Prevention of Pregnancy and STIs Flashcards
What is conception?
- Viable egg released during ovulation to be available for fertilization
- Conception occurs during a 6-day window (5 days before ovulation + ovulation day)
- Peak occurs that day before ovulation
- Sperm penetrate cervix to reach cervix to reach egg (live 3-5 days, up to 7 days in tract)
- Fertilized egg is implanted into uterine lining
What are the ways to prevent pregnancy?
Suppress ovulation
Prevent fertilizations
Prevent implantation
What is the fertility window?
During a typical 28 day cycle, probability increases by day 7, peaks at day 12 or 13 before declining
How do you get STIs?
Genital tissues, mucus membranes, bodily fluids
True/False: patients with uterus are less prone to reproductive consequences
False
What are reproductive consequences that are associated with STIs?
Pelvic inflammatory disease, chromic pelvic pain, ectopic pregnancy, epididymitis, malignancy, infertility
What are perinatal consequences associated with STIs?
Morbidity/mortality, low birth weight, premature birth, transmission
How are STIs transmittable?
Secretions
Infected skin or mucosal surfaces
Which STIs are spread through infected secretions?
HIV, Gonorrhea, Chlamydia, Trichomoniasis, Bacterial Vaginosis (BV), Hepatitis B
Which STIs are spread through infected skin or mucosal surfaces?
HSV, Syphilis, Chancroid, HPV
How do you minimize the risk of STI?
Vaccines and contraception
Which STIs are treated with vaccines?
HPV, Hepatitis B
Which contraception’s are used to treat STIs?
Condoms, spermicides, sponge (self-care)
Fertility Awareness-Based Methods (self care)
EC (self care)
Hormonal contraception (CQA furnishing by pharmacist)
What is the most common STI in the US?
HPV
When is there the highest risk of HIV infection?
During the first few years after sexual activity begins
What is a major cause of genital warts and cervical cancer?
HPV
Which subtypes of HPV cause cervical cell changes, warts, and laryngeal papilloma?
Subtypes 6 and 11
Which subtypes are responsible for 70% of cervical cancers?
subtypes 16 and 18
Which vaccine is used to treat HPV?
Gardasil-9
Which HPV subtypes is Gardasil-9 protective against?
6, 11, 16, 18
What are the doing regimens for the different age groups taking Gardasil-9?
11-12 yo should receive vaccine (as young as 9); catch-up through 26
- <15yo: 2 doses at 0 and 6-12 months - ≥15 yo: 3 doses at 0, 1 - 2 months, and 6 months
When is it best to take Gardasil-9?
prior to HPV exposure (but previous sexual intercourse does not preclude vaccination with expected benefit)
What adverse effects are associated with Gardasil-9?
injection site irritation, malaise, syncope
About 79% of new Hepatitis B infections are associated with _____ & _____
High-risk sexual behaviors and injection drug use
What is the dosing regimen for the inactivated hepatitis B vaccine?
Recombivax/Engerix: 3 doses at 0, 1, and 6 months
Heplisav-B: 2 doses at 0 and 1 month
Which candidates who are not previously vaccinated meet the criteria for the inactivated Hepatitis B vaccine?
Sexual exposure to partners of Hep-B infected persons
Not in long-term mutually monogamous sexual relationships
In need of evaluations/treatment for STI
Men who have sex with men (MSM)
True/False: No method of contraception (other than abstinence) is 100% effective
True
What is the difference between perfect and typical effectiveness?
Perfect (method-related failure): Theoretical and difficult to measure + assumes accurate/ consistent use every time
Typical (use/user-related failure): More realistic; accounts for pregnancies due to inconsistent or incorrect use
What are the most effective methods of avoiding STIs?
abstaining from risky sexual activity
being involved in long-term mutually monogamous relationships with uninfected partners
Preventive strategies + contraceptives
What are the advantages/disadvantages of vaginal spermicides?
Advantages
- Cheap
- Various dosage forms
Disadvantages
- No protection against STI transmission
- High failure rate when used alone
- Not recommended patients with vaginal anatomic abnormalities
What are the advantages/disadvantages of contraceptive sponge (Today Sponge)?
Advantages
- Serves as a mechanical barrier
- Cheap
Disadvantages
- No STI protection
- Failure rates higher in patients who have given birth previously
- Vaginal dryness; Toxic shock syndrome (rare)
What are the advantages/disadvantages of emergency contraceptive (EC)?
Advantages
- Can use up to 3 - 5 days after unprotected sex
Disadvantages
- Not as effective with BMI >26
- Expensive
- AEs: N/V
Explain Fertility Awareness-Based (FAB) Methods
Techniques to determine fertile phase of menstruation cycle
Intercourse should be avoided or another contraception method used
Explain the Calendar Method
o Uses monthly menstrual cycle length to calculate fertile window
o Factors in viability of ovum (up to 24 hours) and sperm (3-5 days)
Explain the Cervical Mucus Methods
o Rely on detection of changes in cervical mucus during menstrual cycle
o Patients should avoid intercourse during first cycle
o Vaginal foams, gels, creams, and douches will interfere with cervical mucus
o Billings Ovulation Method
Daily observation/charting of mucus character and quantity
o TwoDay Method
If mucus that day or the day before, likely fertile
Explain the appropriate use of EC
Regimen: 1.5 mg LNG po x 1 within 72 hours of unprotected sex or contraceptive failure (effective up to 120 hours but declines with time)
- If within 120hrs, can offer non-rx EC products OR refer to PCP for UPA or copper IUD
- my not be as effective as in patients with BMI >26
- Refer to PCP after 120hrs
AEs: N/V
- if vomit within 1-2hrs after taking, repeat dose
$40-50 for single use
EC training in 2 weeks
In California, what type of hormonal contraception may a pharmacist furnish?
Oral tablets (combo hormonal contraception)
Transdermal patch
Vaginal ring
Depot injection
What is the pharmacists role in terms of necessary requirements for furnishing oral contraceptives in California?
Patients fills out self-screening tool and pharmacist reviews it
Check and record PT’s seated BP if desiring oral tablets
Counsel on how to use contraceptives
