EHC 1

Question 1

where can EHC be supplied?

Answer 1

GP
community pharmacy
A&E
GUM clinics
out of hour clinics

Question 2

what is the biggest UK provider of EHC?

Answer 2

community pharmacy

Question 3

active ingredient in levonnele?

Answer 3

levonorgestrel 1.5mg

Question 4

active ingredient in ellaone

Answer 4

Ulipristal acetate 30mg

Question 5

non hormonal EHC? where can you get it?

Answer 5

copper bearing IUD

from GP or GUM clinic

Question 6

what type of EHC is most effective?

Answer 6

IUD

Question 7

what part of the cycle do you ovulat

Answer 7

MIDDLE

Question 8

why do you ovulate

Answer 8

due to a hormone surge

increasing levels of LH and FSH

Question 9

how does EHC work?

Answer 9

stops ovulation

Question 10

when is day 1 of the natural cycle

Answer 10

first day of period or first pill in the pill pack

Question 11

how many people actually ovulate at day 14?

Answer 11

25% women

Question 12

what days can ovulation occur in

Answer 12

6-21

Question 13

7 indications for EHC?

Answer 13

UPSI on any day
IPSI in the 28 days following enzyme inducing drugs
UPSI from 21 days post partum
UPSI 5 days post abortion/ miscarriage/ ectopic pregnancy
ejaculation onto external genitalia
UPSI before new contraception is effective
contraceptive failure

Question 14

how long does a diaphragm need to stay in place for?

Answer 14

6 hours after intercourse

Question 15

what can you give if a patient has UPSI within 28 days following use of liver enzyme inducing drugs

Answer 15

offer Cu-IUD

or a double dose 3mg LNG

Question 16

levonelle mechanism of action and what is it

Answer 16

type of progestogen

prevents ovulation and discourage implantation

Question 17

what is levonelle licensed for (age?)

Answer 17

16 years and older

Question 18

ellaone what is it? how does it work?

Answer 18

progesterone receptor modulator

delays ovulation and alters endometrium to prevent implantation

Question 19

who is ella one licensed for?

Answer 19

all women of childbearing age
aka if a young girl has started period
must use professional judgement and that the child is gillick competence

Question 20

levonelle timeframe?

Answer 20

72 hours

Question 21

ellaone timeframe?

Answer 21

5 days

Question 22

IUD timeframe?

Answer 22

10 days roughly

Question 23

how effective is levonelle at:
<24 hours after UPSI
25-48 hours after UPSI
48-72 hours after UPSI

Answer 23

<24: 95%
25-48: 85%
49-72: 58%

Question 24

levonelle overalll efficacy? why should we be cautious about telling patients this?

Answer 24

84%

wrong to say this if theyre getting it on the third day

Question 25

effect of BMI on levonelle?

Answer 25

if BMI >26 they may find the efficacy is reduced | important to make patient aware

Question 26

ella one efficacy? pregnancy rate in 48-120 hour time window?

Answer 26

higher than LNG | 48-120 hours theres 2% pregnancy rate

Question 27

what reduces the efficacy of ellaone?

Answer 27

if any progesterone is taken in 5 days post taking ellaone aka all forms of contraception

Question 28

``` 1000 women have sex, how many will get pregnant with: no contraception? those who use ellaone? those who use levonelle? those who use IUD ```

Answer 28

NONE: 80 EllaOne: 5 LNG: 10 IUD: 1

Question 29

adverse effects of levonelle:

Answer 29

``` headache nausea breast tenderness lower abdo pain irregular bleeding: mensural changes fatigue increased risk of ectopic pregnancy- REFER ABDO PAIN dizziness ```

Question 30

ellaone adverse effects?

Answer 30

``` headache nausea abdo pain dysmenorrhea mild dizziness ```

Question 31

what side effect must women be counselled on?

Answer 31

nausea: if occurs within 3 hours come back for another dose

Question 32

is pregnancy a C/I for EHC?

Answer 32

YES, cannot take this as an abortion product

Question 33

would EHC affect an unborn child?

Answer 33

no

Question 34

C/I of levonelle?

Answer 34

pregnancy bowel disease- reduces absorption hepatic impairment- metabolism enzyme inducers (CYP3A4 inducing drugs

Question 35

examples of enzyme inducers which can effect Levonelle

Answer 35

St john wort, rifampicin, ritonavir, ciclosporin, griseofulvin, phenytoin, carbamazepine, barbituates

Question 36

what to do if patient is on enzyme inducers? what will happen?

Answer 36

refer to GUM clinic or GP: will be given 2 doses 12 hours apart

Question 37

is a second dose licensed?

Answer 37

no

Question 38

ellaone contraindications?

Answer 38

pregnancy hepatic impairment asthma uncontrolled by oral steroids (oral not inhalsed) breastfeeding- discard for 1 week

Question 39

ellaone drug interactions?

Answer 39

``` CYPA43 inhibitors ritonavir levonorgestrel hormonal contraception progestogen containing drugs ```

Question 40

what must you do if you want to give ellaone to someone who is breastfeeding?

Answer 40

advise that it passes into milk so they need to pump and discard for 1 week

Question 41

how does progesterones impact ellaone. so what do we advise?

Answer 41

prevents the ability of UPA to delay ovulation | dont take hormonal contraception for 5 days after ellaone

Question 42

checklist for OTC consultation if NOT on contraception

Answer 42

``` introduction indicated? exclude pregnancy? Other medications? Is cost/ efficacy an issue? choose correct EHC administration counselling MOA counselling efficacy counselling side effects explained VOMITING advice advise to do a pregnancy test if next period is more than 5 days late for LNG or 7 days if taken ellaone contraception must be used going forward- doesnt protect against future pregnancy continuing contraception? seek medical advice if lower abdominal pain STI? conclude ```

Question 43

when to take a pregnancy test?

Answer 43

if period if 5 days late for LNG or 7 days in the case of ella one 3 weeks after UPSI