MCP Oral Contraceptives Flashcards
(43 cards)
1
Q
Oral Contraceptives: MOA
A
- Contraception is orchestrated through a negative feedback mechansim that “tricks” the body into thinking it’s pregnant
- Estrogen-like hormone: suppresses FDH release from the pituitary gland, stops follicle maturation
- Progesterone-like hormone: Blocks LH Surge, thickens cervical mucus, induces endometrial atrophy, stops ovulation
2
Q
Oral Contraceptives: Indications
A
Contraception, acne, dysmenorrhea, polycystic ovary syndrome, endometriosis, irregular menstrual cycles, etc.
3
Q
Combination Pills
A
- Both estrogen-like and progesterone-like hormones
- Progesterone-like: varies
- Estrogen-like: ethinyl estradiol
4
Q
“Mini Pills”
A
Norethindrone
5
Q
Oral Contraceptives: Phasic Differences
A
- Monophasic: Same dosing through all active pills
- Triphasic: Different dosing each week for the active pills
6
Q
Monophasic Oral Contraceptives
A
- Same amount of estrogen and progesterone through all active pills
- Normal: 21 tablets combo active pills and 7 placebo pills
- Aviane
- Loestrin FE
- Ortho-Cyclen
- Continuous: 24 tablets combo active pills and 4 placebo pills
- Yaz
- Yasmin
- Lo Lestrin FE
- Extended: 84 tablets combo active pills and 7 placebo pills
- Seasonale
7
Q
Triphasic Oral Contraceptives
A
- Amount of estrogen varies each week to mimic the hormonal changes in a normal menstural cycle
- Normal: 21 tablets of combo active pills and 7 placebo pills
- OrthoTri-Cyclen
- Necon 7/7/7
- Extended: 84 tablets combo + 7 Ethinyl estradiol. Possiblity of spotting or no period during the 7 days
- Seasonique
8
Q
Oral Contraceptives: Drug Interactions
A
- Certain antibiotics
- Ex: Rifampin
- Certain natural supplements
- Ex: St. John’s Wort
- May decrease OC plasma concentrations and effectivness
9
Q
Estrogen: Side Effects
A
•Nausea/Vomiting
•Breast Tenderness
•Spotting
•Water retention
10
Q
Progesterone: Side Effects
A
- Acne
- Increased appetite
- Weight gain
- Nausea
11
Q
Rare/Serious Side Effects of Oral Contraceptives
A
- Blood clots (DVT/PE)
- Stroke
- Hypertension
12
Q
Blood Clot associated with OC (and symptoms)
A
- Increase risk with age
- Caused by estrogen
- Symptoms:
- A: Abdominal pain
- C: Chest pain, cough, SOB
- H: Headache, dizziness, numbness
- E: eye (vision loss)
- S: severe leg pain, swelling
13
Q
Combination Pills: Contraindications
A
- Excacerbations of certain cancers
- Breast Cancer
- Endometrial Cancer
- History of abnormal clotting
- Severe or uncontrolled hypertension
- Smoking and over age 35 years
14
Q
Combination Pills: Counseling Points
A
- Must take at the same time EVERY DAY
- Do not skip active pills
- Use back-up method (e.g. condoms) until at least 7 days have passed since start of regimen
- Take with food to minimize nausea/vomiting
- If side effects persits, discuss with MD
- Side effects should go away in about 2-3 months
- Possible drug interactions-antibiotics
- Missed dose? Read package insert
15
Q
Combination Pill: Missed Dose
A
- Missed 1 Pill
- Take 1 tab as soon as you remember and 1 tab next day on regular scheduled time
- No backup method needed
16
Q
When to start the FIRST pack of pills
A
- Day 1 Starter:
- Take the first active pill on day 1 of cycle (first 24 hours of your period)
- No back-up method required
- Sunday Starter
- Take the first active pill on the Sunday after you are still bleeding
- If period begins on Sunday, start the pack the same day
- Use back-up method for 7 days after starting the first pack
17
Q
Progesterone ONLY pills: MOA
A
- Thicken of mucus in the cervix to prevent entrance of sperm
- Only suppreses ovulation in half of the patients
18
Q
Who is progesterone ONLY pill for?
A
- Breast feeding women
- Estrogen can suppress breast milk production
- High risk for blood clots (>35yr old)
- Hypertension
- Migraine
19
Q
Progesterone only pills: Contraindications
A
- Breast cancer
- Known/suspected pregnancy (both types of pills)
- Genital bleeding
20
Q
Progesterone-Only Pills: Counseling Points
A
- Must take at same time every day-VERY IMPORTANT
- Start first pack on the first day on menstrual period
- Use back up method for 2 days if started first pack on another day
- Irregular menstral bleeding or spotting is common
- Prolonged episodes of side-effect, contact MD
- If you miss 2 period in a row, take pregnancy test
- What about missed doses-read package insert
- Take missed dose as soon as you remember
- If missed >3hrs, use backup method for 2 days
21
Q
Emergancy Contraceptive: MOA
A
Inhibits ovulation
22
Q
Emergency Contraceptive: Dosing
A
- Next Choice: 2 tablets in a day
- OTC>17 yo, Rx: <17 yo
- Plan B One-Step: 1 tablet
- OTC: No age restriction
23
Q
Emergency Contraceptive: Side Effects
A
- Nausea/vomiting
- Headache
- Dysmenorrhea
- Abdominal pain
24
Q
Emergency Contraceptives: Counseling Points
A
- Less effective in obese patients, recommend alternative
- Cooper IUD
- Ella
- Take within 72 hours after unprotected sex
- Take with food to prevent GI upset
- If vomiting occur within 3 hours of dose, need to redose
- Can take medicine to prevent nausea
25
Alternative to OC: in order of most effective to least effective
* IUD
* Ring
* Patch
* Injectables
* Condom
* Diaphragm
* Spermacide
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Menopause: Definition
* Perimenopause
* Dysfunction uterine bleeding-anovulatory cycle (3-4 missed cycles)
* Begins mid-late 40s
* Last about 4 year
* Menopause
* Permanent cessation of ovulation and menses
* Amenorrhea for 12 consecutive months
* Median onset age: ~51
27
Menopause: Symptoms
* Vasomotor symptoms (hot flash, night sweat)
* Sleep disturbance
* Mood changes
* Sexual dysfunction
* Vaginal dryness
* Painful intercourse (dyspareunia)
* Decreased libido
* Memory problem
* Urinary symptoms
* Osteoporosis
28
Menopause Treatment
* No medical "treatment" is required for most women
* Need to understand patient's view on symptom control and preventative medicine
* Educate patients regarding health lifestyles, weight loss, exercise, & smoking cessation
* Address individual symptoms-such as hot glashes or vaginal dryness
29
"Traditional Treatment for Menopause"-HRT
* Menopause symptoms and osteoporosis prevention
* Intact Uterus:
* Estrogen+progestogen
* Estrogen alone (associated with endrometrial hyperplasia)
* Hysterectomy (uterus removed)
* "Unopposed" estrogen (given w/o progestogen)
* Why HRT?
* Post-menopausal women stop producing estrogen and progesterone, use HRT to supplement the hormone that females are not mking anymore to reduce menopausal symptoms and risk of osteoporosis.
30
HRT: Contraindications
* Breast cancer
* Undiagnosed vaginal bleeding
* Endometrial hyperplasia/cancer
* Active blood clot (DVT/PE)
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HRT: Side Effects, Common
* Nausea/Vomiting
* Headache
* Breast tenderness/pain
* Irregular bleeding/spotting
* Vaginal irritation, itching, burning
* skin irritation, rash
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HRT: Serious/Rare Side Effects
* Coronary heart disease
* Stroke
* Blood clots (DVT/PE)
* Breast cancer
* Gallbladder disease
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HRT: Oral drugs
* Estrace
* Premarin
* Provera
* Prometrium
34
HRT: Topical Drugs
* EstroGel
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HRT: Transdermal Drugs
* Vivelle Dot
* Combipatch
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HRT: Vaginal Drugs
* Vagifem
* Estring
* Premarin cream
* Estrace cream
37
Oral Estrogen vs. Progestin: Drug names
* Estrogen
* Estrace (Estradiol)
* Premarin (Conjugated Estrogen)
* Progestin
* Provera (Medroxyprogesterone)
* Used in combination with estrogen
* Anti-estrogenic effect to reduce the risk of endrometrial hyperplasia
* Prometrium (Microionized Progesterone)
* Used in combo with estrogen
* Contraindication: peanut allergy
* Can be used vaginally
* Minimum length of therapy for progestin added to estrogen: 12-14 days/month (either start of day 1 of cycle or day 16 of cycle)
38
Oral HRT: Counseling Points
* Take medication at the same time every day
* Take food if medication causes stomach upset
* Time for effect (oral):~4 week
* Lower doses take 8-12 weeks
* ACHES: contact MD
* Abdominal pain
* Chest pain
* Headache
* Eye (Vision loss)
* Swelling of legs
* Avoid driving until you know how the medication is affecting you
* Withdrawal bleeding is common with cyclic progestin
39
Transdermal HRT
* Vivelle Dot
* Estrogen only patch
* Apply 1 patch to skin twice weekly
* CombiPatch
* Estrogen+progestin patch
* Designed for postmenopausal women who have intact uterus
* Apply 1 patch to skin twice weekly
40
Topical/Vaginal HRT
* Estrogel
* Estrace Vaginal Cream
* Premarin Vaginal Cream
* Estring
* Insert 1 ring vaginally every 90 days
* Vagifem
41
Transdermal/Topical/Vaginal HRT Counseling Points
* Prime EstroGel before use
* Fully depress pump twice
* Time to effect: 4 weeks for vasomotor improvement
* Wash hand before/after using topical products
* Apply patch to clean/dry area
* Apply patch to lower abdomen, below waistline
* Rotate site of application
* DO NOT apply patch or use gel on breast
42
Alternatives to HRT
* All used for Hot Flashes
* Soy
* phytoestrogen
* MOA: weak estrogenic
* Grade C (unclear/conflicting evidence)
* LIttle to no effect on increasing BMD
* May increase risk of endometrial hyperplasia
* Black Cohosh
* MOA: unclear
* Grade C
* Only studies done with Remifemin have show to improve menopause
* S/E: GI complaints, rash
* Red Clover
* Contains phytoestrogen
* Grade D (fair negative scientific evidence)
* Majority of studies show that lacks efficacy
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