OCSH2

Question 1

COC missed pills

Answer 1

missed Time in cycle Action

1. •anytime 2 pills Asap ( EC if other doses missed in the past month )
2. Week 1-2 or 3. Week 1-2: 2 pills now and 2 pills the next day. Back up for 7 days
   WK3 : continuing pack, skip placebo straight to a new pack. Back up 7 days
3. Week 1-2 or 3 Finish active tabs, ( skip placebo days )then start a new pack back up contraception for 7 _____________________________________days, EC for sex in past 7 days

Question 2

One missed dose? —>

Answer 2

2 tabs asap

Question 3

2 missed tabs and it’s during 1st or 2nd week?

Answer 3

2 tabs asap, 2 tabs the next day. Back up for 7 days

Question 4

2 tabs missed and on week 3 of cycle

Answer 4

Week 3 or 3 consecutive missed doses —> finish pack, skip placebo days straight to a new pack. Back up for 7 days

Question 5

Missed pills Progestin only

Answer 5

norethindrone- every single pill is the same and must take at same time every time.
≥ 3 hours late : take pill asap ; backup for 2 days

Drospirenone ( Slynd ) - progesterone only 4 mg. This does have placebo days.
4 mg tabs for 24 days followed by 4 days of placebo.
If one pill missed we dont worry about it as much as norethindrone. if one pill is missed take it asap, back up is NOT required when a dose is taken up to 24 hours late.

≥ 2 tabs missed take tab ASAP; nonhormonal contraception taken until 7 continuous days are taken.

Question 6

Emergency contraception

Answer 6

Plan B- Levonorgestrel 1.5 mg tabs
Does not cause abortive effects. Not an abortion.
Within 72 hours up to 5 days of UPI. Sooner the more effective

May inhibit implantation, delay ovulation, or inhibit fertilization

No age restriction - all OTC

Consider repeating the dose if vomiting occurs within 2 hours

Plan B; My Way

Question 7

Ulipristal

Answer 7

Ella RX only

Selective progesterone Receptor modulator ( agonist / antagonists ) to delay/inhibit ovulation & prevent implantation.

*not abortive. Like levonorgestrel ( plan B ), Ulipristal ( Ella ) does not interfere with pregnancy after implantation.
If vomiting within 3 hours, repeat dose.

Take 1 tablets asap withing 5 days ( 120 hours ) after UPI
- levonorgestrel efficacy decreases after 3 days.

Patients should use contraceptive for the rest of the cycle since ovulation may be e delayed

Question 8

BMI > 25 kg/mˆ2 / weight ≥ 75 kg ( 165 lbs)

Answer 8

Levonorgestrel based contraception may be less effective in women ≥ 75 kg ( 165 lbs) - however dont let that deter you from recommending ASAP

Efficacy of levonorgestrel EC may be decreased as BMI increases above normal range.

May recommend copper releasing IUD as first line to prevent pregnancy

Question 9

Promethium is a capsule and is contraindicated with this allergy?

Answer 9

PEANUT allergy

Question 10

Annovera Vaginal ring

Answer 10

Newer contraceptive

Like nuvaring but they use the same ring all year. 3 weeks on 1 week off. But keep using same ring

Question 11

Sylnd

Answer 11

Drospirenone 4 mg
Progestin only minipill

Different than other mini pills bc it’s 4 mg ( not 1 ), and 24 active and 4 placebos ( all other mini pills were active )

If pill missed take it asap, backup is not required when a dose is taken up to 24 hours late.

Advise checking potassium if take other potassium raising meds ( ace, arb, bactrim )

Question 12

COCs can decrease lamotrigine by

Answer 12

45 to 60 %

Question 13

Estrogen metabolism is accelerated by inducers like

Answer 13

Phenobarbital
Phenytoin
Griseofulvin
And
RIFAMPIN

St. John’s wort

Question 14

Grapefruit and amiodarone are inhbitors of cyp and can

Answer 14

Increase estrogen levels. Decrease metabolism of estrogen

Question 15

Chewable forms of COCs

Answer 15

Lo Minastrin Fe

Femcon Fe

Question 16

Nearly all COCs use eithinyl estradiol but this COCs uses estradiol valerate?

Answer 16

Natazia
4 phase COCs