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Flashcards in 13 - Emergency Contraception Deck (23)
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1

How does Emergency Contraception Work?

Pregnancy/Fertilization is 
NOT instantaneous

Sperm can survive for several days
awaiting for fertilization

Ovulation takes time

2

Types of EMERGENCY CONTRACEPTIVES

Pharmacological Agents
ECPs Combined emergency contraception pills

Progestrin-ONLY ECP's

ECP + Ulipristal Acetate

NON-pharmacological
IUD = Copper T Intrauterine Device

3

Combined ECPs

Contain WHAT?

ESTROGEN + PROGESTRIN

Estrogen = Ethinyl Estradiol

Progestrin = Levonogestrel or Norgestrel

 

4

Combined ECP's

Use / Products

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

Combined ECP's

MECHANISM OF ACTION

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

Combined ECPs
Estrogen + Progestin

Timing / ADR / CIs

<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

Combined ECPs

COUNSELING POINTS

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

Progestin-only ECPs

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

Progestin-Only ECPs

MOA

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

Progestin-Only ECPs

ADR's + CI's

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

Progestin-Only ECPs

COUNSELING

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

UPA ECP

ELLA = Ulipristal Acetate
30mg Tablet

Pharmacist prescribing = State specific

Effectiveness does NOT decline with delay in treatment

13

UPA ECP

MoA

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

UPA ECP
Ella = Ulipristal

ADR / CI's

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

CONTRAINDICATIONS:
pregnancy / breastfeeding
same menstrual cycle use / hypersensitivity

15

UPA ECP = ELLA

COUNSELING

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

Copper T IUD

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

Copper T IUD

MOA

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

Copper T IUD
Paraguard

Timing / Facts

<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

Copper T IUD

ADR / CI's

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

Copper T IUD

Counseling

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

ECP

SAFETY

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

Barriers to EC Use

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

Patient Assessment

ECPs

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