QuestionSBA
QuestionChoice
Ulipristal acetate may be given as oral emergency contraception for up to 120 hours following unprotected sexual intercourse. However the dose here is indicated for treatment of fibroids rather than as emergency contraception
34028
d
Ulipristal acetate 5mg PO
QuestionChoice
This is a progesterone-only contraceptive that has no emergency contraception effects
34027
c
Noresthisterone 15mg PO
QuestionChoice
This may be given as oral emergency contraception for up to 72 hours following unprotected sexual intercourse. 1.5mg is a standard dose but this should be doubled as the patient is taking a p450 inducer
34026
b
Levonorgestrel 1.5mg PO
QuestionChoice
Ulipristal acetate may be given as oral emergency contraception for up to 120 hours following unprotected sexual intercourse. However the dose here is much too low to be used as emergency contraception
34029
e
Ulipristal acetate 10mg PO
QuestionChoice
This may be given as oral emergency contraception for up to 72 hours following unprotected sexual intercourse. The doubled dose accounts for increased metabolisation of the drug due to the patient taking a p450 inducer
34025
a
Levonorgestrel 3mg PO
QuestionComment
big narsty

17610
User
subscriber
Jargon Gland
QuestionComment
Where in the BNF does it say to double the dose?
19192
QuestionComment
Under the indications:

"Dose adjustments due to interactionsfor levonorgestrel
When used orally as an emergency contraceptive, the effectiveness of levonorgestrel could be reduced in women taking enzyme-inducing drugs (and for up to 4 weeks after stopping); a copper intra-uterine device should preferably be used instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3 mg taken as a single dose; pregnancy should be excluded following use, and medical advice sought if pregnancy occurs"

It's a bit of a mean question, I also chose the 1.5 mg option. Guess need to delve a bit deeper if the same option is listed twice at different doses 
20988
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Roshimitsu
User
subscriber
Axillary Dominant
QuestionComment
Carbamazepine = enzyme inducer. According to BNF:
When used orally as an emergency contraceptive, the effectiveness of levonorgestrel could be reduced in women taking enzyme-inducing drugs (and for up to 4 weeks after stopping); a copper intra-uterine device should preferably be used instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3 mg taken as a single dose; 
40062
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Monica
QuestionComment
no amount of trying will ever get me to recall inducers/inhibitors. brazy
40426
User
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Kawasaki Fever
QuestionComment
she also has pcos
60902
User
subscriber
Kawasaki Ketone
QuestionComment
you can rule out use of ulipristal as she has asthma
61498
User
subscriber
m
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2749
Levonorgestrel
Topic
76
Obstetrics and Gynaecology
6816
Case Presentation: A 30 year old woman attends a walk-in GUM clinic to request emergency contraception. She had protected sexual intercourse the evening before but realised afterwards that the condom had split without her noticing, and she is now worried about getting pregnant as she is not taking any other form of contraception. **PH** polycystic ovarian syndrome, trigeminal neuralgia, asthma. **DH** carbamazepine 300mg PO TDS, salbutamol 200 micrograms inhaler PRN, beclometasone dipropionate 200 micrograms inhaler BD, regular multivitamins. NKDA.


Her last menstrual bleed was 16 days ago, but she has an irregular cycle ranging from between 24 days to 40 days. She has never been pregnant before and has never been admitted to hospital. On counselling, she mentions having used a Mirena coil in the past but had it removed due to pelvic pain, and feels she would not consider trying intrauterine devices again.

Question: Select the most appropriate management at this stage.
a