Contraception Pharm Flashcards
(52 cards)
How do we prevent pregnancy (3 mechanisms)?
- Inhibition of sperm from reaching a mature ovum.
- Prevent fertilized ovum from implanting in the endometrium.
- Mechanisms that create an unfavorable uterine environment.
What are some barrier methods to preventing pregnancy? Advantage of?
- Barrier b/t sperm and ovum – Condoms (male and female), Diaphragms, Cervical caps.
* Condoms are used for STI protection as well.
What is the problem with barrier methods?
It depends on proper use before or at time of intercourse; there is a higher failure rate than oral contraceptives.
Highly effective and safe forms of reversible contraception?
IUD – Intrauterine Device.
What does OCP stand for?
Oral Contraceptive Pills.
What are the 2 types of OCPs?
- Combination – estrogen and progestin.
- Progestin only.
**Highly effective and safe, when used properly.
What are some NON-Contraceptive benefits of OCPs?
- More predictable cycles w/less pain and blood loss.
- Improved ACNE (Yaz, Ortho-Tri-Cyclen, LoEstrin, FE 24).
- Decreased incidence of:
- Endometrial and Ovarian CA.
- Benign Breast Dz.
- Pelvic infections.
- Ectopic pregnancies.
- Iron Def. Anemia.
Traditional OCPs are based on?
The 28 day menstrual cycle w/21 hormonal active pills and 7 inactive (placebo) pills in which bleeding occurs this week.
*Original pills were monophasic; newer pills are now biphasic or triphasic.
What does monophasic, biphasic and triphasic OCPs mean?
- Monophasic – deliver the same amount of estrogen and progestin each day.
- Biphasic – delivers a lower dose of estrogen/progestin the first half of the pill cycle and a higher dose during the second half of the pill cycle.
- Triphasic – have 3 different doses of estrogen/progestin that change every 7 days.
What is the MOA of Estrogen hormonal contraceptives?
Suppress the production of FSH to prevent the selection and emergence of a dominant follicle.
What are the two types of synthetic estrogens?
- Ethinyl Estradiol (EE).
2. Mestranol.
Which estrogen is only found in a couple of OCPS and converted to EE (Ethinyl Estradiol) in the liver?
Mestranol.
Adverse effects of estrogen OCPs?
Breast tenderness, breakthrough bleeding, thromboembolism and increases complications of women w/CV risk factors/disease – most worrisome.
Nauseas, HA, Melasma, Na/water retention, hypertriglyceridemia.
Adverse effects of progestin OCPs?
Increased appetite/weight gain, oily skin/acne, hirsutism, incr. LDL/decr. HDL.
Breast tenderness, HA, Fatigue, mood changes, gallbladder dysfunction.
Most common combination contraceptive best for PMS/PMDD, acne, hirsutism or PCOS?
Drospirenone/EE (Yasmin, Yaz).
*EE = Ethinyl Estradiol.
Medications that may be affected by OCPs?
Anticoagulants, Insulin, Hypoglycemics, TCAs, BZDs, Corticosteroids.
Effectiveness of these drugs due to OCP drug interaction?
- Abx, esp Rifampin, Griseofulvin.
- Anticonvulsants – topiramate, phenytoin, carbamazepine.
- St. Johns Wart.
What drugs (1) increase OCP hormone levels?
Protease inhibitors – ‘navir’ drugs that inhibit the action of HIV-1 protease.
Choosing an OCP?
- Know a few common brands of varying amounts and types of hormones.
- Estrogen:
- -low dose recommended: 20-35 mcg EE.
- -20 mcg may be beneficial in pt’s sensitive to estrogen AE w/women >40 y/o. - Progestin – all fine, drospirenone has special characteristics.
Patient education when starting OCPs?
- Start during first 5 days of next cycle – most start first SUNDAY of next period.
- Use backup method for one week after starting.
- TAKE AT SAME TIME QDAY!
- Don’t forget to restart a new pack after the 7-day placebo or pill-free interval.
What to do if you miss one pill?
Take is ASAP after remembering and the next pill at the regular time.
What to do if you miss two pills?
Take 2 pills the day you remember, 2 pills the next day, and then back to one Qday pill.
What should be used if more than 2 pills missed?
Backup birth control – condoms, etc.
What may happen with missed pills?
Breakthrough bleeding.
