LECTURE 6 Flashcards
Emergency COntraceptive and Medical Abortion
What are the different types of EC ?
Hormonal : Levonorgestrel , Ulipristal and uzpe method
Intrauterine COntraceptive : Copper or LNG IUD
What are the main mechanisms by which hormonal EC acts ?
*** interferes with ovulation through Progestin
Prevent fertilization ( stops sperm binding)
prevent contractility to more the ovum through the fallopian tube
Which EC prevent ovulation ?
LNG EC
Uliprsital
Which EC prevets fertilization ?
Cu-UID
Which EC prevents implantation ?
Cu-IUD
When does LNG EC works the best ?
before the LH surge and prevent ovulation
What happens during the ovulation with LH levels ?
LH surge
What is the timeframe of effectiveness of LNG EC ?
3 days and maybe 5 days
What is the most important DDI to remenber for its interaction with hormonal EC ?
Rifampin: inducer that cause the increase in the metabolism of EC
Whar are the ADR of hormonal EC ?
Spotting/breakthrough, abdominal cramping, nausea/vomiting and others
After the use of LNG, when can we expect the return of menses ?
~ 3 weeks
What is the MOA of ulipristat ?
selective progesterone agonist or antagonist
directly affects the follicular rupture
Why do we need to hold CHC or POP before restarting it after ulipristal É
ulipristal has a strong bind to the progesterone receptors and needs time to be removed before CHC or POP can be initiated.
How many days should the patient wait after taking Plan B forfor starting CHC/POP ?
Wait 5 days
How many daysof backup after ulipristal ?
14 days of backup after waiting 5 days of waiting
How do I do the yupze regimen ?
100 mg extradiol, 500 mg LNG or 1 mg Norgetrol
repeat after 12hours
If pt want to use CHC after ulipristat , what can you let them know ?
hold CHC/POP for 5 days but have have 14 days backup
What is the ADR betwen hormonal EC vs ypzpe method ?
Yupze has more ADR : N/V, breast tenderness and spotting
What are the contraindications for copper IUD ?
pregnancy, history of recent PID, STI
When would you expect return of menses after the emergency pills?
3 weeks
What is gestational age ?
The time after the last period day
What is the MOA of Mifepristone ?
Progesterone antagonist on the endo/myometrium
+ anti glucocorticoids effect
leads to uterine contraction, cervical softening and dilation
What is the MOA of Misoprostol ?
Synthetic PGs
Uterine contraction , soft cervix to expel pregnancy
How effective is MIFE/MISO ?
95-98% gestational up to 70 days
