Emergency Contraception; Plan B: Introduction: While pharmacist are professionally prepared to provide care and support for patients

seeking emergency contraception (CE), the challenges inherent in increased distribution of EC requires a standardized approach. Currently EC are schedule II in some of the provinces like Ontario. Pharmacist's professional responsibility: To help reduce patient stress and anxiety, it is crucial that pharmacists remain supportive and refrain from making judgmental comments or indicating disapproval through body language or facial expressions while discussing EC. Supportive pharmacist attitudes, including respect for population diversity and patient beliefs, also will help compliance and set the stage for effective patient-pharmacist communication if follow up is needed. Patient seeking EC may be under stress after unprotective intercourse for many reasons: a. fear of becoming pregnant b. embarrassment at failing to use contraceptive effectively c. general embarrassment about sexual issues d. lack of knowledge about EC e. rape and or sexual abuse trauma f. worry about missing the narrow window of opportunity for EC g. concern about auto-immune deficiency syndrome (AIDS) and sexually transmitted diseases(STD) or a combination of these factors. Pharmacists who do not wish to provide EC treatment for personal reasons should maintain objectivity and remain professional in manner when dealing with patients. In this case, patients should be referred to an alternate source like another pharmacist or another pharmacy. Patient counselling summary: 1. Obtain the following information from the patients: Certainty that the patient does not want to become pregnant. Date of patient's last menstrual period to rule out established pregnancy. The time that has elapsed since unprotected intercourse occurred (less than 72 hours is more likely to prevent pregnancy). Whether the patient has been a victim of sexual assault. 2. Explain how to take EC correctly and conveniently. The earlier the regimen is started, the more effective it is. Take first dose as soon as possible. If timing is not convenient to take the second dose

after 12 hours, you may take both pills together. 3. EC does not protect from STDs. 4. EC is not 100% effective and will not terminate an established pregnancy. If the patient does not get her period within 3 weeks she may want to take a home pregnancy test or call for referral with a nurse or physician. 5. Remind the patient that her period should be on time, but may be a few days earlier or later. 6. Emphasize that EC is for emergency use only and it is less effective than other means of birth control. 7. Remind the patient to begin using ongoing contraceptive as soon as she resumes intercourse. 8. Explain about patient information sheet with instructions that she may read. Encourage her to call the pharmacy if she has any further questions. 9. Refer the patient to a physician or family planning clinic provider if established pregnancy cannot be ruled out or if the elapsed time is greater than 72 hours. 10. Follow up with the physician: if the patient has a delay in her next period or wishes to initiate use of regular contraceptive method.

Counselling issues: Responsibilities to minors: If the pharmacist becomes aware that a child (under 19 years old) has been physically harmed, sexually abused or exploited by a parent or other person, the pharmacist must report these cases to the appropriate authority. Dealing with parents: When talking with parents who find birth control pills in the child's personal belonging, the pharmacists should keep the following objectives in mind: 1. Be direct, honest and professional 2. Tell parents that you understand their concern 3. Inform parent that minors can consent to contraceptive and family planning services and it is the pharmacist's obligation to provide them. 4. Ensure confidentiality

Patient information: What is emergency oral contraceptive? It is birth control pills used in high doses, taken within 72 hours of unprotected sex. How effective is EC? It is useful in preventing pregnancy at least 75% of the time if used correctly. What is the dose? Plan B (1 tablet): 750 mcg of levonorgestrel Ovral (need to take 2 tablets): each tablet contains 250 ug d-norgestrel/50 ug ethinyl estradiol (EE) The regimen becomes completely ineffective by day 6 or 7 when implantation usually occur. What unwanted effects should I expect? Nausea and vomiting, to minimize this problem, take pill with food, and even gravol (dimenhydrinate) half hour before taking plan B. Repeat the dose if you vomit within one hour after taking the pill. Breast tenderness; headaches, cramps, etc. Who should not use EC? History of blood clots; diabetes; liver/kidney/heart disease; high blood pressure; requires special considerations.