Emergency contraception: levonorgestrel Sample Only
Indications |
Emergency contraception in postpubertal females over 14 years of age after unprotected intercourse, contraception failure or sexual assault
If patient is under 14 years of age refer to a medical officer |
Drug |
Levonorgestrel |
Presentation |
Levonorgestrel 1.5 mg as a single dose (1 × 1.5 mg tablet or 50 × 30 microgram tablets) |
Contraindications and precautions[1] |
Established pregnancy
Known allergy or hypersensitivity to levonorgestrel or excipients
Treatment in the previous 28 days with drugs that induce CYP3A4 (e.g. carbamazepine, efavirenz, nevirapine, phenytoin, St John’s wort) may reduce effectiveness of ulipristal acetate
Severe liver impairment
Hereditary problems of galactose intolerance, glucose-galactose malabsorption
Continued breastfeeding is considered safe as the infant’s exposure to levonorgestrel is very small
Severe diarrhoea and malabsorption may affect absorption
|
Pregnancy category |
Category D[2]
Levonorgestrel emergency contraception has no effect on an established pregnancy; failure of emergency contraception is not thought to increase the risk of birth defects or ectopic pregnancy[3] |
Dose and frequency |
Levonorgestrel 1.5 mg as a single dose orally[4]
|
Administration and supply |
Give levonorgestrel as soon as possible after unprotected intercourse, as its efficacy decreases with time. Give it within 96 hours (4 days) afterwards, but preferably within 72 hours (3 days). Levonorgestrel can still be considered 96–120 hours afterwards, as its risks are minimal, but its efficacy is uncerta¬in.
Local supply and administration will vary. Levonorgestrel may be administered within a service and/or supplied via prelabelled stock for use outside the service. Some services refer patients to a community pharmacy for over-the-counter supply. |
1 The drug information provided is to act as a guide only; for further information reference should be made to the full product information available in
MIMS or the
Australian Medicines Handbook. If contraindications, precautions or interactions are present, refer to a medical officer before administration.
2 Category D drugs are those which have caused, are suspected to have caused or may be expected to cause an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects.
3 See the
Australian Medicines Handbook.
4 The labels on two-pill emergency contraceptive pill packages specify that the second pill should be taken 12 hours after the first. However, these labels do not reflect current scientific information.
Drug interactions |
Concomitant use of drugs that induce the CYP3A4 pathway. Consult with a medical officer.
Do not use ulipristal and levonorgestrel together for emergency contraception; levonorgestrel may reduce the effectiveness of ulipristal |
Adverse effects relevant to STI treatment |
Menstrual disturbance is common
Women may experience irregular bleeding, an implantation bleed or bleeding from an ectopic pregnancy after levonorgestrel, which can be difficult to differentiate from normal menstruation
Headache, dizziness, abdominal pain, nausea |
Patient education |
Provide information on levonorgestrel including efficacy, side effects and ongoing contraception
Provide patient information leaflet
Offer STI screening
|
Follow-up |
A pregnancy test in 3–4 weeks may be important in the following situations:
- when the risk of pregnancy was high at the time when the emergency contraception was given
- if hormonal contraception is started immediately after levonorgestrel (‘quick start’ use) or 5 days after ulipristal
- if levonorgestrel or ulipristal is used more than once in the current menstrual cycle
- if next menstrual period is more than 7 days later than usual (may occur for about one woman in five with ulipristal)
- if the next menstrual period is light or unusual in any way
- if vomiting occurs within 2 hours of administration, in which case repeat dosing is recommended with the addition of an antiemetic.
Refer to GP for ongoing contraception |
Documentation |
Document history and assessment in the patient’s medical record
Document administration of emergency contraception in the patient’s medical record
|
Emergency contraception: ulipristal acetate
Indications |
Emergency contraception in postpubertal females over 14 years of age after unprotected intercourse, contraception failure or sexual assault
If patient is under 14 years of age refer to a medical officer |
Drug |
Ulipristal acetate |
Presentation |
Ulipristal acetate 30 mg tablet |
Contraindications and precautionsa |
Established pregnancy
Known allergy or hypersensitivity to ulipristal or excipients
Treatment in the previous 28 days with drugs that induce CYP3A4 (e.g. carbamazipine, efavirenz, nevirapine, phenytoin, St John’s wort) may reduce effectiveness of ulipristal acetate
Treatment with progestogens may reduce effectiveness of ulipristal; combination is not recommended. After using ulipristal acetate for emergency contraception, wait at least 5 days before starting progestogen-containing hormonal contraception.
Severe liver impairment
Severe asthma treated with glucocorticoids
Hereditary problems of galactose intolerance, glucose-galactose malabsorption
If breastfeeding, express and discard breastmilk for 7 days after taking ulipristal acetate
Severe diarrhoea and malabsorption may affect absorption
|
Pregnancy category |
Category Db
Limited information is available, but ulipristal is not thought to increase the risk of birth defects. See the Australian Medicines Handbook. |
Dose and frequency |
Ulipristal acetate 30 mg as a single dose orally
|
Administration and supply |
Give ulipristal acetate as a single dose within 120 hours of unprotected intercourse. It should be given as soon as possible after unprotected intercourse to optimise its efficacy.
Local supply and administration will vary. Ulipristal may be administered within a service and/or supplied via prelabelled stock for use outside the service. Some services refer patients to a community pharmacy for over-the-counter supply. |
Drug interactions |
Concomitant use of drugs that induce the CYP3A4 pathway. Consult with a medical officer.
Wait at least 5 days before taking hormonal contraception. Use a barrier method (e.g. condoms) during this time and for another 7 days with a combined hormonal contraceptive (9 days for Qlaira) or 2 days for progestogen-only pills.
Do not use ulipristal and levonorgestrel together for emergency contraception; levonorgestrel may reduce the effectiveness of ulipristal. |
Adverse effects relevant to STI treatment |
Menstrual disturbance is common
Women may experience irregular bleeding, an implantation bleed or bleeding from an ectopic pregnancy after taking ulipristal. This can be difficult to differentiate from normal menstruation.
Headache, dizziness, abdominal pain, nausea |
Patient education |
Provide information on ulipristal acetate including efficacy, side effects and ongoing contraception
Provide patient information leaflet
Offer STI screening
|
Follow-up |
A pregnancy test in 3–4 weeks may be important in the following situations:
when the risk of pregnancy was high at the time when the emergency contraception was given
- if hormonal contraception is started 5 days after ulipristal acetate
- if levonorgestrel emergency contraception or ulipristal acetate were used more than once in the current menstrual cycle
- if the next menstrual period is more than 7 days late (can occur for about one woman in five using ulipristal)
- if the next menstrual period is light or unusual in any way. If vomiting occurs within 3 hours of administration, repeat dosing is recommended with the addition of an antiemetic Refer to GP for ongoing contraception
|
Documentation |
Document history and assessment in the patient’s medical record
Document administration of emergency contraception in the patient’s medical record
|
a The drug information provided is to act as a guide only; for further information reference should be made to the full product information available in MIMS or the Australian Medicines Handbook. If contraindications, precautions or interactions are present, refer to MO a medical officer before administration.
b Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects.
Definition: urogenital
relating to or denoting both the urinary and genital organs.
Definition: Systemically unwell
Pertaining to whole body and not rather than localised area or region of body. Systemic features include fever, tachycardia, tachypnoea or elevated white cell count.
Definition: HIV Risk Reduction
Approaches to decrease an individual’s risk of HIV acquisition. Examples include condom use, use of PrEP, early HIV treatment to achieve viral suppression, reduce the number of sexual partners, use of safe injecting equipment.
Definition: anogenital
encompasses anal and genital areas
Definition: Referral
Patient is referred to another external service, department or health care practitioner (i.e. specialist) for care. All referral letters are to be kept in medical record. Examples include emergency department, external counselling services or a medical specialist.
Definition: Review
A medical officer undertakes a clinical consultation with patient either face to face or by telehealth
Definition: Consultation
Consultation is the process of seeking deliberation with a medical officer employed by the service or a doctor who has an established collaborative arrangement with the service. Consultation occurs when a patients signs, symptoms, care and management plan when is beyond the delegated clinical practices or where the nurse is seeking support or confirmation of clinical findings and/or management plan. Can occur face to face or telephone.
Definition: uncomplicated
state of condition; symptoms not present for more than 7 days including symptoms not present for more than 7 days.
Definition: must
Indicates a mandatory action requiring compliance.
Definition: should
Indicates obligation, duty or correctness of an action to be followed unless there are sound reasons for taking a different course of action.
Definition: VCNT Plates
Stands for vancomycin–colistin–nystatin–trimethoprim combination (in culture plate for testing for N. gonorrhoeae
Definition: trans woman
someone with a female gender identity but who was assigned male sex at birth
Definition: trans man
someone with a male gender identity but who was assigned female sex at birth
Definition: transgender
a person whose gender identity differs from the sex that was assigned at birth. May be abbreviated to trans.
Definition: toxic epidermal necrolysis
is a type of severe skin reaction commonly caused by certain medications such as lamotrigine, carbamazepine, allopurinol, sulfonamide antibiotics, and nevirapine.
Definition: Symptoms
any feeling of illness or physical or mental change apparent to the patient that is caused by a particular disease. On symptoms review patient reports presence of pharyngeal, genital or anal symptoms.
Definition: Stevens–Johnson syndrome
is a type of severe skin reaction commonly caused by certain medications such as lamotrigine, carbamazepine, allopurinol, sulfonamide antibiotics, and nevirapine.
Definition: standing order
Any subjective evidence of disease. In contrast, a sign is objective.
Definition: signs
Any objective evidence of a disease, such as a skin rash or a cough, is a sign.
Definition: sex
includes oral sex and vaginal and anal intercourse [but not manual sex? does oral sex include rimming?]
Definition: Serology
diagnostic examination of blood serum, especially with regard to the response of the immune system to pathogens
Definition: seroconversion illness
Acute infection seen in in 70% of patients; fever, rash, lymphadenopathy, pharyngitis, myalgia, diarrhoea, about 2 weeks after exposure during which HIV antibodies develop and become detectable.
Definition: seroadaptive behaviours
(=pos–pos sex and strategic positioning? replace term in Ch 6?)
Definition: self-collected
(of a body fluid sample) – specimens collected by patient
Definition: screening test
A screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of disease.
Definition: rapid plasma regain
a type of rapid diagnostic test that looks for non-specific antibodies in the blood of the patient that may indicate a syphilis infection.
Definition: psychosocial practitioner
encompasses social worker, counsellors and psychologists
Definition: priority population
patients with symptoms, contacts of a person with an STI, and those populations outlined in the NSW STI Strategy and NSW HIV Strategy. These include people whose risk factors, country of origin etc. put them at higher than average risk of HIV, other STIs and/or BBVs They include men who have sex with men, Aboriginal people, sex workers, culturally and linguistically diverse people, people who inject drugs, and people living with HIV.
Definition: Presumptive Treatment
of clinically suspected cases without, or prior to, results from confirmatory laboratory tests.
Definition: pre-exposure prophylaxis
any preventive medical treatment started before exposure to a pathogen to prevent infection from occurring.
Definition: postexposure prophylaxis
any preventive medical treatment started after exposure to a pathogen to prevent infection from occurring.
Definition: postcoital bleeding
spotting or bleeding during or after sexual intercourse unrelated to menstruation.
Definition: polymorphonuclear leukocyte
[polymorph] A type of white blood cell distinguished by its multilobed nucleus. Neutrophils are by far the most abundant type of polymorph, and are among the first inflammatory cells to be recruited to the site of injury. Informally called a poly
Definition: pharyngeal
relating to or located or produced in the region of the pharynx.
Definition: personal protective equipment
items such as gloves and face masks used by healthworkers to reduce the risk of transmission of infection from patient to healthworker
Definition: partner
(i.e. of a patient); a sexual contact, not necessarily social partner such as girlfriend/boyfriend, wife/husband. May include injecting partner.
Definition: neovagina
A vagina created through sex reassignment surgery.
Definition: over the counter
(=without a prescription) Over-the-counter medicines (OTC) are medicines that are not prescription medicines and are not complementary medicines. The medicines can be pharmacy medications (schedule 2), pharmacist-only medicines (schedule 3) or general medicine.
Definition: off-label use
[of a drug] Off-label’ prescribing occurs when a drug is prescribed for an indication, a route of administration, or a patient group that is not included in the approved product information document for that drug.
Definition: necrosis
(used re instructions to patient) the death of tissue due to disease, injury, or failure of the blood supply.
Definition: Morbidity
a diseased state or symptom; the rate of disease in a population
Definition: men who have sex with men
includes any homosexually active men, even if they do not identify themselves as gay, homosexual or bisexual. The term is used to describe behaviour rather than sexual identity to guide clinical care.
Definition: medical officer
a doctor of medicine who is responsible for the medical care of patients within a PFSHS
Definition: liquid-based cytology
is a method of preparing samples for examination in cytopathology where the sample is deposited into a small bottle of preservative liquid.
Definition: intermenstrual bleeding
refers to vaginal bleeding (other than postcoital) at any time during the menstrual cycle other than during normal menstruation.
Definition: interaction
one drug affects the activity of a another drug when both are administered together.
Definition: intake process
the steps taken by a patient to contact a PFSHS seeking services or an appointment
Definition: index case
is the first documented patient in the onset of an epidemiological investigation
Definition: index patient
is the first documented patient in the onset of an epidemiological investigation
Definition: imprest
(medication) An “imprest system” means the method by which medicines are supplied from the pharmacy department of a hospital to establish and maintain a stock of medicines at a pre-determined level for use in clinical services.
Definition: incarcerated
held in prison, detention centres, Juvenile Justice, police lock-up etc.
Definition: implantation bleed
thought to happen when the fertilized egg attaches to the lining of the uterus.
Definition: hysterectomy
is the surgical removal of the uterus.
Definition: hyphae
(Candida albicans) are long, branching filamentous structures of a fungus,
Definition: hypersensitivity
Abnormal sensitivity, a condition in which there is an exaggerated response by the body to the stimulus of a foreign agent.
Definition: hormonal contraception
refers to birth control methods that act on the endocrine system
Definition: case conference
planned and structured event involving is to provide holistic, coordinated, and integrated care to support the patient and improve their health outcomes including a documented plan with actions.
Definition: history (medical)
the patient’s past and present conditions which may contain relevant information bearing on their health past, present, and future.
Definition: genital reassignment
surgery or other procedure which changes the physical appearance and function of a person’s genitals to bring them into alignment with their affirmed gender identity. For example, male to female gender reassignment surgery may be a penile inversion operation to create a neovagina.
Definition: gender reassignment surgery
surgery or other procedure which changes the physical appearance and function of a person’s genitals to bring them into alignment with their affirmed gender identity. For example, male to female gender reassignment surgery may be a penile inversion operation to create a neovagina.
Definition: epidemiology
is the analysis of the distribution (who, when, and where) of a disease or conditions in defined populations such as geographic.
Definition: enzyme immune assay (ELISA)
stands for “enzyme-linked immunosorbent assay.” This is a rapid immunochemical test that involves an enzyme (a protein that catalyses a biochemical reaction). It also involves an antibody or antigen (immunologic molecules).
Definition: endemic; high-endemicity
constant presence of diseases or infectious agents within a given geographic area or population group.
Definition: emergency contraception
forms of contraception that are effective if administered within a specified period of time after sexual intercourse.
Definition: efficacy
the power to produce an effect
Definition: ectopic pregnancy
a pregnancy that is not in the uterus
Definition: dyspareunia
persistent or recurrent genital pain that occurs just before, during or after intercourse.
Definition: diagnostic test (cf. screening test)
A generic term for any test used to determine the nature or severity of a particular condition—e.g., imaging, laboratory tests, etc.
Definition: cytology
the microscopic examination of cells obtained from the body (as by aspiration or scraping) for diagnostic purposes
Definition: CYP3A4
is an enzyme found mainly in the liver and in the intestine which oxidizes small foreign organic molecules such as toxins or drugs, so that they can be removed from the body.
Definition: custodial settings
includes adult correction centres, detention centres, forensic hospital and juvenile justice centres and juvenile corrections centres.
Definition: contraindication
something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable
Definition: contraception
deliberate prevention of conception or impregnation
Definition: contact tracing
Contact tracing is defined as the identification and follow-up of persons who may have come into contact with a person infected with an STI or BBV.
Definition: contact
(of a patient/person with an STI or BBV) a person who may have come into contact with a person infected with an STI or BBV.
Definition: community pharmacy
commercial pharmacy
Definition: competencies
A competency is a set of defined behaviours or skills that provide a structured guide enabling the identification, evaluation and development of the skill or behaviours.
Definition: co-morbidity
existing simultaneously with and usually independently of another medical condition
Definition: clinician
nurses, doctors and counsellors providing clinical care to patients
Definition: cisgender
identifying with one’s sex assigned at birth (i.e. not transgender)
Definition: chronic
lasting a long time; in contrast to acute.
Definition: bloodborne virus
(explain what ones are generally meant by this term) Are passed from person to person through blood-to-blood contact. Refers to Hepatitis B, Hepatitis C, Syphilis and HIV
Definition: Asymptomatic
on symptoms review patient does not reports presence of pharyngeal, genital or anal symptoms.
Definition: Antiretroviral therapy
also known as ART HIV drugs that act on different viral targets is known as highly active antiretroviral therapy
Definition: Aetiology
the cause, set of causes, or manner of causation of a disease or condition. Antiemetic chiefly a drug preventing vomiting.
Definition: Acute
abrupt onset, progressive and generally short duration; sign or symptoms not present for more than 7 days.