Exam 4 - Prevention of Pregnancy and STIs - Julia’s Quizlet Flashcards
Healthy behaviors for women of reproductive age
- Maintain healthy diet and weight
- Take folic acid
- Be physically active regularly
- Abstain from alcohol if pregnant/planning to be
- Quit tobacco use
- Use effective contraception
- Refrain from excessive alcohol drinking
- Take ONLY medications prescribed by your doctor
- Talk to your healthcare provider about screening and proper management of chronic diseases
- Visit your HCP for healthcare recommendations for your age and pregnancy
- Reproductive age (15-44 years)
(Moms To Be Are QUeens - Really Taking Their Vitamins Right)
Pregnancy
Viable egg is available for fertilization by a sperms
Conception
6 day window that begins 5 days before ovulation through the day of ovulation
Peak risk for accidental pregnancy occurs w/ unprotected intercourse the day before ovulation
STIs
Affect both men and women
Women are more likely to develop reproductive consequences as they are typically asymptomatic
Reproductive consequence examples:
- chronic pelvic pain
- PID
- pregnancy complications
- infertility
- malignancies
(Makes sense because men don’t give a shit if they destroy you to get some cooch)
Non-curable but vaccine-preventable STI disease
Genital warts (HPV) - usually 3 dose series if given before 14 years old
Hepatitis B - now usually given at birth up to 6 months
Vaccines for STI prevention
HPV
Hep B vaccine
Curable STI diseases
Trichomoniasis
Nongonococcal urethritis (in men)
Gonorrhea
Genital chlamydial infection
Hep C
Syphillis
(Totally Nasty Guys Gave Her Syphillis)
NONcurable STIs
Aids
Genital herpes (HSV1/HSV2)
Facts about HPV prevention vaccine
HPV infection is the most common STI in the US
3 vaccines (gardasil 9 - valent HPV vaccine)
Indicated for females and males ages 9-26 years old to prevent cervical, vaginal, vulvar, and anal cancers
Which ages does the ACIP recommend the HPV vaccine for
Recommends for ages 11-12
If the child is vaccinated when child is 9-14 years old, 2 dose series: 1st shot, then second one 6-12 months after
Can get the vaccine up to age 45 now
People older than 11-12 need the 3 dose series
What are the longterm complications of Hep B
Hepatitis
Cirrhosis
Hepatic carcinoma
Possibly death
How is Hep B transmitted
Contact w/ blood or other body fluids
79% of new infections occurs in individuals w/ high risk sexual behaviors or IV drug use
Hep B vaccine recommendations
Recommended at birth, 1 month, and 6 months of age
Those who missed initial dose at birth can do the 3 dose series
Potential candidates for Hep B
International travelers
HCPs/EMS
Multiple sex partners
IV drug users
Liver disease
Diabetes
End stage renal disease
Residents of drug
abuse/correctional facilities
HIV infection/residents of HIV treatment facilities
(I Have MILDER Hepatitis)
What age group is at higher risk for Hep B
Ages 30-49 because they may have never received the Hep B vaccine
What are the primary goals of using contraceptives
Prevent unintended pregnancy
Prevent STIs
NonRx contraceptive products
Male condoms
Contraceptive sponge
Vaginal spermicides
Emergency contraception
Female condoms
(Make Cute Videos Every Friday)
Fertility awareness methods
Home tests for ovulation prediction
Calendar methods
Cervical mucus methods
Symptothermal methods
Lactational amenorrhea method
(Having Children Can Suck Longterm)
Which non-rx contraceptive product is the MOST important barrier contraceptive that helps protect against STIs?
Male condoms
(skins, rubbers)
(T/F): the FDA regulated condoms as medical devices and they must been performance standards for integrity and strength
True
Which type of condom is reserved for those w/ allergies as they have shown significantly higher breakage rates and higher pregnancy rate
Non-latex condoms
Usually made up of polyisoprene and polyurethane
What lubricants are safe for use with latex condoms
- Silicone based lubricants (astroglide)
- Replens inserts
- Saliva
- Water based lubricants (KY jelly)
- Contraceptive foams/gels
- Glycerin
- Water
(Sex Really Sucks When (it) Can’t Get Wet)
Lubricants NOT safe for use w/ latex condoms
Edible oils (olive, peanut, corn, canola, safflower, butter, margarine)
Topical oils (baby oil, mineral oil, massage oil)
Hemorrhoidal ointments
Petroleum jelly
Vaginal creams (monistat, estrace, vagisil, premarin)
(Evolving To HPV)
Facts about condom use
Use-related failure rate: 18 pregnancies per 100 women during first year of use
Breakage rate range: 0-22%
Lamb cecum condoms
Pregnancy prevention ONLY
Presence of pores in membrane may allow passage of viral organisms can (can allow HIV and Hep B)
Do NOT degrade w/ oil based lubricants
More expensive
Conduct heat well and are very strong
What is recommended if a tear/break occurs w/ a condom?
A. Immediately insert spermicidal foam/jelly into the vagina
B. Immediately insert spermicidal vaginal film/suppository as their quick time for dissolution may increase product efficacy
C. Consider emergency contraception ASAP and within 72 hrs, use foam/jelly w/ high concentration spermicide into the vagina
D. Do nothing. Likelihood of pregnancy/STI transmission is very rare
A and C
Behaviors associated w/ increased risk of condom breakage
Incorrect placement of condom/failure to squeeze air from the receptacle tip
Contact w/ sharp objects
Reuse of condom
Increased duration, intensity, or frequency
Prior history of condom breakage/slippage
Self-reported problems w/ fit
Use of oil based lubricant w/ latex condom
History of STI
(If Condom RIPS, Use Ham)
Dental dams
Latex/polyurethane sheets used between the mouth and vagina/anus during oral sex
Female condoms
Polyurethane female condoms (approved in 2003)
FC2 nitrile, a synthetic latex (approved in 2009)
If you use a female condom and a male condom at the same time, there is a higher risk for breaking
Which of the following is a true statement about use of a female condom?
A. Use a male condom w/ female condom to help decrease risk of pregnancy
B. Female condoms do NOT prevent pregnancy, they only decrease STI risks
C. Female condoms can be used for many acts of intercourse
D. Water based lubricants are the only lubricant that can be used w/ this condom
E. During intercourse, make sure the penis enters the vagina inside the pouch and that the outer ring remains outside the vagina
E
Vaginal spermicides
Use surface active agents to immobilize and kill sperm - gels and foams act as a physical barrier against sperm
Effective spermicides: nonoxynol-9 (manufactured/sold in US), octoxynol-9, menfegol
Nonoxynol-9 comes in spermicidal foams, gels/jellies, suppositories, film, sponge
Effective spermicides
Nonoxynol-9
Octoxynol-9
Menfegol
(T/F): efficacy improves greatly if spermicides are used w/ barrier methods such as diaphragms, cervical caps, or condoms
True
(T/F): vaginal spermicides protect against HIV and other STIs
False
Contraceptive sponge
Circular, small, disposable sponge made of polyurethane permeated w/ spermicide nonoxynol-9
One time use
Does not provide protection against STIs
Failure rate for contraceptive depends on whether the woman is parous (has had children) or nulliparous (has NOT had children)
Can be inserted 24 hrs in advance
Must remain in place for 6 hours after intercourse
Increased TSS risk
(T/F): the contraceptive sponge protects against HIV and other STIs
False
Who is the contraceptive sponge more designed for
Nulilparous women (have NOT had children)
Which of the following is the FDA approved condom for anal sex
A. ONE condoms
B. KY jelly
C. Nonoxynol-9 condom
D. Trojan condom
A. ONE condoms
(Because there is ONE kind approved)
Who is NOT recommended to use the contraceptive sponge
A. Men
B. Parous women
C. Nulliparous women
D. Women over 30
A and B
Emergency contraceptive pills
Hormonal method of contraceptions that can be used to prevent pregnancy following an unprotected act of sexual intercourse
When do emergency contraceptives work best
When taken ASAP after unprotected sex, but some studies show that it may be effective up to 3 days after
Should repeat dose if vomiting occurs within 2 hours
Laws about emergency contraceptives
Pharmacy law changes
No longer required to be BTC
No age limit to purchase
Available OTC
Which is a true statement about OTC ECs? SATA
A. AI is one levonorgestrel containing tablet
B. Can cause thickening of cervical mucus and interfere w/ transport of egg/sperm
C. Most common ADE is N/V
D. If a woman vomits within 2-3 hrs of taking the dose, she should repeat the dose
E. BMI > 26 may decrease effectiveness
All are true
What is the AI in emergency contraceptives
Levonorgestrel
A single tablet that is 1.5 mg
(T/F): emergency contraceptives work by delaying/inhibiting ovulation
True
What are the drug interactions that can affect EC effectiveness?
CYP3A4 inducers (ie carbamazepine, phenytoin, rifampin, st johns wart, topiramate) could reduce ulipristal and levonorgestrel efficacy
Labeling advises against the use of ulipristal in patients taking CYP3A4 inducers
What are the two types of ECs that muSt either be prescriber or implanted by a doctor
Ella (ulipristal acetate)
Copper IUD
Types of EC on the market
ParaGuard - copper IUD; works the best and is almost 100% effective
Ella - less effective if over 195 lbs
Plan B/generic - less effective if over 165 lbs
How soon should ECs be taken
ParaGuard IUD - within 5 days
Ella - ASAP, sooner = more effective, can be up to 5 days
Plan B - ASAP, can be up to 3 days
OTC brands available of levonorgestrel
New Day
My Way
Plan B One Step
Preventeza
Opcicon One Step
EContra One Step
(Not Making People Pregnant Or Evil)
What is coitus interruptus
Withdrawal method (pull out method)
Pregnancy can still occur because pre-ejaculation secretions may contain millions of sperm
Requires considerable self-control of the man
Potential for diminished failure by couple due to it being interrupted and NO STI PREVENTION
Patient counseling points for prevention of pregnancy and STIs
Emphasize consistent use of contraception w/ each sexual encounter
Male condoms and female condoms are the preferred methods for prevention of STIs
Sexually active women who miss a menstrual period are encouraged to perform a home pregnancy test/seek medical attention
Symptoms of an STI in a sexually active individual require medical referral
Which states grant pharmacists the ability to provide hormonal contraception without a prescription
Maryland
West Virginia
California
Oregon
Hawaii
Colorado
Idaho
Utah
DC
New Mexico
(Many Women Can Obtain Hormonal Contraceptives If Use Deemed Necessary)
Example of app used to detect ovulation
Natural cycle app
