Contraception Pharm Flashcards
How do we prevent pregnancy (3 mechanisms)?
- Inhibition of sperm from reaching a mature ovum.
- Prevent fertilized ovum from implanting in the endometrium.
- Mechanisms that create an unfavorable uterine environment.
What are some barrier methods to preventing pregnancy? Advantage of?
- Barrier b/t sperm and ovum – Condoms (male and female), Diaphragms, Cervical caps.
* Condoms are used for STI protection as well.
What is the problem with barrier methods?
It depends on proper use before or at time of intercourse; there is a higher failure rate than oral contraceptives.
Highly effective and safe forms of reversible contraception?
IUD – Intrauterine Device.
What does OCP stand for?
Oral Contraceptive Pills.
What are the 2 types of OCPs?
- Combination – estrogen and progestin.
- Progestin only.
**Highly effective and safe, when used properly.
What are some NON-Contraceptive benefits of OCPs?
- More predictable cycles w/less pain and blood loss.
- Improved ACNE (Yaz, Ortho-Tri-Cyclen, LoEstrin, FE 24).
- Decreased incidence of:
- Endometrial and Ovarian CA.
- Benign Breast Dz.
- Pelvic infections.
- Ectopic pregnancies.
- Iron Def. Anemia.
Traditional OCPs are based on?
The 28 day menstrual cycle w/21 hormonal active pills and 7 inactive (placebo) pills in which bleeding occurs this week.
*Original pills were monophasic; newer pills are now biphasic or triphasic.
What does monophasic, biphasic and triphasic OCPs mean?
- Monophasic – deliver the same amount of estrogen and progestin each day.
- Biphasic – delivers a lower dose of estrogen/progestin the first half of the pill cycle and a higher dose during the second half of the pill cycle.
- Triphasic – have 3 different doses of estrogen/progestin that change every 7 days.
What is the MOA of Estrogen hormonal contraceptives?
Suppress the production of FSH to prevent the selection and emergence of a dominant follicle.
What are the two types of synthetic estrogens?
- Ethinyl Estradiol (EE).
2. Mestranol.
Which estrogen is only found in a couple of OCPS and converted to EE (Ethinyl Estradiol) in the liver?
Mestranol.
Adverse effects of estrogen OCPs?
Breast tenderness, breakthrough bleeding, thromboembolism and increases complications of women w/CV risk factors/disease – most worrisome.
Nauseas, HA, Melasma, Na/water retention, hypertriglyceridemia.
Adverse effects of progestin OCPs?
Increased appetite/weight gain, oily skin/acne, hirsutism, incr. LDL/decr. HDL.
Breast tenderness, HA, Fatigue, mood changes, gallbladder dysfunction.
Most common combination contraceptive best for PMS/PMDD, acne, hirsutism or PCOS?
Drospirenone/EE (Yasmin, Yaz).
*EE = Ethinyl Estradiol.
Medications that may be affected by OCPs?
Anticoagulants, Insulin, Hypoglycemics, TCAs, BZDs, Corticosteroids.
Effectiveness of these drugs due to OCP drug interaction?
- Abx, esp Rifampin, Griseofulvin.
- Anticonvulsants – topiramate, phenytoin, carbamazepine.
- St. Johns Wart.
What drugs (1) increase OCP hormone levels?
Protease inhibitors – ‘navir’ drugs that inhibit the action of HIV-1 protease.
Choosing an OCP?
- Know a few common brands of varying amounts and types of hormones.
- Estrogen:
- -low dose recommended: 20-35 mcg EE.
- -20 mcg may be beneficial in pt’s sensitive to estrogen AE w/women >40 y/o. - Progestin – all fine, drospirenone has special characteristics.
Patient education when starting OCPs?
- Start during first 5 days of next cycle – most start first SUNDAY of next period.
- Use backup method for one week after starting.
- TAKE AT SAME TIME QDAY!
- Don’t forget to restart a new pack after the 7-day placebo or pill-free interval.
What to do if you miss one pill?
Take is ASAP after remembering and the next pill at the regular time.
What to do if you miss two pills?
Take 2 pills the day you remember, 2 pills the next day, and then back to one Qday pill.
What should be used if more than 2 pills missed?
Backup birth control – condoms, etc.
What may happen with missed pills?
Breakthrough bleeding.
What are the MC AEs with OCP use?
Nausea, Breast tenderness, bloating, mood changes.
What is common during the first few months of OCP use?
Breakthrough bleeding or spotting, which usually resolve w/out any treatment w/in 2-3 months of use.
What is the most important pt. education for your patient taking OCPs?
DO NOT smoke!
What symptoms are necessary for immediate evaluation while taking OCPs?
Abd. pain, chest pain, severe HAs, severe leg pain/swelling.
*Could be Sx of MI, blood clot, stroke, liver and gallbladder disease.
When should you recommend a patient follow up after starting OCPs?
After 2-3 cycles to discuss any concerns and to check BP.
Further on choosing a contraceptive method?
- Effectiveness.
- Safety.
- Availability.
- Acceptability.
- Consider counsel on HIV/STI transmission risk.
Why is family planning important?
- Approx. 6 million pregnancies per year and almost half are unintended.
- Social, Financial and health repercussions.
What are some medical conditions that make pregnancy unsafe?
Breast CA, complicated valvular heart disease, DM w/vascular Dz, Endometrial/Ovarian CA, Malignant Liver hepatoma/Carcinoma, Sickle cell disease, SLE, Thrombogenic mutations, Epilepsy, Severe HTN, IHD, Bariatric surgery, transplant surgery (last 2 yrs), HIV/AIDS, cardiomyopathy, severe cirrhosis, TB.
Which is the most effective contraception method?
The onse use most consistently and correctly; the one the patient will use!
MOA of Progestin?
Thickens cervical mucus and thins endometrial lining inhibiting implantation.
**Possibly prevents ovulation; maybe 40% of time.
What is the most important aspect when taking a Progestin only OCP?
Timing is extremely important and must be taken at the same time each day.
Who is the Depo Provera injection contraindicated in?
Pt’s w/CAD and liver disease.
AE of Depo Provera?
Weight gain, irregular bleeding, HA, acne.
Which progestin OCPs are considered more androgenic and less thrombophilic?
1st and 2nd generation OCPs.
Which are 1st and 2nd generation OCPs?
1st – Norethindrone, Ethynodiol.
2nd – Levonorgestrel, Norgestrel.
Which progestin OCPs are considered less androgenic and more thrombophillic?
3rd and 4th generation OCPs.
Which are 3rd and 4th generation OCPs?
3rd – Desogestrel, Norgestimate, Etonogestrel, Norelgestromin.
4th – Drospirenone.
What is thrombophilia?
Thrombophilia (sometimes called hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels).
What are the non-contraceptive benefits of Combination OCPs?
Reduction in acne, hirsutism, PMS/PMDD Sx, improved anemia and Sx of Benign breast disease.
Contraindications for Combination OCPs?
Migraines w/Aura, HTN, Smokers >35 y/o, Hx of DVT/Clotting, MI/CVD, Breast/GYN CA, SLE.
Cautions with Combo OCPs?
Uncontrolled HTN, Seizure med, certain Abx, HIV meds, Hx of bariatric surgery.
What is a concern for the Nuvaring?
The pt is at an increased risk of yeast infections and BV.
What contraception is considered Non-Hormonal?
Copper IUD, condoms, diaphragms, sponge, spermicide.
What is a benefit with condoms?
STI protection!
Steps to make in order to Rx an OCP?
- Rule out pregnancy – HCG urine test/UPT.
- Make sure the OCP is safe for your pt.
- -gather a good medical and social history.
- -discuss pt preferences.
Which form of contraception is the only one that requires a pelvic exam before initiating?
An IUD.
What criteria can be used to reasonably be certain that a woman is not pregnant after having no Sx or signs of pregnancy?
- <7 days after the start of menses.
- No sexual intercourse since last normal menses.
- Has correctly and consistently been using reliable method of contraception already.
- <7 days after spontaneous or induced abortion.
- w/in 4 weeks postpartum.
- Fully or nearly fully breastfeeding, amenorrhoeic and <6 months postpartum.
Why is emergency contraception used?
- Indicated after an unexpected or inadequately protected act of sexual intercourse (condom breaks, missed dose of OCP).
- Failure to use any form of contraception.
**NOT to be used as primary method of contraception.
