Emergency contraception

Question 1

When does ovulation occur

Answer 1

Day 14

Question 2

Which emergency contraceptives are available to buy over the counter and give their strength + dose

Answer 2

• levonorgestrel 1500mcg , Once
• ulipristal acetate 30 mg , Once

Question 3

Give examples of levonorgestrel available to buy

Answer 3

• levonnele
• emmeres una

Question 4

Give example of ulpristal acetate

Answer 4

Ella one

Question 5

What questions should you ask a patient before giving it out

Answer 5

1. If they have ovulated

Question 6

how do emergency contraceptive pills work

Answer 6

prevent pregnancy by preventing or delaying ovulation (release of an egg)

Question 7

when is levonorgestrel effective

Answer 7

within 3 days after intercourse

Question 8

when is ulipristal acetate effective

Answer 8

within 5 days after intercourse

Question 9

how does ulipristal acetate work

Answer 9

• 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

Question 10

how does levonorgestrel work

Answer 10

• 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

Question 11

are oral contraceptives effective after ovulation

Answer 11

nope

Question 12

what should you consider before selling oral contraceptive

Answer 12

1. A full history should be taken to confirm whether EC is indicated. The possibility of pregnancy should be reasonably excluded.
2. 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.
3. A regular method of contraception should be offered if the woman is not using regular contraception

Question 13

outline a consultation for oral contraception

Answer 13

1. Ask when the most recent UPSI occurred and whether additional UPSI has occurred in the same cycle.
2. Discuss her menstrual history:
   - Ask about the date of the start of her last menstrual period (LMP) and the usual cycle length.
3. 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.

Question 14

which conditions are contraindicated with oral contraceptives?

Answer 14

• severe asthma
• using enzyme inducing drugs

Question 15

what are the common side effects of Ulipristal acetate

Answer 15

• vomiting
• menstrual irregularities: ealr bleeding
• ectopic pregnancy
• mood disorders
• headaches, dizziness
• nausea
  -abdominal pain/ discomf
• fatigue
• backpain
• pelvic pain
  -dynsmenorrhea
• breast tenderness
• myalgia

Question 16

what are the uncommon side effects of ulipristal acetate

Answer 16

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.

Question 17

What are the common side effects of levonorgestrel?

Answer 17

• vomiting
• menstrual irregularities: ealr bleeding
• ectopic pregnancy
• headache
• lower abdominal pain
• fatigue
• dizziness
• diarrhoea
• breast tenderness

Question 18

what should a woman do if she vomits after using an oral contraceptive within 3 hrs

Answer 18

TO take another one ASAP

Question 19

what should you advise a woman not using ongoing contraception

Answer 19

> 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

Question 20

which patients is ulipristal acetate not recommended in

Answer 20

• have taken CYP3A4 enzyme inducing medicines or herbal products within the last 4 weeks
• pt with severe asthma
• pt with severe liver impairment

Question 21

what are CYP3A4 enzyme inducing medicines

Answer 21

• phenobarbital, phenytoin, rifampicin, St. John’s Wort and glucocorticoids.

Question 22

which patients is levonorgestrel not effective in

Answer 22

• 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 :

Question 23

which patients is levonorgestrel not recommended in

Answer 23

• severe liver dysfunction
• pt who have suffered inflammation of the fallopian tubes
• pt with severe malabsorption syndroms

Question 24

what should a pt using levonorgestrel and CYP 3A4 enzyme inducing medicines be given

Answer 24

• DOUBLE DOSE

Question 25

is ulipristal acetate effective in pt over 70kg

Answer 25

yes

Question 26

can ulipristal be used with regular contraceptives

Answer 26

yes BUT:
-it can reduce the efficacy of combined oral contraceptives and progestogen only containing contraceptives.

• The efficacy of ulipristal as an emergency contraceptive can also be reduced by if used progesterone or progestogen in the last 5 days

Question 27

can regular contraceptives be used following levonorgestrel

Answer 27

yes

Question 28

what do you do if a pt is suspected of pregnancy or is pregnant

Answer 28

refer to GP or family planning clinic

Question 29

can you sell to a patient representative

Answer 29

• You can make the supply to someone else (other than the patient directly) if you are satisfied it is a genuine request and the treatment is clinically appropriate for the patient.
• telephone the patient to assess suitability of the oral emergency contraceptive if their representative cannot provide you with the necessary information to determine whether the request is appropriate and genuine.

Question 30

can you provide advance supply or oral emergency contraception

Answer 30

YES

Question 31

does Oral emergency contraception does not protect against sexually transmitted infections

Answer 31

NO

Question 32

what is the legal consent age

Answer 32

16

Question 33

What are the contra indications for ulipristal acetate

Answer 33

Breast cancer
cervical cancer
ovarian cancer
severe asthma controlled by oral glucocorticoids;
undiagnosed vaginal bleeding
uterine cancer

Question 34

Which cancer should you use in caution with levonorgestrel

Answer 34

Current breast cancer (use with caution for emergency contraception)

Question 35

When does a woman need to take another dose of contraceptive

Answer 35

If she vomits within 3 hrs of use

Question 36

What should breastfeeding women know about levonorgestrel

Answer 36

• take immediately after BF and avoid nursing for at least 8 hours following

Question 37

What should breastfeeding women know about ulipristal acetate

Answer 37

⚠️⚠️Avoid for 1 week after administration—present in milk.

Express milk and discard for one week !

Question 38

What information should you provide to a women after selling ulipristal acetate

Answer 38

✅ - if vomiting occurs within 3 hours of taking a dose, a replacement dose should be taken;

✅- that their next period may be early or late;

✅- to seek medical attention promptly if any lower abdominal pain occurs because this could signify an ectopic pregnancy.