45: Contraception Flashcards by Brooke Thornburg

How to address irregular bleeding side effects

-take pills at same time
-ibuprofen 800mg TID for 5 days
-may improve with continued use

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How to address headache side effects

-discontinue if headaches get WORSE
-OTC pain relievers
-continuous product if during placebo

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how to address nausea side effects

-take pills with food or at bedtime
-continuous product if at start of cycle
-may improve w continued use

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How to address breast tenderness side effects

-supportive bra
-OTC pain relievers
-product w less estrogen

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How to address acne side effects

-topical treatments
-different pill formulation (less androgenic)
-combined product if able

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Serious side effects of combined methods (ACHES)

-Ab pain
-Chest pain (sob and coughing)
-Headache
-Eye problems (double/blurry vision)
-Severe leg pain

-worried about clots

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CHC and migraines w/o auro

-steady level of hormones = potential benefit
-low dose and monophasic
-could also make them more freq and severe tho in that case stop COC

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CHC and migraines w aura

-slightly higher risk of stroke
-inc risk due to temporarily narrowed blood vessels
-DO NOT USE

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CHCs and stroke

->50mcg EE has highest risk
-do not use in pt with migraine with aura (use progestin only)

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Do not use CHC in patients with

-migraines with aura

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COC and antibiotics

-altered intestinal flora
-inc tummy problems
-altered metabolism

-recommend backup contraception for duration AND 7 DAYS AFTERWARDS

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Pt case:

EE 50mcg/ Norethindrone 1mg

complains abt nausea, boobs, mood

-dec estrogen

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Pt case:

EE 20mcg/Levo 0.1mg daily

spotting around days 5-6

-inc estrogen

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Hormonal testosterone does NOT protect from

-pregnancy

-it might dec fertility but u can still get preg
-also use contraceptives to stop menses for gender affirming reasons

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Contraceptives for transgender men

progestin-only (does not interfere w testosterone)
CHC (safe to use but its estrogen yk)
non-hormonal IUD (cramps)
sterilization

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Contraceptives for transgender women

-barrier condoms
-orchiectomy (balls) or vasectomy (block tubes)

Emergency contraceptives

-Copper IUD
-Levonorgestrel
-Ulipristal acetate

LNG and ulipristal acetate EC tips

-take within 120 hours
-may lose efficacy as time passes
-use backup method 5 days with ulipristal

Emergency Contraception mech

-stop ovulation if taken before ovulation
-thicken mucus to trap sperm if taken after ovulation

How to start emergency contraception

-within 5 days
-wait 5 days to re-start hormonal birth control if ulipristal acetate used
-only use ulipristal once per cycle

Emergency contraception side effects

-nausea, vomiting, headache, dizzy, boon hurt, tummy hurt
-repeat dose if pt vomits within 2 hours
-spotting, period might be early or late

return of fertility after emergency contraception

-immediate

Ulipristal acetate

-inhibits ovulation
-leads to follicular rupture
-effective upto 5 days
-better than LNG up to 194lbs
-effective after LH surge has begun

Levonorgestrel

-inhibits ovulation
-OTC
-no drug interactions with other CHCs
-may be less effective >165lbs (BMI25)
-labeled for 72 hours

Medication abortion can be used when

-up to 70 days (10 weeks) gestation -gestational age = first day of last menses

Contraindications of medication abortion

-current IUD!! -long-term corticosteroids -chronic adrenal failure -coagulopathy/anticoagulant therapy -inherited porphyria -intolerance/allergy

Medication abortion regimen

-mifepristone -misoprostol -also used for early pregnancy loss

Mifepristone (mifeprex)

-SPRM (selective progeterone receptor modulator) -antiprogesterone -inhibits actions of progesterone -decidual necrosis, cervical softening, inc uterine contractility, prostaglandin sensitivity

Misoprostol (cytotec)

-prostaglandin E1 analogue -cervical softening -uterine contractions

Medication abortion dose

-Mifepristone 200 mg orally once -Misoprostol 800mcg buccally 24-48 hours later -2x 200mcg tablets in each cheek (30 min)

Counseling points medication abortion

-bleeding and cramping heavier than period -NSAIDs for pain -pain most severe 2.5-4 hours after misoprostol

Cause for concern during medication abortion

-HEAVY blleding >2 pads/hour for 2 hours, blood clots larger than lemon -chills and fever > 100 for >4 hours

Adverse effects of medication abortion

-nausea, vomiting, diarrhea -headache, dizziness -hot flushes, chills

Law that lets pharmacists prescribe contraception

-oral, patch, ring, injection, EC -specific training or graduation required -age restrictions, notify other providers, last visit with other provider -insurance requirement to compensate

Pharmacist prescribing procedure

1. birth control screening 2. pharmacist review 3. screen for pregnancy 4. check blood pressure 5. gen counseling 6. Identify different methods patient is eligible for 7. assess preferences 8. Method counseling

Law requirements for pharmacists prescribinng

-complete training program -cannot require an appointment -patient must be over 18 -can be first time product is prescribed -suggest patient see other healthcare provider if available -self-screener given to patient (risk assessment) -asses BP once every six months -provide prescription for up to 6 months, can renew for another 6 months -refer to primary care or women's health provider -provide written record of method prescribed

Potential opportunities for techs

-inform pts -schedule appts -check in/out pts -paperwork -take BP -ring up product

Screening interval

every 6 months