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Pharm 584 > MCP Oral Contraceptives > Flashcards

MCP Oral Contraceptives Flashcards

1
Q

Oral Contraceptives: MOA

A
  • Contraception is orchestrated through a negative feedback mechansim that “tricks” the body into thinking it’s pregnant
  • Estrogen-like hormone: suppresses FDH release from the pituitary gland, stops follicle maturation
  • Progesterone-like hormone: Blocks LH Surge, thickens cervical mucus, induces endometrial atrophy, stops ovulation
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2
Q

Oral Contraceptives: Indications

A

Contraception, acne, dysmenorrhea, polycystic ovary syndrome, endometriosis, irregular menstrual cycles, etc.

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3
Q

Combination Pills

A
  • Both estrogen-like and progesterone-like hormones
  • Progesterone-like: varies
  • Estrogen-like: ethinyl estradiol
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4
Q

“Mini Pills”

A

Norethindrone

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5
Q

Oral Contraceptives: Phasic Differences

A
  • Monophasic: Same dosing through all active pills
  • Triphasic: Different dosing each week for the active pills
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6
Q

Monophasic Oral Contraceptives

A
  • Same amount of estrogen and progesterone through all active pills
  • Normal: 21 tablets combo active pills and 7 placebo pills
    • Aviane
    • Loestrin FE
    • Ortho-Cyclen
  • Continuous: 24 tablets combo active pills and 4 placebo pills
    • Yaz
    • Yasmin
    • Lo Lestrin FE
  • Extended: 84 tablets combo active pills and 7 placebo pills
    • Seasonale
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7
Q

Triphasic Oral Contraceptives

A
  • Amount of estrogen varies each week to mimic the hormonal changes in a normal menstural cycle
  • Normal: 21 tablets of combo active pills and 7 placebo pills
    • OrthoTri-Cyclen
    • Necon 7/7/7
  • Extended: 84 tablets combo + 7 Ethinyl estradiol. Possiblity of spotting or no period during the 7 days
    • Seasonique
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8
Q

Oral Contraceptives: Drug Interactions

A
  • Certain antibiotics
    • Ex: Rifampin
  • Certain natural supplements
    • Ex: St. John’s Wort
  • May decrease OC plasma concentrations and effectivness
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9
Q

Estrogen: Side Effects

A

•Nausea/Vomiting
•Breast Tenderness
•Spotting
•Water retention
​

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10
Q

Progesterone: Side Effects

A
  • Acne
  • Increased appetite
  • Weight gain
  • Nausea
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11
Q

Rare/Serious Side Effects of Oral Contraceptives

A
  • Blood clots (DVT/PE)
  • Stroke
  • Hypertension
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12
Q

Blood Clot associated with OC (and symptoms)

A
  • Increase risk with age
  • Caused by estrogen
  • Symptoms:
    • A: Abdominal pain
    • C: Chest pain, cough, SOB
    • H: Headache, dizziness, numbness
    • E: eye (vision loss)
    • S: severe leg pain, swelling
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13
Q

Combination Pills: Contraindications

A
  • Excacerbations of certain cancers
    • Breast Cancer
    • Endometrial Cancer
  • History of abnormal clotting
  • Severe or uncontrolled hypertension
  • Smoking and over age 35 years
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14
Q

Combination Pills: Counseling Points

A
  • Must take at the same time EVERY DAY
    • Do not skip active pills
  • Use back-up method (e.g. condoms) until at least 7 days have passed since start of regimen
  • Take with food to minimize nausea/vomiting
  • If side effects persits, discuss with MD
    • Side effects should go away in about 2-3 months
  • Possible drug interactions-antibiotics
  • Missed dose? Read package insert
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15
Q

Combination Pill: Missed Dose

A
  • Missed 1 Pill
    • Take 1 tab as soon as you remember and 1 tab next day on regular scheduled time
    • No backup method needed
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16
Q

When to start the FIRST pack of pills

A
  • Day 1 Starter:
    • Take the first active pill on day 1 of cycle (first 24 hours of your period)
    • No back-up method required
  • Sunday Starter
    • Take the first active pill on the Sunday after you are still bleeding
    • If period begins on Sunday, start the pack the same day
    • Use back-up method for 7 days after starting the first pack
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17
Q

Progesterone ONLY pills: MOA

A
  • Thicken of mucus in the cervix to prevent entrance of sperm
  • Only suppreses ovulation in half of the patients
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18
Q

Who is progesterone ONLY pill for?

A
  • Breast feeding women
    • Estrogen can suppress breast milk production
  • High risk for blood clots (>35yr old)
  • Hypertension
  • Migraine
19
Q

Progesterone only pills: Contraindications

A
  • Breast cancer
  • Known/suspected pregnancy (both types of pills)
  • Genital bleeding
20
Q

Progesterone-Only Pills: Counseling Points

A
  • Must take at same time every day-VERY IMPORTANT
  • Start first pack on the first day on menstrual period
    • Use back up method for 2 days if started first pack on another day
  • Irregular menstral bleeding or spotting is common
  • Prolonged episodes of side-effect, contact MD
  • If you miss 2 period in a row, take pregnancy test
  • What about missed doses-read package insert
    • Take missed dose as soon as you remember
    • If missed >3hrs, use backup method for 2 days
21
Q

Emergancy Contraceptive: MOA

A

Inhibits ovulation

22
Q

Emergency Contraceptive: Dosing

A
  • Next Choice: 2 tablets in a day
    • OTC>17 yo, Rx: <17 yo
  • Plan B One-Step: 1 tablet
    • OTC: No age restriction
23
Q

Emergency Contraceptive: Side Effects

A
  • Nausea/vomiting
  • Headache
  • Dysmenorrhea
  • Abdominal pain
24
Q

Emergency Contraceptives: Counseling Points

A
  • Less effective in obese patients, recommend alternative
    • Cooper IUD
    • Ella
  • Take within 72 hours after unprotected sex
  • Take with food to prevent GI upset
  • If vomiting occur within 3 hours of dose, need to redose
  • Can take medicine to prevent nausea
25
Q

Alternative to OC: in order of most effective to least effective

A
  • IUD
  • Ring
  • Patch
  • Injectables
  • Condom
  • Diaphragm
  • Spermacide
26
Q

Menopause: Definition

A
  • Perimenopause
    • Dysfunction uterine bleeding-anovulatory cycle (3-4 missed cycles)
    • Begins mid-late 40s
    • Last about 4 year
  • Menopause
    • Permanent cessation of ovulation and menses
    • Amenorrhea for 12 consecutive months
    • Median onset age: ~51
27
Q

Menopause: Symptoms

A
  • Vasomotor symptoms (hot flash, night sweat)
  • Sleep disturbance
  • Mood changes
  • Sexual dysfunction
    • Vaginal dryness
    • Painful intercourse (dyspareunia)
    • Decreased libido
  • Memory problem
  • Urinary symptoms
  • Osteoporosis
28
Q

Menopause Treatment

A
  • No medical “treatment” is required for most women
  • Need to understand patient’s view on symptom control and preventative medicine
  • Educate patients regarding health lifestyles, weight loss, exercise, & smoking cessation
  • Address individual symptoms-such as hot glashes or vaginal dryness
29
Q

“Traditional Treatment for Menopause”-HRT

A
  • Menopause symptoms and osteoporosis prevention
  • Intact Uterus:
    • Estrogen+progestogen
    • Estrogen alone (associated with endrometrial hyperplasia)
  • Hysterectomy (uterus removed)
    • “Unopposed” estrogen (given w/o progestogen)
  • Why HRT?
    • Post-menopausal women stop producing estrogen and progesterone, use HRT to supplement the hormone that females are not mking anymore to reduce menopausal symptoms and risk of osteoporosis.
30
Q

HRT: Contraindications

A
  • Breast cancer
  • Undiagnosed vaginal bleeding
  • Endometrial hyperplasia/cancer
  • Active blood clot (DVT/PE)
31
Q

HRT: Side Effects, Common

A
  • Nausea/Vomiting
  • Headache
  • Breast tenderness/pain
  • Irregular bleeding/spotting
  • Vaginal irritation, itching, burning
  • skin irritation, rash
32
Q

HRT: Serious/Rare Side Effects

A
  • Coronary heart disease
  • Stroke
  • Blood clots (DVT/PE)
  • Breast cancer
  • Gallbladder disease
33
Q

HRT: Oral drugs

A
  • Estrace
  • Premarin
  • Provera
  • Prometrium
34
Q

HRT: Topical Drugs

35
Q

HRT: Transdermal Drugs

A
  • Vivelle Dot
  • Combipatch
36
Q

HRT: Vaginal Drugs

A
  • Vagifem
  • Estring
  • Premarin cream
  • Estrace cream
37
Q

Oral Estrogen vs. Progestin: Drug names

A
  • Estrogen
    • Estrace (Estradiol)
    • Premarin (Conjugated Estrogen)
  • Progestin
    • Provera (Medroxyprogesterone)
      • Used in combination with estrogen
      • Anti-estrogenic effect to reduce the risk of endrometrial hyperplasia
    • Prometrium (Microionized Progesterone)
      • Used in combo with estrogen
      • Contraindication: peanut allergy
      • Can be used vaginally
  • ​Minimum length of therapy for progestin added to estrogen: 12-14 days/month (either start of day 1 of cycle or day 16 of cycle)
38
Q

Oral HRT: Counseling Points

A
  • Take medication at the same time every day
  • Take food if medication causes stomach upset
  • Time for effect (oral):~4 week
    • Lower doses take 8-12 weeks
  • ACHES: contact MD
    • Abdominal pain
    • Chest pain
    • Headache
    • Eye (Vision loss)
    • Swelling of legs
  • Avoid driving until you know how the medication is affecting you
  • Withdrawal bleeding is common with cyclic progestin
39
Q

Transdermal HRT

A
  • Vivelle Dot
    • Estrogen only patch
    • Apply 1 patch to skin twice weekly
  • CombiPatch
    • Estrogen+progestin patch
    • Designed for postmenopausal women who have intact uterus
    • Apply 1 patch to skin twice weekly
40
Q

Topical/Vaginal HRT

A
  • Estrogel
  • Estrace Vaginal Cream
  • Premarin Vaginal Cream
  • Estring
    • Insert 1 ring vaginally every 90 days
  • Vagifem
41
Q

Transdermal/Topical/Vaginal HRT Counseling Points

A
  • Prime EstroGel before use
    • Fully depress pump twice
  • Time to effect: 4 weeks for vasomotor improvement
  • Wash hand before/after using topical products
  • Apply patch to clean/dry area
  • Apply patch to lower abdomen, below waistline
    • Rotate site of application
  • DO NOT apply patch or use gel on breast
42
Q

Alternatives to HRT

A
  • All used for Hot Flashes
  • Soy
    • phytoestrogen
    • MOA: weak estrogenic
    • Grade C (unclear/conflicting evidence)
    • LIttle to no effect on increasing BMD
    • May increase risk of endometrial hyperplasia
  • Black Cohosh
    • MOA: unclear
    • Grade C
    • Only studies done with Remifemin have show to improve menopause
    • S/E: GI complaints, rash
  • Red Clover
    • Contains phytoestrogen
    • Grade D (fair negative scientific evidence)
    • Majority of studies show that lacks efficacy

Pharm 584 (13 decks)

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