- Progestin -Effiacy 93% -Oral, daily, 7 day backup -Serious Sx: hyperkalemia, severe headaches -Sx: Spotting and menstrual changes -Safe to breast feed -Immediate return to fertility

Contraception Flashcards by Mezani Muniz

Estrogen uses in contraceptives

-Suppresses FSH production –> Prevent dominant follicle
-Increases sex-hormone binding globulin —> Increase binding of free androgens

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Progestin uses in contraceptives

-Prevent LH surge –> Inhibit ovulation
-Thicken cervical mucus –> Inhibit sperm penetration / transport
-Change motility of fallopian tubes –> Impair transport of sperm / ova
-Atrophy of endometrium –>
Impair implantation

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Side effects of estrogen

Too Much: Bloating, Breast tenderness, Mood changes Headache, Nausea, Heavy menses, Fibroid growth, Melasma, Vision changes, Cyclic weight gain

Too Little: Light menses, Vaginal dryness, spotting, no withdrawal bleeding

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Estrogen Dosing

Very Low Dose = <20 mcg EE
Low Dose= 20-35 mcg EE
High Dose = 50 mcg EE

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Progestin component

Progestational: Prevent ovulation, lessen bleeding, desire high activity

Androgenic: Acne, hirsutism, desire low activity

Antiestrogenic: Androgenic side effects, desire lower activity

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Dropspierenone vs Levonorgestrel

Drospirenone: Progestional activity +/-, - andorgenic and antiestrogenic activity

Levonorgestrel: +++++ Progestional and androgenic activity, - antiestrogenic activity

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Side effects of progestin

Too Much: Hirsutism* Decrease sex drive Depression Increased appetite Increase sex drive* Noncyclical weight gain, Acne*
(*From androgen excess)

Not enough: Breakthrough late in cycle, no withdrawal bleeding, heavy menses

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Potential health benefits beyond pregnancy prevention

-Decreased risk of endometrial cancer
-Decreased risk of menstrual-related headaches
-Decreased risk of ovarian cancer
-Improvement in perimenopausal symptoms

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Implant (Nexplanon)

-Progestin (Etonogestrel): Mood changes, headaches, acne
->99 % efficacy
-Subdermal: pain with insertion
-Irregular bleeding for first 6-12 months
-Fertility may be delayed or rapid return (within 6 weeks)
-Up to 5 years, 7 day backup method

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Levonogestrel IUD

-Progestin only

->99 % efficacy

-Intrauterine

-Up to 3-8 years effiacy, 7 day back up method

-Serious Sxs: Uterine perfiration, expulsion, infection

-Sxs: Cramping, spotting 3-6 months, lighter period, ammenorhea

-Safe to breast feed, long term use, lower risk of uterine cancer

-Return to fertility is immediate

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Copper IUD

-Effiacy >99%
-Intrauterine
-Lasts up to 10+ years, no backup
-Serious Sx:Uterine perfiration, expulsion, infection
-Sx: Cramping, spotting first 3-6 months, periods may become heavier or stay about the same
-Lower risk of uterine cancer, Lower risk of uterine cancer, Long term protection, Safe to breastfeed
-Immediate return to fertility

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DMPA

-Progestin, Medroxyporgesterone acetate
-Effiacy 96%
-IM or SubQ
-Every 3 months, 7 days of backup
-Serious Sx: Lower bone density, heavy bleeding
-Sxs: weight gain, change in acne, mood or headaches, spottign between period, amenorrhea
-Benefits: Lower risk of uterine cancer , Safe to breastfeed, Lighter, less painful periods; amenorrhea
-Possible delayed return

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COC

-Estrogen and Progestin
-93% efficacy
-Oral, Daily, 7 day backup
-Serious Sxs: Blood clots, stroke
-Common: Nausea, spotting, and/or breast discomfort, Change in mood or headaches
Common
-Benefits: improved acne, lower risk of ovarian/uterine cancer, more regular, lighter, less painful periods
-Immediate return to fertility

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Norethindrone/ Norgestrel POP

-Progestin
-Effiacy 93%
-Oral, daily, 2 day backup
-Frequency of administration within 3 hours of the same time daily
- Serious Sxs: Severe headaches, Heavy bleeding Serious, Ectopic pregnancy
-Sx: spotting & menstrual changes
-Safe to breast feed
-Immediate return to fertility

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Drospierenone POP

Progestin
-Effiacy 93%
-Oral, daily, 7 day backup
-Serious Sx: hyperkalemia, severe headaches
-Sx: Spotting and menstrual changes
-Safe to breast feed
-Immediate return to fertility

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Vaginal Ring

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-Disposable or Reusable
-Estrogen and progestin
- Effiacy 93%, vaginal, weekly, 7 day backup
-Disposable: Left in place for 3 weeks → removed for 1 week, New ring inserted after 7 days
-Reusable: Left in place for 3 weeks → removed for 1 week, Wash with mild soap/warm water, pat dry, and place in case, Reinsert into vagina (after cleaning)

Serious Sx: Blood clots, stroke
Disposable SX: Nausea, spotting breast discomfort, changes in mood or hx
Reusable Sx:Headache/migraine, Vulvovaginalinfection/candidiasis, Nausea/vomiting

Benefits: Improved acne, lower risk of ovarian/uterine cancer, more regular, lighter, less painful periods, dont have to remember daily, (resuable used for 1 year- 13 months)
-Immediate return to fertility

Patch- Norelgestromin & EE

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-Estrogen and progestin
-Effiacy 93%, transdermal, weekly, 7 day backup
-Transdermal patch applied to upper outer arm, abdomen, buttock or back
- New patch every week for 3 weeks → patch free for 7 days, Apply new patch
-Serious Sx: blood clots
-SX: Nausea, spotting, breast discomfort, Skin irritation, Change in mood or headaches
-Benefits: Improved acne, Lower risk of ovarian/uterine cancer, More regular, lighter, less painful periods, Don’t have to remember daily
-Immediate return to fertility

Patch -Levonogestrel & EE

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Three approaches to starting contraception

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Quick Start: Start anytime it is reasonably certain person is not pregnant
-If more than1-6 days after period start, use backup method for 2-7 days*

Next Period Start: Start within 1-6 days of period start
-No backup method

Sunday Start: Start on Sunday after period starts
-If more than 1-6 days after period start, use backup method for 2-7 days

Contraception safe for nursing

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Levonogestrel IUD, Copper IUD, DPMA, Norethindrone & Norgestrel, Drosperinone

When changing hormonal methods

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-Switch method at any time or when due for hormonal next injection methods
- No backup needed if no gaps in treatment

Late or missed doses of COC

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-If one dose < 24 hours can take as soon you remember and take following dose as normal
-Miss more than one does > 48 hours, take missed dose as soon as possible, take following does as normal, then use additional contraceptive method for 7 days

Late or missed doses of Patch

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-Delayed application or detachment for < 48 hours: apply new patch as soon as possible, keep same patch change day, no additional contraceptive needed

-Delayed application, or detachment: apply a new patch as soon as possible, use additonal contraceptive for 7 days

Late or missed dose of vaginal ring

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Delayed placement of a new ring or delayed replacement of a current ring for <48 hours: place ring as soon as possible, keep in ring until scheduled removal day, no additonal contraception needed

Delayed replacement of a new ringor delayed replacement for > 48 hours since a ring should have been placed: Place ring as soon as possible, keep in ring until scheduled removal day, 7 day backup needed for contraceptives

Progestin-only injection late or missed doses

< 2 weeks late, recieve injection, no backup method >2 weeks, recieve injection is reasonably not pregnant, no backup method for 7 days

Common Side effects and how to address them

Irregualr bleeding: Take pills at same time, ibuprofen 800 mg 3x a day X5 days Headaches: Discontinued product if headaches get worse, OTC pain relievers, Continous product if during placebo Nausea: Take pills with food or at bedtime, continuous product if at start of cycle Breast Tenderness: Supportive bra, OTC pain relievers, Products with less estrogen Acne: Topical Treatments, Different Pill formulation, combined product

Serious side effects of combined products

ACHES: abdominal pain, Chest pain, headache, eye problems, severe leg pain

CHC Migraine protocol

Migraines w/o Aura: Steady hormones potentialy beneficial, Low dose monophasic, if worsens migraines stop COC Migraines w/ Aura: Higher risk of stroke, No estrogen or COC used, Progestin only contraception reccomended

US MEQ CDC Chart

If category MEQ 3 or 4 pharmacists can not prescribe

Drug Interactions

POP & CHC: Category 3 anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) & Rifampin or rifabutin therapy Category 3 CHC: Antiretrovirals Category 3 & Lamotrigine Category 3

Transgender men contraception considerations

Transgender males retain reproductive capabilities if they have an intact uterus and ovaries ▶ Until menopause or surgical sterilization ▶ Testosterone use may decrease fertility but, can still become pregnant ▶ Also use contraceptives to stop menses altogether for gender affirmation

Transgender men contraception options

-Progestin-Only contraceptives: Do not interfere with testosterone use, POP pills or LARCs (implants, IUDs, porgestin only injectables) -COC more controversial, however no contraindications -Copper IUDs increase menstrual bleeding, but good option for those that wish to avoid hormones -Irreversible: tubal ligation, excision of fallopian tubes

Emergency Contraception Methods

-Copper IUD: one insertion, most effective across all BMI -Levenorgestrel (Plan B): one OTC dose PRN, less effective in >165 lb, BMI of 25, labeled 72 hours -Ulipristal acetate: one RX pill per cycle, up to 5 days, Better effiacy than LNG up to 194 lbs

Emergency Contraception Effiacy

-Sooner the better -Within 5 days of unprotected sex -Wait 5 days to restart hormonal BC if using ulipristal acetate

Emergency Contraception Side effects

-Only common Sx: Nausea, vomiting, headache, dizziness, breast pain, stomach pain, If a patient vomits within two hours of taking, consider repeating dose, Next period may start early or late; may have spotting -Immediate return to fertility

Pharmacist prescribing contraception

-Now in 30 states, Indiana included -Special training required -Oral, ring, patch, SubQ injection: BC that is FDA approved for pregnancy prevention & self administered -NO Ulipristal Acetate or DPM IM -Medicaid provider reibursement -Patient must be 18 yrs old -Provide intial prescription for 6 months, can renew another 6 months if they have seen a provider in the past year

BC prescribing process

-BC Screening, every 6 months -Screen for pregnancy -Check BP -Refer to Provider -Document and Record -Can notify PCP (not required)

Approaches to counseling

-Consumerist: Informed choice, patient forward, foreclosed -Directive: Tiered effectiveness, Provider forward, "first line" -Shared-Decision: Best based on preferences, collaborative

Approaches to contraceptive counseling (6x)

1.Tiered effectiveness: Assumes pregnancy prevention is the most important factor 2.One Key Question 3. PHI-CARE: Past experience, health history, Importance, Counsel, Autonomy, Review, Experience 4. MYPATH 5. PATH approach: Parenting/Pregnancy attitudes, timing, how important delaying pregnancy is 6. Shared Decision Making

Contraception Flashcards

(39 cards)