)
when is levonorgestrel effective
within 3 days after intercourse
when is ulipristal acetate effective
within 5 days after intercourse
how does ulipristal acetate work
- it acts by delaying ovulation for atleast 5 days, via the suppression of the luteinizing hormone surge until the sperm is no longer viable.
- it delays ovulation even after the start of the luteinizing hormone surge
how does levonorgestrel work
- Levonorgestrel acts by inhibiting ovulation. If taken prior to the start of the LH surge, levonorgestrel inhibits ovulation for the next 5 days, until sperm from the UPSI for which it was taken are no longer viable.
-in the late follicular phase, however, levonorgestrel becomes ineffective (unlike ulipristal acetate
are oral contraceptives effective after ovulation
nope
what should you consider before selling oral contraceptive
- A full history should be taken to confirm whether EC is indicated. The possibility of pregnancy should be reasonably excluded.
- The choice of EC should be made with the woman - think about the woman’s preference, current medication, whether she is postpartum or breastfeeding, her body mass index/weight, and timing of UPSI.
- A regular method of contraception should be offered if the woman is not using regular contraception
outline a consultation for oral contraception
- Ask when the most recent UPSI occurred and whether additional UPSI has occurred in the same cycle.
- Discuss her menstrual history:
- Ask about the date of the start of her last menstrual period (LMP) and the usual cycle length. - calculate the earliest likely date of ovulation (estimated as the date of the start of her LMP plus the number of days in the shortest cycle minus 14).
4.Ask about previous use of hormonal EC (confirm which was taken and when it was taken).
5.Ask about other factors that could affect the choice of EC, including:
-Whether she is postpartum or breastfeeding.
-Current medications (with particular attention to liver enzyme-inducing drugs and progestogens).
-Contraindications/restrictions.
which conditions are contraindicated with oral contraceptives?
- severe asthma
- using enzyme inducing drugs
what are the common side effects of Ulipristal acetate
- vomiting
- menstrual irregularities: ealr bleeding
- ectopic pregnancy
- mood disorders
- headaches, dizziness
- nausea
-abdominal pain/ discomf - fatigue
- backpain
- pelvic pain
-dynsmenorrhea - breast tenderness
- myalgia
what are the uncommon side effects of ulipristal acetate
Anxiety, appetite disorder, chills, concentration impaired, diarrhoea, drowsiness, dry mouth, fever, flatulence, hot flush, increased risk of infection, insomnia, libido disorder, malaise, skin reactions, vision disorders, and vulvovaginal disorders.
What are the common side effects of levonorgestrel?
- vomiting
- menstrual irregularities: ealr bleeding
- ectopic pregnancy
- headache
- lower abdominal pain
- fatigue
- dizziness
- diarrhoea
- breast tenderness
what should a woman do if she vomits after using an oral contraceptive within 3 hrs
TO take another one ASAP
what should you advise a woman not using ongoing contraception
> Advise that she would need to use ongoing contraception or abstain from sex to avoid further risk of pregnancy.
> oral contraceptives are intended for occasional use not for regular
which patients is ulipristal acetate not recommended in
- have taken CYP3A4 enzyme inducing medicines or herbal products within the last 4 weeks
- pt with severe asthma
- pt with severe liver impairment
what are CYP3A4 enzyme inducing medicines
- phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids.
which patients is levonorgestrel not effective in
- it is less effective in Patients with a weight over 70kg or a body mass index (BMI) higher than 26kg/m2 = DOUBLE DOSE is offlabel
- pt using CYP3A4 enzyme inducing medicines OR herbal products :
which patients is levonorgestrel not recommended in
- severe liver dysfunction
- pt who have suffered inflammation of the fallopian tubes
- pt with severe malabsorption syndroms
what should a pt using levonorgestrel and CYP 3A4 enzyme inducing medicines be given
- DOUBLE DOSE
