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I now have enough information to give a thorough, accurate review. Here is a detailed fact-check of everything in the image:
Emergency Contraceptives - Fact Check
Methods Table
HORMONAL
| Entry in Image | Verdict | Notes |
|---|---|---|
| Morning after pill: Levonorgestrel 2.5 mg + Conjugated estrogen 15 mg orally twice daily for 5 days | Mostly correct (older regimen) | This is the classic Yuzpe-type regimen. The current standard for combined OC emergency contraception is ethinyl estradiol 100 µg + levonorgestrel 0.5-1 mg (2 doses, 12 hrs apart). The "conjugated estrogen + 2.5 mg LNG" figures reflect older Indian pharmacology textbook values and are still taught in that context. |
| Combined oral contraceptive: Ethinyl estradiol 50 µg + Norgestrel 0.25 mg, 2 tabs stat and 2 after 12 hours | Correct | This is the standard Yuzpe regimen. Ethinyl estradiol 50 µg × 2 tabs = 100 µg total, Norgestrel 0.25 mg × 2 = 0.5 mg total - matches standard references. |
| Levonorgestrel (Emergency pill): 0.75 mg stat and after 12 hours | Correct | Per Rosen's Emergency Medicine: "two doses of 0.75 mg levonorgestrel spaced 12 hours apart." However, the single 1.5 mg dose is now preferred (simpler, equally effective). Both regimens are acceptable to mention. |
NON-HORMONAL
| Entry in Image | Verdict | Notes |
|---|---|---|
| Copper IUCD (gold standard): Insertion within 5 days | Correct | Confirmed by multiple sources. It is indeed the gold standard for emergency contraception. - Rosen's Emergency Medicine |
| Antiprogesterone - Mifepristone: 100 mg single dose | Correct | 100 mg mifepristone is used as a single dose for emergency contraception. (Note: some sources also cite 200 mg for early medical abortion, so the 100 mg dose here specifically refers to emergency contraception.) |
| Newer agent: Ulipristal acetate 30 mg orally | Correct | Confirmed: "a single tablet of 30 mg of ulipristal acetate" - Rosen's Emergency Medicine. Effective up to 120 hours. |
Mechanism of Action
| Entry in Image | Verdict | Notes |
|---|---|---|
| Ovulation is either prevented or delayed when the drug is taken in the beginning of the cycle | Correct | This is the primary mechanism of levonorgestrel and ulipristal. - Rosen's Emergency Medicine: "Both levonorgestrel and ulipristal act to delay or inhibit ovulation." |
| Interference of fertilization | Correct | Particularly relevant to the Copper IUCD, which inhibits sperm function and fertilized egg transport. |
| Prevention of implantation as endometrium is rendered unfavourable | Partially correct / Contested | This is classically taught but current evidence is mixed. Modern studies suggest this is not a proven mechanism for LNG or ulipristal - both primarily work pre-fertilization. It remains relevant for the Copper IUCD. The note is acceptable in traditional/exam contexts. |
| Interferes with the function of corpus luteum or may cause luteolysis | Correct | This is an additional mechanism, particularly relevant to mifepristone (anti-progesterone effect on corpus luteum). Accepted in pharmacology teaching. |
Summary
The notes are largely correct for exam/clinical teaching purposes. Two things worth noting:
- Levonorgestrel dose: The 0.75 mg × 2 (12 hrs apart) regimen is correct but the preferred modern regimen is 1.5 mg as a single dose (same efficacy, simpler). Both are valid to know.
- Implantation prevention: Listed as a mechanism, but current evidence primarily supports pre-ovulatory action for LNG and ulipristal. The copper IUD does act post-fertilization. This point is still commonly included in pharmacology exams.
Everything else - the Yuzpe regimen, copper IUCD timing, mifepristone 100 mg, ulipristal 30 mg, and the mechanisms listed - is accurate and consistent with Lippincott Pharmacology and Rosen's Emergency Medicine.
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