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Nurses Journal Scan, September 2007
Laurie Scudder, MS, NP; Marilyn W. Edmunds, PhD, NP
Authors and Disclosures
Posted: 11/13/2007; Medscape Nurses © 2007 Medscape Print This The Journal for Nurse Practitioners
The Joint Commission Journal on Quality and Patient Safety
Policy, Politics and Nursing Practice
Disaster Management & Response
The Journal of the American Academy of Nurse Practitioners
Information from Industry
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The Journal for Nurse Practitioners

Journal Scan is the clinician's guide to the latest clinical and research findings in Journal for Nurse Practitioners, The Nurse Practitioner: The American Journal of Primary Care, The Journal of the American Academy of Nurse Practitioners, Journal of Pediatric Primary Care, and selected other scholarly journals having articles of value to advanced practice nurses and other clinicians. Links to article abstracts are provided when they are available. Links to related articles on Medscape are available for readers seeking information that is more detailed.

Plan B: Dual Label -- The Nurse Practitioners Role in Education and Provision

Wadsworth P
J Nurs Pract. 2007;3:470-474

Despite the growing availability of birth control throughout the last 50 years, unintentional pregnancy still occurs for a variety of reasons. When it happens, it represents a personal dilemma for many women. Regardless of the reason for the pregnancy, nurse practitioners (NPs) can take steps to help decrease the incidence of unintentional pregnancies.

Plan B, also known as the morning after pill, is a progesterone-only form of contraceptive that began selling over the counter for persons 18 years and older in November 2006. More widespread access to emergency contraception such as Plan B could reduce the number of unintended pregnancies by 50%.

The emergency contraceptive medication has been available in the United Kingdom for some years. After a great deal of debate, in 2006 the Food and Drug Administration (FDA) made a decision to allow women and men to purchase Plan B. The drug is available from regulated pharmacies where it is sold behind the counter so that clients have to ask for it and women younger than 18 must still have a prescription to obtain it. The average cost of over-the-counter Plan B is $39 to $42, thus decreasing the cost for some individuals who are able to purchase it without the cost of an office visit to get a prescription.

The most common form of emergency contraception, Plan B is a progestin-only pill and uses 0.75 mg levonorgestrel in 2 doses, 12 hours apart or 1.5 mg levonorgestrel in 1 dose. Regardless of the formulation, the first dose of emergency contraception is approved for use up to 72 hours after unprotected sex. Some research studies have shown effectiveness may actually last up to 120 hours, or 5 days, after unprotected intercourse. The progestin-only formulation is preferable to other types of emergency contraception products because it is more effective, it has fewer side effects, and it can be given in a single does of 1.5 mg. For progestin-only regimens, effectiveness rates are about 89%.

The exact mechanism of action is not clear. The American College of Obstetrics and Gynecology published guidelines for its members on the use of emergency contraception. They have also encouraged members to educate their patients about its availability. However, early research indicates that most healthcare providers rarely prescribe emergency contraception and do not often include emergency contraception in discussions about contraceptives.

There are few medical contraindications to the use of emergency contraception by women. Pregnancy, hypersensitivity to any component to the medications, and any undiagnosed abnormal genital bleeding are the accepted contraindications. Nausea and vomiting are the most common side effects to emergency contraception. These side effects may be controlled by antiemetic medications administered 1 hour before taking the emergency contraception.

Editor's Comment

Because of the large numbers of unintentional pregnancies and the stress, expense, and moral crisis that they often engender, emergency contraception seems an important contribution to women's health. The authors note that one researcher compared emergency contraception to fire extinguishers -- having a fire extinguisher does not make a person more careless at the kitchen stove, but it is important to have a backup in case other safety measures fail.

Full text

http://www.medscape.com/viewarticle/561667

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