Term
| Name the two drugs in Ortho Evra. |
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Definition
| Ethinyl estradiol (Estrogen) and Norelgestromin (Progestin) |
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Term
| What is the dose of each hormone in the patch? |
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Definition
| The patch is made of 3 layers-The medicine layer is in the middle and contains 0.75 mg of ethinyl estradiol (EE) and 6mg of Norelgestromin. The DAILY dose of each hormone is 20 micrograms of EE and 150 micrograms of progestin. |
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Term
| What is the patch designed to mimic? |
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Definition
| The 28-day dosing of oral contraceptives. |
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Term
| How does the patch work? (MOA) |
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Definition
Prevents ovulation by suppressing gonadotropins (LH, FSH)
Some secondary MOA's include thickening of cervical mucous to prevent sperm from penetrating and thinning the endometrium to prevent implantation. |
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Term
| What are the suggested sites for the patch? |
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Definition
| buttocks, upper torso (not the breasts), upper arms, or lower abdomen. |
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Term
| What would you teach your patient regarding application of the patch and preparation of skin? |
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Definition
| Avoid lotions, oils, powders, or sweat to the area where the patch is going to be placed. Each week for 3 weeks place a new patch in a different site (rotate sites) and remove the old patch. The 4th week is patch free. Pick a day that is your "change patch day". Once the patch is placed, swimming, showering, and exercising should not affect the adherence of the patch. |
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Term
| What three ways can the patient start the patch? Any particular education that goes with them? |
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Definition
1) Day 1 of menses (some say use backup for 7 days)
2) Sunday start following onset of menses
3) Quick start-start immediately
* The Sunday and quick start require back-up for 7 days!! |
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Term
| What are some benefits to the patch? |
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Definition
Increased compliance especially with teens
Easy to use
More forgiving than COC's when initial or changing of patch is delayed.
Easily verifiable
Rapidly reversible
Can be used by those with intestinal absorption problems
No significant weight gain. |
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Term
| What are some risks to the patch? |
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Definition
1) Increased risk of venous thromboembolic events similar to those seen w/use of COC's containing 35 microg ethinylestradiol and norgestimate but they get a 60% higher dose of steady state estrogen. This is the most worrisome risk.
2) Adverse effects such as migraine, cervical adenocarcinomas in situ, cholecystitis, parathesia at patch site, heart attack, liver problems, and menorrhagia.
3) Skin reactions
4) Breakthrough bleeding
5) Change in sexual desire
6) Breast symptoms
7) Headaches
8) N/V |
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Term
| A woman weighing 200 lbs should use the patch...T or F? |
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Definition
| False-Those weighing more than 90kg or 198 lbs have been found to have lower serum levels of hormone and are at increase risk for pregnancy when using the patch. |
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Term
| Name a population the patch would be great for. |
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Definition
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Term
| The patch should not be used postpartum....T or F? |
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Definition
| True-Because of the estrogen content the patch should not be used postpartum or in lactation. |
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Term
| If a patient has dermatologic conditions, such as, psoriasis, eczema, or sunburn they should not use the patch...T or F? |
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Definition
| True-depending on where their skin is affected. |
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Term
| Name some contraindications to the patch. |
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Definition
1) Pregnancy
2) Prolonged bedrest
3) Hx of blood clots or clotting disorders, stroke, heart attack/disease
4) Hx of breast, uterine, or liver CA
5) Migraine with aura
6) Severe liver disease
7) Smoker >35 yo or with HTN
8) Uncontrolled HTN
9) Severe diabetes |
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Term
| What is the effectiveness of the patch at preventing pregnancy with proper use? |
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Definition
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Term
| What is the estimated cost of the patch? |
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Definition
| Planned parenthood says $15-$70/month |
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Term
| How should you counsel a patient who says her patch came off or ripped less than 24* ago? |
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Definition
| Tell her to reapply the patch if possible to the same site or replace the patch with a new one and keep her original "patch change day". No back up is needed |
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Term
| How should you counsel a patient who says her patch came off >24* ago or she isn't sure when it came off? |
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Definition
She should stop the current patch cycle and start a new patch cycle by applying a new patch from a new packet. This will now be patch 1 and potentially a new "change patch day".
Back up is needed for 7 days. |
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