7 - EC & Barrier Methods Flashcards
What are the indications for emergency contraception?
- Unprotected sex when no contraceptive has been used
- Unprotected sex when contraceptive method may have failed
How long can sperm be viable in the female reproductive system?
Up to 5 days
When can a woman become pregnant (what part of the menstrual cycle)?
After she ovulates
When does emergency contraception stop pregnancy from occurring?
After intercourse but before implantation
Can emergency contraceptives be used as a regular contraception?
No, will decrease in efficacy w/ prolonged use
What is the active ingredient of the plan B pill?
Levonorgestrel (progesterone)
What is the mechanism of levonorgestrel?
- Interferes w/ ovulation (prevents/delays ovulation if taken before it occurs)
- Affects muscle contractility of fallopian tubes, impairing oocyte transport
Does levonorgestrel have any affect on implantation?
No
Will levonorgestrel harm an established pregnancy?
No
When is levonorgestrel ineffective?
If taken on day of ovulation or after ovulation
What are contraindications to levonorgestrel?
- Pregnancy (won’t work, but won’t harm fetus)
- Hypersensitivity to product or ingredient
- Undiagnosed vaginal bleeding (*needs referral)
When is levonorgestrel most effective?
If taken less than 24 hours after intercourse
What are the weight restrictions for levonorgestrel? Does this mean we shouldn’t dispense to women of this weight?
- Less effective in women weighing 165-176 pounds
- Not effective in women over 176 pounds
- Don’t withhold based on weight, but counsel on possible decreased effectiveness
What is the dosing of levonorgestrel in the plan B pill?
1.5 mg
How long after intercourse can levonorgestrel be taken?
Up to 72 hours
What are the side effects of levonorgestrel?
- N/V
- Cramps
- Fatigue
- Breast tenderness
What is the monitoring for levonorgestrel?
See physician if no period w/in 21 days and take a pregnancy test
What should be done if a woman vomits w/in 2 hours of taking a dose of levonorgestrel?
- Contact health care provider (ex: pharmacist)
- Additional dose may be administered, based on judgement of HCP
What are the Rx emergency contraception options?
- Copper IUD
- Ulipristal acetate
- Yuzpe method
Copper IUD is a good option for women _____
w/ BMI over 30
What is the most effective form of EC?
Copper IUD
How long after unprotected intercourse can a copper IUD be inserted?
Up to 7 days
How long can a copper IUD remain inserted?
Up to 30 months
What is the mechanism of the copper IUD?
- Inflammatory reaction in uterus
- Copper ions toxic to sperm and oocyte
- Inhibits implantation
What is ulipristal acetate?
Selective progesterone receptor modulator
What is the mechanism of ulipristal acetate?
Inhibits/delays follicular rupture when given prior to LH surge
When is ulipristal acetate ineffective?
When given on day of LH surge (ovulation)
Is ulipristal acetate available OTC?
No, need an Rx
What is the dose of ulipristal acetate? When should it be taken?
- 30 mg
- ASAP w/in 5 days of unprotected intercourse
What are the side effects of ulipristal acetate?
- Nausea
- Headache
- Dysmenorrhea
- Abdominal pain
- Fatigue
- Dizziness
Can ulipristal acetate be taken w/ other hormonal contraception?
- Yes, but other contraception cannot be started until 5 days after taking ulipristal
- Use backup contraception for 7 days after starting hormonal contraception, so 12 days from when ulipristal was taken
What is always the last option for emergency contraception? Why?
- Yuzpe method
- Cause N/V in 50% of px
What is the yuzpe method?
2 doses of 100 mcg ethinyl estradiol and 0.5 mg levonorgestrel given 12 hours apart
What is mifegymiso? What are its active ingredients? What is its mechanism?
- Abortion pill (Rx)
- Mifepristone which blocks progesterone production in uterus
- Misoprostol (taken 24-48 hours after mifepristone) which induces contractions and causes a miscarriage
What is the indication of mifegymiso?
Pregnancy termination up to 63 days measured from first day of last menstrual period
What are the most common SE of mifegymiso?
- Vaginal bleeding, sometimes heavy and prolonged uterine cramping
- N/V, diarrhea
- Headache, dizziness
What are potential complications w/ mifegymiso?
- Risk of infection and sepsis
- Risk of prolonged heavy bleeding
- Risk of incomplete abortion
Only ___ based lubricants can be used w/ latex condoms
Water
Does lubrication of male condoms w/ nonoxynol-9 (spermicide) result in
greater pregnancy or STI prevention?
No, so not recommended b/c of potential side effects
Which types of condoms are recommended for people w/ latex allergies?
Polyurethane or polyisoprene
What is a disadvantage to polyurethane condoms?
Doesn’t have as much stretch as latex, so breakage and slippage is more likely
Are female condoms recommended to be used w/ male condoms?
No
When is a new female condom required?
Each act of intercourse
How should a female condom be removed?
Squeeze and twist outer ring before standing up to keep semen inside condom
What are advantages to female condoms?
- Can be inserted up to 8 hours prior to intercourse
- Safe to use w/ latex sensitivity
- No deterioration when exposed to oil based lubricants
- Longer shelf life than male condoms
What are disadvantages to female condoms?
- Higher failure rate
- Higher cost
- Fit is affected by vaginal anatomy
- Difficult to insert
What is the substance used in spermicides?
Nonoxynol-9
What can frequent use of spermicides cause?
Irritation and lesions on genital mucosa
Do spermicides protect against STIs and HIV?
No
When should spermicides be avoided?
Multiple acts of daily intercourse
Where are spermicides applied?
Vaginally
What are the different formulations of spermicides available?
- Gels
- Foams
- Film
How is spermicide foam used?
Insert 1 applicator-full no more than 1 hour prior to each act of intercourse
How is a spermicide film used?
- Inserted 15 mins up to 3 hours before intercourse
- One film used per act of intercourse
What is a contraceptive sponge?
Small, disposable, polyurethane foam intravaginal device w/ nonoxynol-9
How is a contraceptive sponge used?
- Inserted up to 24 hours before intercourse
- Must be left in vagina at least 6 hours after last act of intercourse
- Should not remain in vagina for more than 30 hours (toxic shock syndrome, irritation, infection)
What is the mechanism of a contraceptive sponge?
- Physical barrier to sperm
- Absorbs sperm
- Contains spermicide
What are advantages to the contraceptive sponge?
- Low failure rate in nulliparous women
- One size fits all
- No need to change w/ repeated acts of intercourse
- Can be used w/ male condoms
What are disadvantages to the contraceptive sponge?
- Contraindicated in those w/ allergies to spermicide
- Difficult to remove
- Increased chance of urinary infection
- No protection from HIV
Which diaphragms require sizing by an HCP? Do they require a prescription?
- Milex wide-seal silicone Omniflex
- Milex Arcing
- Both require an Rx
Which diaphragm doesn’t require sizing? Does it require a prescription?
- Caya SILCS
- No Rx required
How is a diaphragm used?
- Insert up to 2 hours prior to intercourse
- Remain in place for at least 6 hours after intercourse
- Must be removed before 24 hours after initial insertion
- Wash w/ warm water and mild soap
Are cervical caps or diaphragms easier to insert?
Diaphragms
Can diaphragms be used during menstruation?
Yes
What are disadvantages to diaphragms?
- Higher risk of UTIs
- Requires practice to insert
- Risk of toxic shock syndrome
How long after intercourse can a pregnancy test provide a false negative result? Why?
- Up to 17 days
- Sperm can remain viable in fallopian tubes for up to 5 days, and implantation takes another 6-12 days after ovulation
What do pregnancy tests test?
Human chorionic gonadotropin (HCG)
How long does it take for HCG to be detected in blood or urine?
6 to 8 days after conception
What time of day is the highest concentration of HCG found?
Between 9 am and 12 pm
When does HCG peak?
60 to 70 days after conception
How many weeks pregnant would a woman be if a pregnancy test detected pregnancy on first day of missed period?
14 days (2 weeks) pregnant
What can cause vaginal dryness?
Low estrogen levels
What does a decrease in estrogen cause?
- Thinning of vaginal tissue
- Loss of collagen support
- Increased vaginal pH
- Reduced production of vaginal production even w/ sexual arousal
When are vaginal lubricants used?
During intercourse for vaginal dryness, dyspareunia, and comfort w/ condom use
When are vaginal moisturizers used?
On a routine basis, not immediately before intercourse
