Customer scenarios
Georgia is 25 years old and is currently taking Lovima, which was first supplied from her local pharmacy. She has recently moved to the area and has asked for a 6-month supply of Lovima.
She is vegan and was recently found to be B12-deficient so takes OTC supplements for vitamin D, iron and B12. She is not taking any other medication and has had no changes in her health since she started taking Lovima. Her periods have always been a bit irregular, but she is absolutely sure she cannot be pregnant because this is her first relationship in 2 years and they have not yet had sex.
She prefers to be in control of her life and does not want to have to go to a medical clinic to manage her fertility. She has no history of diabetes, liver problems, blood clots or cancer, or other medical history relevant to the use of Lovima.
Select the correct course(s) of action from the following:
Supply Lovima. It is reasonable to assume that Georgia is not pregnant, as she has abstained from sex for 2 years. She has no contraindications to Lovima.
Not supply Lovima as Georgia has irregular periods and could be pregnant.
Not supply Lovima as Georgia has a history of B12 deficiency and so may not be able to absorb Lovima adequately.
Maggie is 49 years old and has a BMI of 32. She has lost a considerable amount of weight, which has resulted in a significant improvement in her Type 2 diabetes mellitus. She has been able to reduce her medication, and now only takes metformin 500 mg twice daily and ramipril 5 mg once daily (for hypertension).
Her GP gave her a progestogen implant. Unfortunately, this caused a lot of irregular bleeding and so she had it removed. Her GP was encouraging her to consider a hormone-releasing intra-uterine contraceptive system such as Mirena®, but Maggie's sister didn't like the coil and so Maggie has been put off this idea. Maggie has heard about the desogestrel pill being available from a pharmacist and wanted to find out whether it would be suitable for her. You discuss the available options with Maggie, including highlighting that only barrier methods can protect from STIs and HIV infection. You also explain that LARCs, such as the coil recommended by her doctor, are one of the most effective options and her experience may differ from that of her sister. Maggie ultimately decides that she would like to try Lovima instead.
Select the correct course(s) of action from the following:
Supply Lovima as Maggie has Type 2 diabetes but this is well-controlled and so you can supply Lovima
Supply Lovima as Maggie has hypertension, but this is adequately treated with ramipril and so you can supply Lovima
Not supply Lovima as Maggie has a diagnosis of diabetes and therefore should discuss her contraceptive options with her GP
Not supply as Maggie has hypertension and needs to be referred to her doctor before Lovima is supplied
Complete your learning
Download and work through the following resources to consolidate your knowledge and complete your learning on Lovima.
Now you have completed this module, proceed to the next screen to record your learning. You can use this learning as part of your revalidation.
1. Lovima® 75 microgram film-coated tablets Summary of Product Characteristics 2020.
2. Faculty of Sexual & Reproductive Healthcare. FSRH Clinical Guideline: Progestogen-only Pills (March 2015, Amended April 2019) - Faculty of Sexual and Reproductive Healthcare [Internet]. Fsrh.org. 2019 [cited 3 March 2019]. Available from: https://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-pop-mar-2015/
3. SmPC. Cerazette 75 microgram film-coated tablet - Summary of Product Characteristics (SmPC) - (emc) [Internet]. Medicines.org.uk. 2019 [cited 28 March 2019]. Available from: https://www.medicines.org.uk/emc/product/1698/smpc
4. NICE. Contraception - progestogen-only methods - NICE CKS 2019 [Internet]. Cks.nice.org.uk. 2020 [cited 28 March 2019]. Available from: https://cks.nice.org.uk/contraception-progestogen-only-methods
5. UK Medical Eligibility Criteria for Contraceptive. UKMEC April 2016 (Amended September 2019) - Faculty of Sexual and Reproductive Healthcare [Internet]. Fsrh.org. 2020 [cited 4 March 2019]. Available from: https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016/
6. Faculty of Sexual & Reproductive Healthcare. Quick Starting Contraception. FSRH Clinical Guidance. 2017. [Cited 4 March 2019.] Available from: https://www.fsrh.org/standards-and-guidance/documents/fsrh-clinical-guidance-quick-starting-contraception-april-2017/
Online references last accessed November 2020
LOVIMA® 75 MICROGRAM FILM-COATED TABLETS (DESOGESTREL) - PL 42807/0002
Indications: Oral contraception for women of childbearing age including adolescents. Posology: One tablet every day continuously; 24 hours between tablets. First tablet taken on the first day of menstrual bleeding. Contraindications: Active venous thromboembolic disorder. Presence or history of severe hepatic disease. Known or suspected sex-steroid sensitive malignancies. Undiagnosed vaginal bleeding. Hypersensitivity to any ingredients. Peanut or soya allergy. Precautions: Pregnancy should be excluded. Contains lactose. Not for patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency, or glucose-galactose malabsorption. Caution in patients with: a history of breast cancer, diabetes, liver cancer or chloasma or depressed mood arising during use. Efficacy may be reduced with missed tablets, gastro-intestinal disturbances, or concomitant medications. Stop if sustained hypertension not controlled. Side effects: Common (≥1/100 to <1/10) breast pain; depressed mood; mood altered; libido decreased; menstrual cycle irregularities; nausea; acne; weight increased, headache. Uncommon (≥1/1,000 to <1/100) vaginal infections; contact lens intolerance; vomiting; alopecia; dysmenorrhoea; ovarian cyst; fatigue. Rare (≥1/10,000 to <1/1,000) rash, urticaria, erythema nodosum. MA holder: Maxwellia Ltd, Alderley Park, Alderley Edge, SK10 4TG Classification: P Price (ex.VAT): 28 tablets £14.28, 84 tablets £28.56. Date: July 2021.