MCP Oral Contraceptives Flashcards
Oral Contraceptives: MOA
- 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
Oral Contraceptives: Indications
Contraception, acne, dysmenorrhea, polycystic ovary syndrome, endometriosis, irregular menstrual cycles, etc.
Combination Pills
- Both estrogen-like and progesterone-like hormones
- Progesterone-like: varies
- Estrogen-like: ethinyl estradiol
“Mini Pills”
Norethindrone
Oral Contraceptives: Phasic Differences
- Monophasic: Same dosing through all active pills
- Triphasic: Different dosing each week for the active pills
Monophasic Oral Contraceptives
- 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
Triphasic Oral Contraceptives
- 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
Oral Contraceptives: Drug Interactions
- Certain antibiotics
- Ex: Rifampin
- Certain natural supplements
- Ex: St. John’s Wort
- May decrease OC plasma concentrations and effectivness
Estrogen: Side Effects
•Nausea/Vomiting
•Breast Tenderness
•Spotting
•Water retention
Progesterone: Side Effects
- Acne
- Increased appetite
- Weight gain
- Nausea
Rare/Serious Side Effects of Oral Contraceptives
- Blood clots (DVT/PE)
- Stroke
- Hypertension
Blood Clot associated with OC (and symptoms)
- 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
Combination Pills: Contraindications
- Excacerbations of certain cancers
- Breast Cancer
- Endometrial Cancer
- History of abnormal clotting
- Severe or uncontrolled hypertension
- Smoking and over age 35 years
Combination Pills: Counseling Points
- 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
Combination Pill: Missed Dose
- Missed 1 Pill
- Take 1 tab as soon as you remember and 1 tab next day on regular scheduled time
- No backup method needed
When to start the FIRST pack of pills
- 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
Progesterone ONLY pills: MOA
- Thicken of mucus in the cervix to prevent entrance of sperm
- Only suppreses ovulation in half of the patients