contraceptives Flashcards
levonorgestrel
plan b
norethindrone
ortho microner, microner
ulipristal
ella
ethinyl estradiol and desogestrel
apri, mircette, desogen, ortho-cept
ethinyl estradiol and drospirenone
yasmin, yaz
ethinyl estradiol and levonorgestrel
alesse, lutera, trivora, triphasil, lybrel
ethinyl estradiol and norethindrone
loestrin, loestrin FE
ethinyl estradiol and etonogestrel
NuvaRing
which contraceptives can pharmacists furnish?
self-administered hormonal contraceptives like oral, transdermal, vaginal, and depot injections(IM)
what do you have to measure for pts if you are considering furnishing a combined hormonal contraceptive?
blood pressure
counseling points for pharmacist?
use/administration, dosage, effectiveness, potential side effects, safety, recommend preventative health screenings, information that the hormonal contraceptives don’t protect against STDs
what training do pharmacists complete to furnish?
one hour of board-approved education, or training program during PharmD program at accredited school
what hormonal contraceptive can pharmacists choose?
safe as category 1 or 2
what can you give/not give for high/low risk of recurrent DVT/PE with/withoutanticoagulant therapy?
anything but CHC
what can you give/not give for acute DVT/PE?
anything but CHC
what can you give/not give if the patient has major surgery with prolonged immobilization?
anything but CHC
what can you give if the pt has diabetes with no complications?
anything
what can you give/not give for diabetes with one of the pathies?
anything but DMPA and CHC
what can you give/not give for diabetes with a vascular disease or diabetes for more than 20 years?
anything but DMPA and CHC
what can you give/not give if the patient had a stroke?
no DMPA or CHC, can start implant/POP but cannot continue them
what can you give/not give for hypertension
no CHC, no DMPA if vascular disease or BP of 160/100
what can you give/not give if pt is pregnant?
nothing
breastfeeding of any kind is a nono with CHC except for when (2 instances) (can still use implant, DMPA, and POP during this time)
more than 42 days postpartum and 30-42 days postpartum without risk for VTE
what can you give/not give if the pt currently has breast cancer or past breast cancer
cannot give anything besides Copper IUD
what can you give/not give for current pelvic inflammatory disease?
can start anything besides Copper IUD and LNG IUD (but can you still continue these two)
when are CHC not an option for migraines?
migraines with aura
when are CHCs not an option with smoking?
age is at least 35 and it doesn’t matter how many cigs they smoke
contraindications for Combination oral contraceptives
renal impairment, adrenal insufficiency, high risk of arterial/venous thrombotic diseases, undiagnosed abnormal uterine bleeding, breast cancer or other estrogen/progestin sensitive cancer, liver tumors orliver disease, pregnancy, co-administration with hepatitis C drug combinations containing ombitasvir, paritaprevir/ritonavir, with or without dasabuvir
what can be used with liver tumors?
benign focal nodular hyperplasia can be used with anything; any other liver tumor- you can only use the copper IUD
what are the low/moderate/high doses for estrogen(ethinyl estradiol)
low is 25 mcg max
moderate is 30-35 mcg
high is at least 50 mcg
progestin androgenic activity(discontinuation is the same) ranking from low to high
3rd & 4th generation < 2nd generation < 1st generation
progestin bleeding risk from low to high
3rd < 2nd
progestin and VTE risk
levonorgestrel < drospirenone
what to do (take missed pills/start new pack/use protection) if you miss 1 active pill in a row during any week
just take the pill (you end up taking 2 pills in one day), no protection needed
what to do (take missed pills/start new pack/use protection) if you miss 2 active pills in a row during weeks 1 or 2
just take the pill and will need to use protection for 7 days
what to do (take missed pills/start new pack/use protection) if you miss 2 active pills in a row during weeks 3 or 4
start a new pack and use protection for 7 days; if sunday start, use the old pack until following Sunday then start the new pack on Sunday; if you miss your period 2 months in a row then call provider because you might be pregnant
what to do (take missed pills/start new pack/use protection) if you miss 3 active pills in a row during an week
start a new pack and use protection for 7 days; if Sunday, continue old pack until Sunday
what to do if you miss inactive pills
keep taking 1 pill a day, so skip the one you missed; don’t need protection
when starting oral contraceptives, when do you need a back up method for contraception
if doing Sunday start instead of day 1 start, and need back up for 7 days
main signs of estrogen excess
cyclic weight gain due to fluid retention, dysmenorrhea, and menorrhagia
signs of estrogen deficiency
vasomotor symptoms, nervousness, decreased libido, early cycle breakthrough bleeding and spotting; absence of withdrawal bleeding (amenorrhea)
