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Clinical 1 (Part B) > 9 - Barrier Methods > Flashcards

9 - Barrier Methods Flashcards

1
Q

Indications of emergency contraception?

A

Unprotected sex

  • when no contraception has been used
  • when a contraceptive method may have failed
  • in cases of sexual assault
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2
Q

What does emergency contraception contain?

A

Levonorgestrel (progesterone)

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3
Q

MOA of Levonorgestrel

A
  • Interferes with ovulation (prevents or delays ovulation if taken before ovulation)
  • Affects muscle contractility of Fallopian tubes, impairing oocyte transport and concentration of glycodelin A (an inhibitor of sperm binding)
  • Does not affect endometrium or implantation
  • Does not interfere with an established pregnancy
  • Ineffective if taken on day of ovulation or after ovulation
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4
Q

CI of Levonorgestrel?

A
  • Pregnancy (wouldn’t work but wouldn’t harm fetus either)
  • Hypersensitivity to product (DUH DRENA)
  • Undiagnosed vaginal bleeding (could be ectopic pregnancy) - requires referral
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5
Q

Levonorgestrel: Effectiveness?

A

Dependent on time taken after intercourse:
<24 hours = 95%
25-48 hours = 85%
49-72 hours = 58%

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6
Q

Levonorgestrel: Ineffective in??

A

women who weigh over 176 pounds

*may be less effective in women weighting 165-175 pounds

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7
Q

Levonorgestrel: Dosing?

A
  • 2 tablets (0.75mg) must be taken together for a single dose of 1.5mg as soon as possible after unprotected sex
  • approved for use up to 72 hours after (some have efficacy for up to 5 days)
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8
Q

Levonorgestrel: adverse effects?

A

nausea
*may take dimenhydrinate 30 mins prior to use
vomiting
cramps

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9
Q

Levonorgestrel: monitoring?

A

see physician if no period within 21 days and take a pregnancy test

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10
Q

Levonorgestrel: what if the patient vomits after ingestion?

A

Take another dose

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11
Q

List some Rx Emergency Contraception Options

A
  • Copper IUD
  • Ulipristal Acetate
  • Yuzpe method
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12
Q

Describe the Copper IUD

A
  • Most effective form of emergency contraception
  • May be inserted up to 7 days after
  • Requires Rx
  • Can remain inserted for up to 30 months for ongoing protection
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13
Q

MOA of Copper IUD

A
  • inflammaotry reaction in uterus, as well as the copper ions are toxic to sperm and oocyte
  • inhibits implantation
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14
Q

MOA of Ulipristal Acetate

A
  • Inhibits or delays follicular rupture when given prior to LH surge
  • Ineffective if given on day of LH surge (ovulation)
  • Endometrium not affected (if sperm has met egg - it will not disrupt implantation)
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15
Q

Describe Ulipristal Acetate

A
  • Requires Rx
  • Single dose of 30 mg to be taken as soon as possible within 5 days after unprotected intercourse
  • more effective than levonorgestrel especially at day 4 or 5
  • may have less efficacy in women with a BMI > 35
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16
Q

Describe the Yuzpe Method

A
  • Two doses of: 100 mcg ethanol estradiol and 0.5 mg levonorgestrel given 12 hours apart
  • Less effective and more side effects versus Levonorgestrel or Ulipristal acetate
  • Rx
  • 50% have nausea
  • 20% vomit
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17
Q

Mifegymiso is a type of ??

A

medical abortion

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18
Q

Describe Mifegymiso

A

It contains:

  • 200mg of mifepristone (oral)
  • 800 microg of misoprotol (buccal) which is taken 24-48 hours after mifepristone
  • Indicated for pregnancy termination for up to 49 days although company is requesting Health Canada to approve use up to 9 weeks
  • Only given out at clinics from physicians - will not see in community pharmacy
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19
Q

List some barrier methods

A
  • male condoms
  • female condoms
  • contraceptive sponge
  • diaphragm
  • cervical barriers
20
Q

Advantages of barrier methods?

A
  • Acts as a mechanical barrier (FUCKING DUH DRENA)
  • Prevents against STI’s
  • Most effective method next to abstinence in protection against STIs and HIV
  • Prevention of pregnancy
  • Convenient
  • Widely available
  • Easy to use
  • Used only when needed
  • No systemic effects
  • Inexpensive
  • Variety of choices
  • Discreet
21
Q

Disadvantages of barrier methods?

A
  • Requries motivation to use and practise for proper use
  • May reduce sensitivity
  • May interfere with erection
  • May deteriorate in storage or when oil based lubricants used
  • Allergies or sensitive to latex in some women
  • Typical failure rate is 18%
22
Q

Nonoxynol-9 is what?

A

spermicide

23
Q

Is Nonoxynol-9 (spermicide) effective?

A

No evidence that it’s more effective than just condoms so it’s not recommended due to potential side effects

24
Q

Describe polyurethane or polyisoprene

A
  • Both are recommended for those with latex allergies
  • Polyurethane is stronger than latex, but do not have as much stretch, so breakage and slippage rates increased
  • Polyisoprene is a synthetic version of latex, is softer with stretchiness and more resistant to breakage
  • More expensive than latex
  • Can be used with water based lubricants

Products: SKYN, AVNATI BARE, BARESKIN

25
Q

FC2 is the only ____ _____ in Canada

A

female condom

26
Q

Describe FC2 (the only female condom in Canada)

A
  • Nitrile sheath with 2 flexible rings
  • Not intended for use with male condom !!!!
  • Requires a new female condom for each act of intercourse
  • Remove and throw away immediately after
  • Squeeze and twist outer ring before standing up to keep semen inside of condom
27
Q

Advantages to a female condom?

A
  • Can be inserted 8 hours prior to intercourse
  • Safe to use with latex sensitivity
  • No deterioration when exposed to oil based lubricants
  • Longer shelf life than male condoms
28
Q

Disadvantages to a female condom?

A
  • Typical failure rate is 21%
  • No data for nitrile polymer regarding efficacy and STI prevention
  • Higher cost than male condoms ($3/condom)
  • Fit is affected by vaginal anatomy
  • Difficult to insert
29
Q

Describe Spermicidal Products

A
  • Most contain Nonoxynol-9 that destroys sperm
  • May be used alone or with a second method (condoms, cervical caps, diaphragms)
  • Frequent use may lead to irritation and lesions on genital mucosa (which may increase risk of transmission of infections)
  • Will not prevent transmission of STIs and STDs (obvs)
  • Avoid use if multiple acts of daily intercourse
30
Q

Spermicidal products include ??

A
  • Gels - used with a diaphragm or cervical cap
  • Foams - VCF Foam (Nonoxynol-9 12.5%). Insert 1 applicatorful no more than 1 hour prior to each act of intercourse
  • Film - VCF (Nonoxynol 9 28% films). Inserted 15 mins (up to 3 hours) before intercourse. One film used per act of intercourse.
31
Q

Describe the Contraceptive Sponge

A
  • Small, disposable (single use), polyurethane foam intravaginal device, contains nonoxynol-9
  • Concave side should sit over cervix, loop on other side helps with removal
  • Inserted up to 24 hours before intercourse and must be left in the vagina for at least 6 hours after last act of intercourse but should not remain in vagina for more than 30 hours (risk of toxic shock syndrome)
32
Q

MOA of the Contraceptive Sponge

A
  • Provides a physical barrier to sperm
  • Absorbs sperm
  • Contains a spermicide
33
Q

Advantages to the Contraceptive Sponge

A
  • 12% failure rate in nulliparous women
  • 24% failure rate in porous women
  • One size fits all
  • 24 hours of protection
    • Protection begins right away
    • No need to change with repeated acts of intercourse
    • Can be used with male condoms (increases effectiveness)
34
Q

Disadvantages to the Contraceptive Sponge

A
  • CI in those with allergic to spermicidal
  • Difficulty in removing - must remain in vagina for at least 6 hours after intercourse and must not be left in vagina for more than 30 hours
  • Avoid those with history of TSS
  • Increased chances of urinary infections
  • No protection from HIV (Sponge may damage vaginal tissue and increase chances of HIV transmission)
35
Q

CI to sponge or spermicide ?

A
  • Being at high risk for HIV (Absolute CI)
  • Being HIV positive or having AIDs due to increased chance of transmission to uninfected sexual partners
  • Allergy to nonoxynol-9
  • History of TSS
  • Inability to correctly insert
  • Repeated urinary tract infections
  • Full term delivery (within 6 weeks), recent abortion (spontaneous or induced), vaginal bleeding (including menstrual flow for sponge)
36
Q

Describe a Diaphragm

A
  • Intravaginal barrier used with a gel
  • 3 types available in Canada:
  • Milex wide-seal silicone, Omniflex, and Milex Arcing
  • Requires sizing and Rx by HCP
  • Yearly replacement

Caya SILCS

  • one size available, Rx not required
  • can last up to 2 years
  • has an area to help hold during insertion and removal
37
Q

How do you use a diaphragm ?

A
  • Insert up to 2 hours prior to intercourse
  • Additional acid-buffering lubricant needed to be inserted with an applicator for repeated acts of intercourse of if >2 hours since diaphragm inserted and intercourse has not yet occurred
  • Must remain in place for a minimum of 6 hours after intercourse
  • Must be removed before 24 hours after initial insertion (risk of TSS)
  • Wash with warm water and mild soap
38
Q

Advantages of a diaphragm ?

A
  • 12% failure rate
  • Can be inserted up to 6 hours prior to intercourse
  • Easier to insert than the cervical cap
  • Can be used during menstruation
  • Can be re-used for subsequent acts of intercourse
  • Re-useable for several years
39
Q

Disadvantages of a diaphragm ?

A
  • Higher risk of urinary tract infections
  • Requires practise to insert prior to first time use
  • Risk of TSS
  • Must inspect regularly for rips/tears
40
Q

Describe pregnancy tests

A
  • Use human chorionic gonadotropic (HCG)
  • Detected in blood or urine after 6-8 days after conception
  • Highest concentration between 9am and 12 pm
  • Concentration doubles every 2 days, peaks in 60 to 70 days
  • Initial tests use urine, then confirmed with a blood test
41
Q

Describe the HCG levels after conception

A

HCG levels after conception:

  • After 1 week: 5mlU/ml
  • Peak at 100 000 mlU/ml
  • Urine tests can detect levels at 20-100 mlU/ml
42
Q

What can false-positive and false-negative results be from?

A
  • May be due to human error
  • False-negative test can occur up to 17 days after insemination
  • Testing too early
  • Testing too late
  • Expired test kit
  • Tumor production of HCG
43
Q

Describe Vaginal Dryness and what it’s caused by

A
  • Usually a postmenopausal issue
  • Low levels of estrogen during perimenopause and menopause may result in vaginal dryness

Decrease in estrogen causes:

  • Thinning of vaginal tissue
  • Loss of collagen support
  • Increased vaginal pH
  • Reduced production of vaginal lubrication even with sexual arousal
44
Q

What are vaginal lubricants used for?

A
  • vaginal dryness
  • dyspareunia (pain during sex)
  • comfort with condom use
  • can be used during intercourse
45
Q

Describe vaginal moisturizers

A

Replens: contains bioadhesive polymers that bind to vaginal epithelium and provide water and electrolytes to cells

  • Others contain equally effective ingredients (ex. pectin)
  • Longer duration of action, 2-3 days versus lubricants
  • Used on a routine basis - not immediately before intercourse
  • Like a hand cream to prevent dry skin.. Moisture not lubrication !!

Clinical 1 (Part B) (11 decks)

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