13 - Emergency Contraception Flashcards Preview

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Flashcards in 13 - Emergency Contraception Deck (23)
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1
Q

How does Emergency Contraception Work?

A
  • *Pregnancy/Fertilization** is
  • NOT instantaneous*

Sperm can survive for several days
awaiting for fertilization

Ovulation takes time

2
Q

Types of EMERGENCY CONTRACEPTIVES

A

Pharmacological Agents
ECPs = Combined emergency contraception pills

Progestrin-ONLY ECP’s

ECP + Ulipristal Acetate

  • NON-pharmacological*
  • *IUD** = Copper T Intrauterine Device
3
Q

Combined ECPs

Contain WHAT?

A

ESTROGEN + PROGESTRIN

Estrogen = Ethinyl Estradiol

Progestrin = Levonogestrel or Norgestrel

4
Q

Combined ECP’s

Use / Products

A

RARELY USED
Estrogen + Progestrin
Progestin-ONLY ECP’s are more effective w/ less ADRs

Contain Levonorgestrel at VARIED doses

19 products
Cryselle / Aviane / Low-Ogestrel / Ogestrel
Lo/Ovral
/ Sronyx

5
Q

Combined ECP’s

MECHANISM OF ACTION

A

Estrogen + Progestrin

  • **INHIBIT or DELAY —>* OVULATION
  • NOT an abortifacient // disrupts follicular development***
  • BLOCKS* Luteinizing Hormone (LH) SERGE
  • disrupts luteal phase*

Progestin causes thinning of endometrium
preventing implantation

Progestin also thickens the mucus in the cervix
PREVENTING sperm from reaching eggs

6
Q
  • *Combined ECPs**
  • *Estrogen + Progestin**

Timing / ADR / CIs

A

<120 hours
RX Only / 74% effective / 0-30$

  • *N/V** + Headache/Dizziness
  • *Breast tenderness** + Irregular Bleeding

Contraindications:
pregnancy / breast cancer (or history)
hepatic disease / abnormal uterine bleeding
risk for venous/arterial disease / hypersensitivity

7
Q

Combined ECPs

COUNSELING POINTS

A

Use BACK-UP contraception methed for 7 DAYS

Restart hormonal contraception
AFTER next menses or day after ECPs

Take with food
Vomiting within 3 HOURS of dose
may require an _additional dose_ due to insufficient absorption
can PREVENT w/ DPH or Meclizine
1hr b4 ECP

Pregnancy Test
>21 days since menstrual cycle
DOES NOT PROTECT AGAINST STDS

8
Q

Progestin-only ECPs

A

Levonorgestrel 1.5mg
Next Choice / Plan B / Take Action / My Way
2 tablet formulation discontinued
2x 0.75-mg doses 12 hours apart

Preferred over Yuzpe Method (Combined ECPs)

9
Q

Progestin-Only ECPs

MOA

A

Inhibit / Delay of ovulation

  • NOT an abortifacient*
  • not a lot of info on endometrium / cervical mucus*

< 72 hours post-coital

NO NEED FOR RX ALL AGES

89% effective , 0-45$

10
Q

Progestin-Only ECPs

ADR’s + CI’s

A

Changes in your menstrual periods

  • *Nausea + Vomiting** within 2 hours
  • may REPEAT dose if LESS THAN 2 HOURS*

Stomach/Ab Pain + Diarrhea

Fatigue / Headache / Dizziness / Breast Pain/tender

CONTRAINDICATIONS:
pregnancy / HYPERsensitivity

11
Q

Progestin-Only ECPs

COUNSELING

A

no RX required / OTC
DO NOT USE IF ALREADY PREGNANT
use backup for 7 days

may start hormonal contraception after:
start of next menses /// day after ECPs

If taken too close to ovulation = may be INNEFECTIVE
>21 days since menstrual cycle –> recommend pregnancy test

  • *FDA Approved 72 hours** /// Reasonably effective <120 hours
  • efficacy declines as time elapses*
12
Q

UPA ECP

A

ELLA = Ulipristal Acetate
30mg Tablet

Pharmacist prescribing = State specific

Effectiveness does NOT decline with delay in treatment

13
Q

UPA ECP

MoA

A

ELLA = Ulipristal Acetate 30mg

  • *Selective Progestrone-Receptor Modulator**
  • inhibition or delay of* ovulation
  • prevents implantation ?*
  • *<120 hours after intercourse**,
  • does NOT decrease in efficacy over time*

More effective > progestin ECPs = 98%

10-70$, RX ONLY

14
Q

UPA ECP
Ella = Ulipristal

ADR / CI’s

A

HA / Nausea / Dizziness / Tiredness
Stomach pain / Menstrual Pain

CONTRAINDICATIONS:

  • *pregnancy / breastfeeding**
  • *same menstrual cycle use** / hypersensitivity
15
Q

UPA ECP = ELLA

COUNSELING

A

Requires Prescription

do not use if PREGNANT / not a regular birth control
if you vomit <3 hours –> contact MD

use back up barrier contraception method 7 days
effective for up to 120 hours
>21 days since menstrual cycle –> rec. pregnancy test

wait at least 5 days to restart hormonal contraception after ELLA
do not use ELLA > 1 time in the same menstrual cycle

16
Q

Copper T IUD

A

Paragard = Hormone-Free

Mostly implanted WITHIN 5-7 DAYS

  • after unprotected intercourse* (unknown ovulation)
  • *does NOT decrease in effectiveness during the 5 days**

can be implanted <8 days after intercourse
if ovulation occured >72 hours post intercourse

effective ongoing conraception for 10-12 years

17
Q

Copper T IUD

MOA

A

ENHANCE Inflammatory response

Copper diminishes sperm motility / viability
Copper alters the metabolism of the endometrial cells
massive decidual changes
trophic glands / atrophy of entire functional layer

18
Q

Copper T IUD
Paraguard

Timing / Facts

A

<120 hours

Prescription / Procedure

99% within 5 days

0-1000$

RARELY used for emergency contraception
insertion requires proper training / scheduling issue
cost prohibitive w/o insurance

19
Q

Copper T IUD

ADR / CI’s

A
  • *Heavier / Longer periods** + spotting between periods
  • *Pelvic inflammatory disease**

difficult removals / perforation / expulsion / anemia
backache / pain during intercourse / menstrual cramps

allergic reaction / vaginal infection+discharge / faintness

CONTRAINDICATIONS:
pelvic infections / frequent infections / cancer

20
Q

Copper T IUD

Counseling

A
  • do NOT use if you have a:*
  • *pelvic infection** / get infections easily / certain cancers

persistant pelvic pain / stomach pain
if IUD comes out –> tell MD & use backup birth control

  • *bleeding / spotting** may INCREASE at FIRST
  • but should DECREASE in* 2-3 months
  • *IUD migration –> surgically removed**
  • *PREGNANCY w/ IUD can be LIFE threatening
  • > loss of fertility or pregnancy**
21
Q

ECP

SAFETY

A

if breastfeeding, may safely use progestin-only ECPs
may experience transient change in milk suppl

ECP’s can be safely used in women with contraindications to ROUTINE use of combo hormonal contraception:

past ectopic pregnancy / CV disease / Migraines
thromboembolic risk / liver disease

pregnancy > risk for thromboembolic & liver disease
than 1 day course of estrogen / progestin

22
Q

Barriers to EC Use

A

UNDERESTIMATE RISK of Pregnancy

Belief that OTC EC is behind the counter

timeliness / POLITICS

lack of awareness / clinical discussion

Emergency department access is limite

lack of marketing / COST

23
Q

Patient Assessment

ECPs

A

Last time since unprotected intercourse

RISK for unprotected intercourse

Patient appropriateness EC use

Using intermediate / high failure rate forms of contraception
encourage to keep advanced supply of ECPs