MW Lecture 11 Flashcards
OC supply criteria?
a. Has been prescribed the same type of OC within the last 3 years
b. Not developed risk factors
c. Aged 16-39 for COC or 16-52 for POP
Pharmacist supply COCs
Ethinylestradiol + norethisterone
Ethinylestradiol + levonorgestrel
Pharmacist supply POPs
Desogestrel
Levonorgestrel
Norethisterone
Criteria for switching between OCs
Formulation is not available in NZ If breastfeeding (COC to POP)
Is pharmacist supply of OCs funded?
No
Contraindications to OCs (general)
Breast cancer
Severe cirrhosis, active hepatitis, tumours
Undiagnosed vaginal bleeding
Contraindications to COCs
Hx MI, ischaemic heart disease or vascular disease (DVT, PE) Hx Stroke Migraines with aura or without aura if 35+ years Hypertension Smoker (>15 cigs/day) and 35+ years Uncontrolled inflammatory bowel disease Active systemic lupus erythematosus Active cancer Less than 6 weeks postpartum
OC counselling
When to start pill When you are protected Timing of doses Missed pill (time) Missed pill (sugar pills) Adverse effects management
Common OC adverse effects
Nausea Breakthrough bleeding Breast tenderness Weight gain Migraines Acne
OCs danger signs (ACHES)
Abdominal pain (severe) Chest pain (severe), SoB Headaches (severe) Eye problems (blurred vision, flashing lights, blindness) Severe leg pain (calf or thigh)
What is the ECP medicine?
Levonorgestrel tablet
What is the day of ovulation in the cycle?
14 days (12-16) before next period starts
How long can sperm survive?
Max 7 days
How long can egg survive?
Max 12-24 hours
Missed COC on first week
7 day rule is essential and ECP needed if unprotected sex during 7 days before missed pills
Missed COC on second week
No additional precautions
Missed COC on third week
Miss 7 day break and no additional precautions
OCs interactions
Rifampicin
Antiepileptics (carbamazepine, phenytoin)
HIV drugs
St John’s Wort
How does POP work?
Increases the viscosity of cervical mucus
Time frame for taking COC
12 hours
Time frame for taking POP
3 hours
Time for COC to work
7 days
Time for POP to work
2 days
ECP options
Copper uterine device
Emergency contraceptive pilol
Benefits of Cu IUD for emergency contraception
Works up to 5 days after intercourse Not affected by weight Few contraindications Can be left for future contraception Funded
ECP mechanism of action
Interferes with sperm motility
May delay ovulation
Levonorgestrel efficacy
98-99%
ECP increased risk of failure
High fertility risk
Subsequent UPSI in same cycle
High BMI/weight
Taken post fertilization
