AAAAA
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frank100 wrote:
A 20 y/o nulligravid woman comes to the physician 12 hours after her boyfriend´s condom broke during sexual intercourse. She uses no other contrasceptive method. Her last menstrual period was 14 days ago. Examination shows no abnormalities. She is concerned becuse she does not want to become pregnant. Which of the following is the most appropriate next step in management?
a) Oral gonadotropin releasing hormone agonist therapy.
b) High dose oral contrasceptive therapy.
c) Injection of human chorionic gonadothropin.
d) Insertion of an IUD.
e) Immediate dilatation and curettage.
Post-coital progestone contraceptive which can be bought over the counter wittout a prescription !
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| AAAAA
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Oral gonadotropin releasing hormone agonist therapy.
Way too expensive $$$$$$$$$$$$$
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| AAAAA
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frank100 wrote:
A 20 y/o nulligravid woman comes to the physician 12 hours after her boyfriend´s condom broke during sexual intercourse. She uses no other contrasceptive method. Her last menstrual period was 14 days ago. Examination shows no abnormalities. She is concerned becuse she does not want to become pregnant. Which of the following is the most appropriate next step in management?
a) Oral gonadotropin releasing hormone agonist therapy.
b) High dose oral contrasceptive therapy.
c) Injection of human chorionic gonadothropin.
d) Insertion of an IUD.
e) Immediate dilatation and curettage.
Worldwide, emergency contraception has been used extensively for over two decades. The options currently available include an estrogen-progestin combination (ethinyl estradiol with levonorgestrel), progestin alone (levonorgestrel), the antiprogestin synthetic steroid RU 486 (mifepristone; Mifeprex), estrogen alone (high-dose ethinyl estradiol) and the copper intrauterine device (IUD) (Table 1).3
a,c,e are wrong !!! b? But d should be the correct answer
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| AAAAA
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d is seldom done so despite it may be the correct answer, most doctors prescribe a progestone post-coital contraceptive !
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| AAAAA
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Emergency Contraceptive Options
The earlier that hormone pills are taken for emergency contraception within a 72-hour period after unprotected intercourse, the more effective they are likely to be.
Combined Ethinyl Estradiol and Levonorgestrel
In 1977, Yuzpe and Lancee5 introduced a regimen for emergency contraception consisting of ethinyl estradiol, 100 µg, and levonorgestrel, 0.5 mg, to be taken within 72 hours of unprotected intercourse and repeated 12 hours later. This regimen remains the most commonly prescribed postcoital birth control method in the United States. A number of pills from different trade name birth control pill packages are used (Table 2). More recently, a prepackaged, dedicated product consisting of four pills (Preven) has been developed.
TABLE 2
Emergency Oral Contraceptive Regimens Currently Used in the United States
------------------------------------------------------------------------- -------
Trade name Pills per dose Ethinyl estradiol per dose (µg) Levonorgestrel per dose (mg) Cost*
Ovral**¶ 2 white pills 100 0.50 $47
Alesse 5 pink pills 100 0.50 29
Levlite 5 pink pills 100 0.50 28
Nordette** 4 light-orange pills 120 0.60 30
Levlen** 4 light-orange pills 120 0.60 30
Levora 4 white pills 120 0.60 27
Lo/Ovral*¶ 4 white pills 120 0.60 31
Triphasil** 4 yellow pills 120 0.50 29
Tri-Levlen** 4 yellow pills 120 0.50 28
Trivora 4 pink pills 120 0.50 28
Ovrette¶ 20 yellow pills 0 0.75 31
Dedicated products
Preven§ || 2 blue pills 100 0.50 20
Plan B|| 1 white pill 0 0.75 20
------------------------------------------------------------------------- -------
note: Course of therapy is one dose taken within 72 hours of unprotected intercourse; second dose taken 12 hours later.
*--Cost to the pharmacist based on wholesale price, rounded to nearest dollar amount, as listed in Red book. Montvale, N.J.: Medical Economics Data, 1999.
**--These products were declared safe and effective for use as emergency contraception by the U.S. Food and Drug Administration (FDA) in February 1997. The other products listed are bioequivalents.
¶--The progestin in Ovral, Lo/Ovral and Ovrette is norgestrel, which contains two isomers, only one of which (levonorgestrel) is bioactive; the amount of norgestrel in each tablet is twice the amount of levonorgestrel.
§-- Preven comes with a pregnancy test kit.
||--Both Plan B and Preven are labeled by the FDA for emergency contraceptive use.
Information from Twelve brands of emergency contraceptive pills in the United States. J Am Med Womens Assoc 1998;53:213.
If 100 women have unprotected intercourse during the second or third week of their cycle, the probability is that eight will become pregnant. If the Yuzpe method is used, only two women will become pregnant (about a 75 percent reduction). A recent review of eight studies showed a precise reduced risk of pregnancy of 74.1 percent (95 percent confidence interval, range: 62.9 to 79.2 percent).6
Common side effects include nausea (50 percent of women) and vomiting (20 percent). No studies have analyzed the effect of vomiting on the efficacy of this regimen. Some physicians prescribe antiemetics routinely with the hormone therapy or repeat the dose of medication if vomiting occurs within one to two hours of ingestion. Others theorize that if nausea is experienced, the medication must already be absorbed systemically. Less common side effects include heavy menses and mastalgia.
Withdrawal bleeding occurs within three weeks of treatment. Thirty-eight percent of women bleed before their menstrual period is due. Only 8 percent are estimated to be four or more days late.3
No data support the occurrence of vascular complications in women resulting from this brief use of estrogen and progesterone therapy.7 In England, where emergency contraception has been used in over 4 million cases in 13 years, no statistically significant increase in the rate of deep venous thrombosis has occurred.3
There are no absolute contraindications to emergency contraception other than pregnancy. Furthermore, studies have shown no evidence of harm to the developing fetus. Investigators have not specifically examined the teratogenic effects associated with emergency contraceptive use, although a reasonable extrapolation may be made from extensive experience with prospective studies of unintended pregnancy in oral contraceptive users.
It is not known whether using estrogen-progestin combinations other than those described by Yuzpe would also be effective, whether the second dose given 12 hours after the first dose is necessary or whether the pills would be effective if started later than 72 hours after intercourse. A recent analysis of the timing of pill use suggests an inverse linear relationship between efficacy and the time from intercourse to treatment. The earlier the pills were used, the more effective they were during the 72-hour period studied. Delaying the first dose by 12 hours increased the odds of pregnancy by almost 50 percent.8 This analysis did not, however, study effectiveness beyond 72 hours. (If a patient first contacts her physician more than 72 hours after unprotected intercourse takes place, the medication can still be prescribed, with reassurance that no harm will be done if she becomes pregnant and a discussion of the presumably reduced efficacy of this regimen beyond 72 hours.)
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| yasmeen
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B IS FOR EMERGENCY CONTRACEPTION
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| mazinger
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b
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| frank100
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but before you insert an IUD, you should rule out pregnancy. thát´s why B is the answer for me.
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