45: Contraception

Question 1

How to address irregular bleeding side effects

Answer 1

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

Question 2

How to address headache side effects

Answer 2

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

Question 3

how to address nausea side effects

Answer 3

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

Question 4

How to address breast tenderness side effects

Answer 4

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

Question 5

How to address acne side effects

Answer 5

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

Question 6

Serious side effects of combined methods (ACHES)

Answer 6

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

-worried about clots

Question 7

CHC and migraines w/o auro

Answer 7

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

Question 8

CHC and migraines w aura

Answer 8

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

Question 9

CHCs and stroke

Answer 9

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

Question 10

Do not use CHC in patients with

Answer 10

-migraines with aura

Question 11

COC and antibiotics

Answer 11

-altered intestinal flora
-inc tummy problems
-altered metabolism

-recommend backup contraception for duration AND 7 DAYS AFTERWARDS

Question 12

Pt case:

EE 50mcg/ Norethindrone 1mg

complains abt nausea, boobs, mood

Answer 12

-dec estrogen

Question 13

Pt case:

EE 20mcg/Levo 0.1mg daily

spotting around days 5-6

Answer 13

-inc estrogen

Question 14

Hormonal testosterone does NOT protect from

Answer 14

-pregnancy

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

Question 15

Contraceptives for transgender men

Answer 15

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

Question 16

Contraceptives for transgender women

Answer 16

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

Question 17

Emergency contraceptives

Answer 17

-Copper IUD
-Levonorgestrel
-Ulipristal acetate

Question 18

LNG and ulipristal acetate EC tips

Answer 18

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

Question 19

Emergency Contraception mech

Answer 19

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

Question 20

How to start emergency contraception

Answer 20

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

Question 21

Emergency contraception side effects

Answer 21

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

Question 22

return of fertility after emergency contraception

Answer 22

-immediate

Question 23

Ulipristal acetate

Answer 23

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

Question 24

Levonorgestrel

Answer 24

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

Question 25

Medication abortion can be used when

Answer 25

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

Question 26

Contraindications of medication abortion

Answer 26

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

Question 27

Medication abortion regimen

Answer 27

-mifepristone
-misoprostol
-also used for early pregnancy loss

Question 28

Mifepristone (mifeprex)

Answer 28

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

Question 29

Misoprostol (cytotec)

Answer 29

-prostaglandin E1 analogue
-cervical softening
-uterine contractions

Question 30

Medication abortion dose

Answer 30

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

Question 31

Counseling points medication abortion

Answer 31

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

Question 32

Cause for concern during medication abortion

Answer 32

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

Question 33

Adverse effects of medication abortion

Answer 33

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

Question 34

Law that lets pharmacists prescribe contraception

Answer 34

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

Question 35

Pharmacist prescribing procedure

Answer 35

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

Question 36

Law requirements for pharmacists prescribinng

Answer 36

-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

Question 37

Potential opportunities for techs

Answer 37

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

Question 38

Screening interval

Answer 38

every 6 months