Emergency Hormonal Contraception Flashcards
What is a PGD (Patient group direction)? Using a PGD is not a form of prescribing.
A PGD provides a legal mechanism by which medicines can be supplied or administered to patients by a specified range of healthcare professionals, without first seeing a doctor or dentist. PGDs allow named registered healthcare professionals to supply or administer medicines to groups of patients that fit the criteria laid out in the PGD. So, a healthcare professional could supply (e.g. provide an inhaler or tablets) and / or administer a medicine (e.g. give an injection or a suppository) directly to a patient without the need for a prescription or an instruction from a prescriber.
Explain the needs for a PGD?
Support self-care and improving health of patients
Improving choice, convenience and access to treatment by:
Making medicines available via PGDs where there would otherwise be problems in accessing the medicines easily or promptly
Providing medicines at NHS expense for those exempt from prescription charges (people who are not exempt from prescription charges would be required to pay the normal prescription charge)
Providing advice and support to patients alongside treatment or prophylaxis for the condition being managed.
Improving primary care capacity, for example by reducing medical practice workload or augmenting capacity.
Describe the need for supplying emergency hormonal contraception (EHC) via a PGD
Pharmacists can supply emergency hormonal contraception via a patient group direction (no charge to patient) or as an over-the-counter sale (approximately £25). Around 77% of women access EHC through pharmacies rather than visiting GPs.
To increase the knowledge, especially among young people, of the availability of emergency contraception3 and contraception from pharmacies.
To improve access to emergency contraception and sexual health advice.
To increase the use of EHC by women who have had unprotected sex and help contribute to a reduction in the number of unplanned pregnancies in the client group.
To refer clients, especially those from hard to reach groups, into mainstream contraceptive services.
To increase the knowledge of risks associated with STIs.
To refer clients who may have been at risk of STIs to an appropriate service.
To strengthen the local network of contraceptive and sexual health services to help ensure easy and swift access to advice
Inclusion criteria of the PGD
Define age range/sex, eg, patients over 12 years
old.
• Do you include pregnant women?
• Do you include breast feeding women?
• Include clinical criteria.
Must reflect local and/or national clinical guidelines or
policies where available.
Drug interactions with EHC
Drug interactions of Levonelle = Antiepileptics, Abx, Antiretrovirals, Respiratory drugs, CNS drugs and Herbal.
Drug interactions of ellaone: Proton Pump inhibitors, Rifampicin and Ketoconazole.
Side effects of EHC
Side effects of ellaone: Abdominal pain / discomfort
- Irregular vaginal bleeding, pelvic pain, breast tenderness
- Headache, dizziness
- Nausea, vomiting
- Mood disorders
- Myalgia, back pain
- Fatigue
Side effects of Levonelle: - Nausea - Vomiting - Breast tenderness - Headache - Dizziness - Fatigue Temporary disturbance of menstrual bleeding pattern (if menstrual bleed is more than 7 days overdue, pregnancy should be excluded (by taking a pregnancy test))
Summarise the ovarian cycle
1) Oocyte (contain follicles) develops as FSH ↑
2) FSH ↓ = only 1 or two follicles develop = release oestrogen = thickens endometrium
3) LH and FSH ↑ dramatically = high level of LH stimulate ovulation Take ellaone = interrupt surge in LH before ovulation
4) Ruptured follicle forms corpus luteum = produce large amount progesterone
5) thick lining of uterus maintained = waiting for fertilised ovum to implant
6) No fertilisation = corpus luteum degenerates. = ↓ progesterone production & ↓ level oestrogen = new menstrual cycle
How is emergency contraception defined?
Emergency contraception is defined as the measures taken after an act of unprotected (or inadequately protected) sexual intercourse (UPSI) to avoid pregnancy.
What are the three methods of emergency contraception that are licensed for use?
In the UK, three methods are licensed for use: two types of emergency hormonal contraception (EHC) as well as the insertion of a copper bearing intrauterine contraceptive device (IUCD).
Exclusion criteria of PGD?
Who is not eligible to receive the medicine, eg,
upper and lower age limits?
• Must reflect local and/or national clinical guidelines
or policies where available.
Reasons for exclusion may include:
• age
• concurrent conditions
• concurrent treatment – such as patients taking
medicines which may give rise to toxicity or the
need for increased dose (eg, salbutamol PGD
exclusion would be patients taking beta-blockers, as
beta-blockers can induce asthma and will also
prevent the action of salbutamol)
• previous local or general reactions to the medicine
• hypersensitivity to the medicine or any of its
ingredients
• pregnancy and breast feeding
• anything else stated in the SPC that may give
reason for exclusion of specific patients
• degrees of renal/hepatic insufficiency
What is the Frasers competency? - under 16 year olds
When deciding whether a child is mature enough to make decisions, they must meet the following criteria:
1. The young person understands the advice being given.
2. The young person cannot be convinced to involve parents/carers or allow
the medical practitioner to do so on their behalf.
3. It is likely that the young person will begin or continue having intercourse
with or without treatment/contraception.
4. Unless he or she receives treatment/contraception their physical or mental
health (or both) is likely to suffer.
5. The young person’s best interests require contraceptive advice, treatment
or supplies to be given without parental consent.
What are IUCDs used for?
IUCD: It may prevent an egg from implanting in your womb or being fertilised. Efficacy, number of hours within which to take following UPSI:
99% and 120 hours after UPSI of 5 days after earliest time woman could have ovulated. Women should be advised that the IUCD is the most effective method of emergency contraception
What is EllaOne used for?
EllaOne: Progestogen receptor modulator and appears to work later in the cycle than Levonelle, interrupting the luteinising hormone surge just before ovulation. It is licensed for use within 120 hours of UPSI and studies indicate that the rate of pregnancy prevention continues at the same level for the five days.
Efficacy, number of hours within which to take following UPSI:
120 hours - sooner taken the better.
What is Levonelle used for?
Levonelle: If taken before ovulation, this appears to delay ovulation by five to seven days and arrests the development of the ovarian follicle. Levonelle is not effective once the process of implantation has begun. Efficacy, number of hours within which to take following UPSI:
72 hours - sooner taken the better
A WHO study showed use in the first 24 hours to be most effective. Levonelle appears to be effective up to at least 96 hours post USPI.
