Janet Farmer Scenario 1- EHC and pregnancies Flashcards
What are the Fraser guidelines, and how do they relate to this case study?
Set of guidlines that asses wheather a minor is competent to consent to medical treatment, including contraception
What factors should the pharmacist consider when assessing Janet Jones’ competency to consent to emergency contraception?
- Age
- Ability to understand the nature of treatment
- Risks and benefits of the treatment
- Consequences of not
getting the treatment - Can she be persuaded to inform her parents or guardians about the treatment
- Any chance she could be pregnant already
What are the potential side effects of emergency contraception such as EllaOne or levonelle?
Nausea
Vomiting
Abdominal pain
Headache
Change in menstral cycle
Symptoms are usually mild and short lived
How does the effectiveness of emergency contraception vary with the timing of administration?
Less effective overtime, therefore it is important to take it as soon as possible ideally within 24 hours of UPSI
When should EllaOne and Levonelle be taken within?
EllaOne (5days)
Levonelle (3 days)
What resources and referrals can the pharmacist provide to Janet Jones for ongoing care and support?
BeNHS website
Referral to sexual health clinics or GP
Can give advice about long term contraception and STI testing
How can the pharmacist create a safe and supportive environment for Janet Jones during the consultation?
Be Non-judgmental
Empathetic
Can help build trust and encourage open communication
Try and reduce the feeling of any embarrassment , shame or fear that the patient may be experiencing
What are the potential long-term consequences of unprotected sexual activity?
Unwanted pregnancy
STI
Emotional distress
How can individuals reduce their risk of STIs and unintended pregnancies?
Barrier methods such as condoms and practicing safe sex
Regular STI testing
Routine gynoclogica exams
Long term contraception
What is the mechanism of action of Levonorgestrel (Levonelle one step) as emergency contraception?
Binds to progesterone and androgen receptors
Slows the release of gonadotropin releasing hormone (GnRH) from the hypothalamus
Suppresses LH surge that proceeds ovulation
Inhibits the rupture of follicles and viable egg release from the ovaries
Prevents sperm from fertilizing egg that may already be released.
Which medication is not recommended for use in individuals with a history of breast cancer within 5 years of diagnosis?
levonelle
What is the maximum time frame for taking Ulipristal acetate (Ella one) after unprotected sexual intercourse?
within a maximum of 5 days (120 hours).
What are some potential side effects of Levonorgestrel?
Headache
Nausea
Gastrointestinal discomfort/lower abdomen pain
Menstrual cycle irregularities/irregular bleeding
Tiredness
What is the mechanism of action of Ulipristal acetate as emergency contraception?
Binds to progesterone receptors to produce an anti-progesterone contraceptive effect on the ovaries
Inhibits ovulation
Decreases endometrial thickness
If you vomit within 3 hours of taking Ulipristal acetate, you should take another pill as soon as possible.
If you vomit within 3 hours of taking Ulipristal acetate, you should take another pill as soon as possible.
If your period is more than 5 days later than expected after taking Levonorgestrel, you should take a pregnancy test.
you should take a pregnancy test.
Wha condition is both emergency contraception contraindicated to?
Emergency contraception is not recommended for individuals with uncontrolled severe asthma.
What is the recommended timeframe for taking Levonorgestrel after unprotected sexual intercourse?
Levonorgestrel should be taken as soon as possible after unprotected sexual intercourse, preferably within 12 hours but no later than 72 hours.
What is Microgynon 30 and how is it taken?
Oral contraceptive pill that contains both estrogen and progestogen.
It is taken daily for 21 days, followed by a 7-day pill-free interval. During this pill-free interval, menstruation usually occurs.
What should Janet do if she misses a pill?
Single pill, she should take it as soon as she remembers, even if it means taking two pills in one day.
Since she has been consistant for 7 days it is unlikely that she will need EHC
If she misses two or more pills, she should refer to the patient information leaflet
May require EHC
Should Janet be concerned about her symptoms of headache, sensitivity to light, and nausea?
Oestrogen may worsen migraine and increase risk of stroke
- Tell the patient to stop taking the medicine
Give advice on alternative contraception - Refer them to the GP to change the medicine to something else ideally progesterone only pill or change to the implant or depo injection
- Counsel on STIs and refer to sexual health clinic
- Offer pain killers for migraine
How does Microgynon 30 work as a long-term hormonal contraception?
Suppressing the mid-cycle surge of LH,
which thickens cervical mucus and prevents implantation of an egg.
What are the contraindications for taking Microgynon 30?
VTE,
current VTE,
history of PE or DVT,
risk or current ATE, cerebrovascular disease (e.g., stroke, TIA), or current breast cancer.
What are some potential side effects of Microgynon 30?
nausea,
headaches,
weight gain,
stomach ache,
mood swings,
sore breasts.
How should you take Microgynon 30?
same time, starting with a pill marked with the correct day of the week and following the direction of the arrows on the strip.
What should you do if you miss a pill?
If you miss a pill, you should take it as soon as possible and continue taking the rest of the pills at the usual time.
If you miss more than one pill or start a new pack late, you may need additional contraception such as condoms.
What should you do if you experience severe migraines or headaches while taking Microgynon 30?
You should seek medical advice as severe migraines or headaches may be a sign of blood clots.
What should you expect
within a few days of taking the last pill from a strip of Microgynon 30?
Within a few days of taking the last pill from a strip of Microgynon 30, you should have a withdrawal bleed like a period.
What vitamins are recommended for someone who wants to try for a baby?
Folic acid (at least 400 mcg/day),
iron (at least 27 mg/day),
vitamin D, calcium, and zinc.
Vitamin A should be avoided
She should you start taking prenatal vitamins and for how long during pregnancy?
At least one month before and thoughout pregnency
True or false?
You can continue with contraception whilst on folic acid
No, talk to the GP to stop ur oral contraception
What lifetsylea dvice would you give to someone trying for a baby?
Healthy diet
Folic acid
Regular exercise
Quit smoking
Limit alcohol and affine intake- reduce fertility
Managing stress levels: interfere with facility- yoga or meditation or exercise
What types of foods are not recommended during pregnancy?
Raw uncooked meat/eggs- harmful bacteria
Certain fish that contain high levels if mercury, swaordfish , kin mackerel, tile fish
Caffeine limitations
Alcohol
Foods that contains liestera- Brie, Camembert other cheeses and dairy products
What are the red flag symptoms of morning sickness in pregnancy?
- Very dark urine, or no urination for more than 8 hours
- Abdominal pain or fever
- Severe weakness or feeling faint
- Vomiting blood
5.repeated unstoppable vomiting
- Inability to keep down flood or fluids for 24 hour
What would you give someone with symptoms of morning sickness
There is nothing we can cell over the count
er for morning sickness
Lifestyle advice:
1. Eat small, frequent meals throughout the day rather than larger meals three times a day
- Avoid foods that may tigger nausea
- Stay hydrated- small sips throughout the day
- Try ginger- tea, biscuits, may help
- Rest as much as possible
Refer to the GP if there’s no improvement after 2 weeks
When does morning sickness normally start in pregnancies and for how long?
6 week- start
9 weeks- at its worst
16-18 weeks- stops
What’s the first line treatment of morning sickness ?
Cyclizine
Promethazine
