Final Flashcards
Most common estrogen component in hormonal birth control:
Ethinyl estradiol
Who makes the guidelines for contraception?
CDC
What form of estrogen is used after menopause?
estradiol valerate
What does HB2879 say?
That a pharmacist may prescribe and dispense hormonal birth control to anyone over age 18 w/o evidence of a prior prescription or someone under age 18 with evidence of a prior prescription.
What does a pharmacist have to so in order to become certified to prescribe hormonal birth control?
Complete a training program approved by the board of pharmacy
Provide a self-screening tool to the patient
Refer the patient to their women’s health care practitioner.
Provide the patient with a record of their prescription.
Can a pharmacist prescribe hormonal birth control for a patient that they prescribed to three years ago if they have not visited a women’s health provider since then?
No. However, the patient may be tricky and go to the pharmacy across the street to get it prescribed.
Can insurance cover this birth control?
Yes.
What has to be ACPE accredited?
The pharmacist training must be ACPE accredited.
What is a difference between pharmacists and doctors prescribing to self and family members?
Doctors are recommended not to, while pharmacist are prohibited from prescribing to self and family members.
What subjects are covered in the pharmacists training program?
Foundation for women's health Pharmacology Therapeutics Patient Self-Assement Workflow
What contraception method is most widely used?
The pill, while male condom comes in second. The 1st line option, the IUD is only 10% of the contraception used.
Is the rate of VTE higher for birth control, during pregnancy, or during postpartum?
VTE risk is the highest postpartum, second-highest during pregnancy, and third-highest while on OC’s.
What percentage of pregnancies are unintended?
50%
What did the Direct Access Study do?
- 2008
- Used a validated self-assessment questionnaire
- Collaborative practice agreement
- It was determined that pharmacist could effectively screen women and provide birth control. Women and pharmacists were satisfied.
What laws do Colorado, Washington, and California have in place regarding pharmacists providing birth control?
Washington has a window sticker law. California and Colorado have a state protocol that is identical to Oregon’s protocol. New Mexico also has a state protocol, while Missouri and Tennessee have a CPA.
What is US MEC?
Medical Eligibility Criteria
What are the categories for eligibility for contraceptive use?
- No restrictions
- Benefits usually outweigh risks
- Risks usually outweigh benefits
- Unacceptable health risk if contraceptive is used
What has the self-assessment questionnaire shown?
That women are capable of assessing their own risk more than a provider. However, OTC status is not a good idea, as studies have to be done first.
What are the patient-care centered steps?
Collect Assess Plan Implement Follow-up
How much medication can you give the patient?
Initially, 3 months worth. Then another 9 months. The more medication you can give the patient, the more adherent they will be.
For continuing ex’s, can do 12 months.
What important documents are needed?
Standard procedures algorithm Self-Screening questionnaire Rules and regulations policies and procedures Patient visit summary US MEC List of nearby clinics for referral
What steps are required in order to prescribe someone birth control as a pharmacist?
- Health and history screen
- Pregnancy screen (period w.i last 7 days, 6 month old baby w/ no periods, abstaining since last period, using a contraceptive method consistently and correctly, etc.)
- Medication screen (cabamezepine, phenytoin, phenobarbital, primidone, topiramate. NOT St. John’s wort)
- Blood pressure (<140/90)
- After-visit summary may be provided, or circle referral instead, where it will have you list the reason. Provide list of nearby clinics.
- Discuss initiation strategy for treatment/change in treatment (counsel on starting now, using backup for 7 days, SE of bleeding irregularities, adherence, follow-up)
- Discuss and provide referral or visit summary.
**Pharmacy has to retain a cope of AVS and questionnaire, and send a copy to the PCP if they have one. Will still collect a fee.
What are the necessary things to counsel on?
Take by mouth At same time every day Set up first pill back Start ASAP and use backup if needed for 1 week. Placebo week, or not When follow-up is needed Hormonal contraception does not protect against STI's Some drug interactions Adherence is very important Have back-up method on hand (condoms)
Expect:
Common- breakthrough bleeding for about 3 months
Serious - blood clots (five people in 10,000)
If side effects don’t go away, there are alternate formulations
What types of patients should be referred to a women’s healthcare provider?
No insurance - refer to free clinic
Contraindications
What do pharmacies need to have to for a pharmacist to prescribe hormonal contraceptives?
A pharmacist’s NPI needs to be changed to a pharmacist clinician.
Certify their pharmacists as providers with each insurance company
Some have software to interface pharmacy systems with billing.
Do you bill pharmacy or medical coverage for prescribing birth control?
Medical coverage
What is antimicrobial stewardship?
It is a professional role in infectious control. They make sure that inappropriate prescribing is not going on to curb resistance.
What is the difference between bacteriostatic and bactericidal? Which is more important for getting the right dose?
Bacteriostatic stops growth, while bactericidal kills bacteria. Bactericidal is more important for getting the right dose.
