Prevention of Pregnancy and STIs

Question 1

What is conception?

Answer 1

• 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

Question 2

What are the ways to prevent pregnancy?

Answer 2

Suppress ovulation

Prevent fertilizations

Prevent implantation

Question 3

What is the fertility window?

Answer 3

During a typical 28 day cycle, probability increases by day 7, peaks at day 12 or 13 before declining

Question 4

How do you get STIs?

Answer 4

Genital tissues, mucus membranes, bodily fluids

Question 5

True/False: patients with uterus are less prone to reproductive consequences

Answer 5

False

Question 6

What are reproductive consequences that are associated with STIs?

Answer 6

Pelvic inflammatory disease, chromic pelvic pain, ectopic pregnancy, epididymitis, malignancy, infertility

Question 7

What are perinatal consequences associated with STIs?

Answer 7

Morbidity/mortality, low birth weight, premature birth, transmission

Question 8

How are STIs transmittable?

Answer 8

Secretions

Infected skin or mucosal surfaces

Question 9

Which STIs are spread through infected secretions?

Answer 9

HIV, Gonorrhea, Chlamydia, Trichomoniasis, Bacterial Vaginosis (BV), Hepatitis B

Question 10

Which STIs are spread through infected skin or mucosal surfaces?

Answer 10

HSV, Syphilis, Chancroid, HPV

Question 11

How do you minimize the risk of STI?

Answer 11

Vaccines and contraception

Question 12

Which STIs are treated with vaccines?

Answer 12

HPV, Hepatitis B

Question 13

Which contraception’s are used to treat STIs?

Answer 13

Condoms, spermicides, sponge (self-care)
Fertility Awareness-Based Methods (self care)
EC (self care)
Hormonal contraception (CQA furnishing by pharmacist)

Question 14

What is the most common STI in the US?

Answer 14

HPV

Question 15

When is there the highest risk of HIV infection?

Answer 15

During the first few years after sexual activity begins

Question 16

What is a major cause of genital warts and cervical cancer?

Answer 16

HPV

Question 17

Which subtypes of HPV cause cervical cell changes, warts, and laryngeal papilloma?

Answer 17

Subtypes 6 and 11

Question 18

Which subtypes are responsible for 70% of cervical cancers?

Answer 18

subtypes 16 and 18

Question 19

Which vaccine is used to treat HPV?

Answer 19

Gardasil-9

Question 20

Which HPV subtypes is Gardasil-9 protective against?

Answer 20

6, 11, 16, 18

Question 21

What are the doing regimens for the different age groups taking Gardasil-9?

Answer 21

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

Question 22

When is it best to take Gardasil-9?

Answer 22

prior to HPV exposure (but previous sexual intercourse does not preclude vaccination with expected benefit)

Question 23

What adverse effects are associated with Gardasil-9?

Answer 23

injection site irritation, malaise, syncope

Question 24

About 79% of new Hepatitis B infections are associated with _____ & _____

Answer 24

High-risk sexual behaviors and injection drug use

Question 25

What is the dosing regimen for the inactivated hepatitis B vaccine?

Answer 25

Recombivax/Engerix: 3 doses at 0, 1, and 6 months | Heplisav-B: 2 doses at 0 and 1 month

Question 26

Which candidates who are not previously vaccinated meet the criteria for the inactivated Hepatitis B vaccine?

Answer 26

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)

Question 27

True/False: No method of contraception (other than abstinence) is 100% effective

Answer 27

True

Question 28

What is the difference between perfect and typical effectiveness?

Answer 28

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

Question 29

What are the most effective methods of avoiding STIs?

Answer 29

abstaining from risky sexual activity being involved in long-term mutually monogamous relationships with uninfected partners Preventive strategies + contraceptives

Question 30

What are the advantages/disadvantages of vaginal spermicides?

Answer 30

Advantages - Cheap - Various dosage forms Disadvantages - No protection against STI transmission - High failure rate when used alone - Not recommended patients with vaginal anatomic abnormalities

Question 31

What are the advantages/disadvantages of contraceptive sponge (Today Sponge)?

Answer 31

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)

Question 32

What are the advantages/disadvantages of emergency contraceptive (EC)?

Answer 32

Advantages - Can use up to 3 - 5 days after unprotected sex Disadvantages - Not as effective with BMI >26 - Expensive - AEs: N/V

Question 33

Explain Fertility Awareness-Based (FAB) Methods

Answer 33

Techniques to determine fertile phase of menstruation cycle Intercourse should be avoided or another contraception method used

Question 34

Explain the Calendar Method

Answer 34

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)

Question 35

Explain the Cervical Mucus Methods

Answer 35

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

Question 36

Explain the appropriate use of EC

Answer 36

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

Question 37

In California, what type of hormonal contraception may a pharmacist furnish?

Answer 37

Oral tablets (combo hormonal contraception) Transdermal patch Vaginal ring Depot injection

Question 38

What is the pharmacists role in terms of necessary requirements for furnishing oral contraceptives in California?

Answer 38

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