45: Contraception Flashcards
How to address irregular bleeding side effects
-take pills at same time
-ibuprofen 800mg TID for 5 days
-may improve with continued use
How to address headache side effects
-discontinue if headaches get WORSE
-OTC pain relievers
-continuous product if during placebo
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
How to address breast tenderness side effects
-supportive bra
-OTC pain relievers
-product w less estrogen
How to address acne side effects
-topical treatments
-different pill formulation (less androgenic)
-combined product if able
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
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
CHC and migraines w aura
-slightly higher risk of stroke
-inc risk due to temporarily narrowed blood vessels
-DO NOT USE
CHCs and stroke
->50mcg EE has highest risk
-do not use in pt with migraine with aura (use progestin only)
Do not use CHC in patients with
-migraines with aura
COC and antibiotics
-altered intestinal flora
-inc tummy problems
-altered metabolism
-recommend backup contraception for duration AND 7 DAYS AFTERWARDS
Pt case:
EE 50mcg/ Norethindrone 1mg
complains abt nausea, boobs, mood
-dec estrogen
Pt case:
EE 20mcg/Levo 0.1mg daily
spotting around days 5-6
-inc estrogen
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
Contraceptives for transgender men
- progestin-only (does not interfere w testosterone)
- CHC (safe to use but its estrogen yk)
- non-hormonal IUD (cramps)
- sterilization
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
- birth control screening
- pharmacist review
- screen for pregnancy
- check blood pressure
- gen counseling
- Identify different methods patient is eligible for
- assess preferences
- 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
