Term
|
Definition
DAY 1
the day menses first appears
DAY 1-4 (length varies per person)
menstruation
"FERTILE WINDOW"
days 10-17 (unpredictable)
in the middle of the menstrual cycle
[image]
during the menstrual cycle (0-5) there is a low level of estrogen and progesterone and FSH and LH are low
the endometrium thickens and becomes a favorable environment for implantation
ovulation occurs; LH and FSH surge occurs at ovulation
after fertilization, the ovum is ready to implant on the endometrium
for the endometrium to be favorable it has to be thick
at the end of the cycle, when the hormones decrease then the endometrium is sloughed
to suppress the LH and FSH surge, it would prevent ovulation from occurring |
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|
Term
|
Definition
contraception: prevention of pregnancy following sexual intercourse by
1) inhibiting viable sperm from coming into contact with a mature ovum (barriers or prevent ovulation)
2) preventing a fertilized ovum from implanting successfully in the endometrium (create an unfavorable uterine environment)
goal: planned and desired pregnancies |
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|
Term
| benefits of contraception |
|
Definition
control the rapid population growth that has begun to threaten human survival
essential to a woman's ability to achieve her individual goals and to contribute to her sense of well being |
|
|
Term
|
Definition
effectiveness
safety
accessibility
acceptability
complexity
spontaneity
cost |
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|
Term
| natural contraception methods |
|
Definition
lactational infertility (amenorrhea)
infant receives only breast milk and mother does not have menses
baby suckling on mother's nipples causes surge in maternal prolactin, which inhibits estrogen production and ovulation
may last up to 6 months
HIGH FAILURE RATE |
|
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Term
|
Definition
TYPICAL USE FAILURE = USER FAILURE
failure that occurs secondary to person using methods, following directions correctly and consistently
ex) taking the medication and vomiting; taking the medication while taking antibiotics
PERFECT USE FAILURE = METHOD/PRODUCT FAILURE
failure that subject has no control over, does not depend on the proper use of contraceptive alone |
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|
Term
| mechanism of action for hormonal contraceptives |
|
Definition
ESTROGEN
suppress FSH, preventing development of a dominant follicle
suppress LH
stabilize endometrial lining: bleeding control
potentiates progestin's action
induction of luteolysis (degradation of corpus luteum, not allowing implantation)
accelerated ovum transport
PROGESTIN
suppress FSH and LH surge, inhibiting ovulation
thickens cervical mucus
atrophies (thins) endometrium: inhibition of implantation
inability of capacitation: inhibits activation of spermatic enzymes needed for penetration into ovum
slows ovum transport
just progesterone will not give the optimal suppression of FSH and LH |
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|
Term
| hormonal contraception examples |
|
Definition
oral: combination (estrogen and progestin) - COCs; progestin only - POPs
vaginal ring
transdermal patch
injectable
intrauterine devices (IUD) |
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|
Term
| most common estrogens in oral contraceptions |
|
Definition
1980s FDA states no OCs are to have > 50 mcg of estrogen; the higher the amount of estrogen, the more at risk of complications and ADRs
mestranol (ME): present in older pills, liver biotransforms mestranol to ethinyl estradiol
ethinyl estradiol (EE): most commonly used |
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|
Term
| most common progestins used in oral contraception |
|
Definition
progestins can have progestin activity, estrogenic activity, and androgenic activity
androgenic activity may cause male-like characteristics: hair growth (hirsutism), oily skin, increased sex drive
if someone is complaining of low sex drive, consider switching to a higher androgenic activity progestin
if someone is complaining of oily skin and hair growth then want to switch them to a progestin with less androgenic activity
levonorgestrol is the most common progestin used |
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Term
| progestins with high androgenic activity |
|
Definition
norgestrel (levonorgestrel is the active isomer of norgestrel)
norethindrone
ethynodiol |
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Term
| progestins with low androgenic activity |
|
Definition
desogestrel
norgestimate
drospirenone has anti-androgenic effects |
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Term
| combination products - 21 day regimens vs. 28 day regimens |
|
Definition
21 day regimen:
take the pills for 21 days and on days 22-28 don't take anything or continue taking the pills
28 day regimen: active pills for 21 days and on days 22-28 they take placebo pills (to help remember to take the pills every day) |
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|
Term
| monophasic vs. multiphasic |
|
Definition
monophasic:
same amount of estrogen and progestin in all of the pills
multiphasic:
to prevent break through bleeding
OCs are supposed to mimic the menstrual cycle, normally the levels fluctuate throughout the cycle
biphasic: start at a low dose of estrogen and titrate to a higher dose of estrogen
triphasic: 3 levels of estrogen
multiphasic OCs usually contain the same level of progesterone in each tablet
less break through bleeding with muliphasic OCs; shorter menses |
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Term
|
Definition
21 day regimen
monophasic
you can take the week off, but it is recommended to continue to take the pills (do not take a break)
less suppression of LH and FSH; only a 3 hour window to take the pill
combination products: should take around the same time each day, but doesn't matter as much as with the POPs
less effective than COCs with typical use
irregular and unpredictable menstrual bleeding
may not inhibit ovulation completely
risk of ectopic pregnancy |
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Term
| selecting an OC for your patient: initial choice for a young, healthy female with no pre-existing conditions |
|
Definition
low-dose combination oral contraceptive
30-35 mcg ethinyl estradiol
metabolically neutral progestin (doesn't have high androgenic activity)
multiphasic |
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Term
| first day or Sunday start or quick start |
|
Definition
first day:
use hormonal contraceptive during the first 24 hours of menstrual cycle
Sunday start:
1st Sunday after start of menstrual cycle
MUST USE BACK UP FOR 1ST 7 DAYS
quick start (any day):
MUST USE BACK UP FOR 1ST 7 DAYS |
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|
Term
| patient instructions: combination oral contraceptive |
|
Definition
begin on day 1 or Sunday after start of menstrual cycle
take one pill daily for 21 days; then may take placebo pills (28 day pills) or stop for 7 days
NOTE: important to take pill ~ the same time each day esp. with decreased hormone content |
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|
Term
| patient instructions: progestin only |
|
Definition
begin on day 1 of menstrual cycle
no other options with progestin only except to begin on day 1 of the menstrual cycle
take one pill every day continuously at the same time
ONLY HAVE A 3 HOUR WINDOW WITH PROGESTIN ONLY!
use another birth control method for next 48 hours if more than 27 hours between pills or miss 1 pill
NOTE: important to take pill ~ the same time each day (+/- 3 hours) |
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|
Term
|
Definition
nausea, vomiting
headaches
dizziness
spotting and bleeding
mood changes including depression
possible weight gain
side effects worse in the 1st 3 months:
nausea/dizziness
cyclic weight gain, edema
breast fullness, tenderness
BTB
contact lenses fail to fit: due to estrogens making the eyes swollen; fixed by decreasing estrogen component
abdominal cramping |
|
|
Term
|
Definition
spotting
breakthrough bleeding: do not have the stabilization of the endometrium from estrogens
amenorrhea
mood changes
headaches
hot flashes |
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|
Term
| COC side effects requiring an adjustment: symptoms of ESTROGEN EXCESS |
|
Definition
nausea
bloating
hypermenorrhea
hyperpigmentation
hypertension
migraine headache
leg cramps
cervical mucorrhea |
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|
Term
| COC side effects requiring an adjustment: symptoms of ESTROGEN DEFICIENCY |
|
Definition
irritability
early and/or midcycle breakthrough bleeding
nervousness |
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|
Term
| COC side effects requiring an adjustment: symptoms of PROGESTIN EXCESS |
|
Definition
increased appetite
weight gain
hypomenorrhea
oily skin and hair
acne
hair loss or hirsutism (if androgenic)
depression |
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|
Term
| COC side effects requiring an adjustment: symptoms of PROGESTIN DEFICIENCY |
|
Definition
late breakthrough bleeding
weight loss
hypermenorrhea
amenorrhea |
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Term
| postpartum use of birth control in non-breastfeeding women |
|
Definition
Category 1: > 42 days
Category 2: 21-42 days without risk factors
Category 3: 21-42 days with risk factors for VTE (> 35y, previous VTE, thrombophilia, immobility, postcesarean delivery, smoking, transfusion at delivery, BMI > 30, postpartum hemorrhage)
Category 4: < 21 days
WITH RISK FACTORS: START AT 42 DAYS
WITHOUT RISK FACTORS: START AT 21 DAYS |
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|
Term
| postpartum use of birth control in breastfeeding women |
|
Definition
Category 2: > 42 days; 30-42 days without risk factors
Category 3: 30-42 days with risk factors; 21-30 days with or without risk factors
Category 4: < 21 days
COC IN BREAST FEEDING WOMEN CAN BE STARTED (WITHOUT ANY RISK FACTORS OR WITH RISK FACTORS) AT 42 DAYS |
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|
Term
| postpartum, lactating: use of progestin only OC |
|
Definition
should not be initiated < 1 month postpartum
decreased natural anticoagulants, hypercoaguable state
low dose COCs can be used: concerns of decreased milk production
pelvic rest recommened for 4 weeks (vaginal delivery) or 6 weeks (Caesarean) |
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|
Term
| COC CONTRAINTICATIONS (WHO CATEGORY 4) |
|
Definition
DVT/PE or history of
CVD, CAD
complicated DM: nephropathy, retinopathy, neuropathy, diabetes for more than 20 years
breast cancer or strong family history
pregnancy
lactation (<6 weeks postpartum)
gallbladder disease: the estrogen component can cause gallstones, can worsen gallbladder disease
hypertension: > 160/100; get blood pressure under control first
liver abnormalities: metabolized in the liver
HA or migraines with neurologic symptoms: rare cases of retino-thrombosis associated with COC; if you have migraines with neurologic symptoms you are at increased risk of retino-thrombosis; neurologic symptoms = seizures
major surgery: hypercoaguable state
>25 yo + smoker: nicotine and age and estrogen puts them at risk for clots; DO NOT USE A PRODUCT WITH ESTROGEN IN IT
undiagnosed abnormal bleeding |
|
|
Term
| complications associated with COC use |
|
Definition
myocardial infarction and ischemic stroke
venous thromboembolism
hypertension - small increase
cholelithiasis/cholecystitis - gallbladder disease
visual changes
symptoms of concern:
ACHES - KNOW THESE!!
abdominal pain (possible gallbladder disease)
chest pain (possible MI)
headaches which are severe (stoke)
eye problems: blurred or loss of vision (retinal thrombosis)
severe leg pain (DVT) |
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|
Term
|
Definition
date of last menstrual period
regularity in cycles
incidence of PMS
previous treatment
physical exam:
BP
breast examination
PAP smear
liver evaluation
family history
social history |
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|
Term
| progestin only candidates |
|
Definition
smokers > 35 years of age
history of thromboembolic events
nursing moms (low dose COC's can also be used)
history of estrogen related headaches
uncontrolled hypertension
any estrogen related side effect |
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|
Term
| special populations: smokers |
|
Definition
> 15 cigarettes per day and > 35 years old = NO ESTROGEN CONTAINING OCS
risks exceed pregnancy risk
< 15 cigarettes per day and > 35 years old = use with caution
may use low dose 20 mcg estrogen formulation
progestin only pills - recommended as best option |
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|
Term
| special populations: hypertension |
|
Definition
estrogen - small increases in blood pressure
blood pressure restoration 3-6 months after D/C
low dose estrogen OCs ok if well controlled
end organ disease (CAD, CHF, CVD) = NO!!!
K+ cautions
yaz and yasmin can increase K and cause hyperkalemia b/c it contains a different type of progesterone |
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|
Term
| special populations: diabetes |
|
Definition
no significant effects on insulin, glucose or glucagon release
women with diabetes AND vascular disease = NO |
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|
Term
| special populations: dyslipidemia |
|
Definition
progestins: decrease HDL and increase LHL
estrogens: increase removal of LHL from circulation and increase HDL
estrogens alter VLHL composition and increase triglycerides
uncontrolled (LHL > 160, HDL < 35, TGs > 250) + additional risk factors = USE ALTERNATIVE METHOD |
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|
Term
| special populations: systemic lupus erythematosus |
|
Definition
risk associated with pregnancy is high
association between VTE and OCO use in women with:
systemic lupus erythematosus
history of vascular disease
antiphospholipid antibodies
POPs should be used |
|
|
Term
|
Definition
hepatic induction (enzyme inducers):
st. john's wort, RIFAMPIN, GRISEOFULVIN, anticonvulsants, sedative/hypnotics
decreased effectiveness of the oral contraceptives
use a back up for the ENTIRE PACK
decreased enterohepatic recirculation:
broad spectrum antibiotics kill the friendly "bacteria"
use a back up method while on the antibiotic AND 7 days after the completion of the antibiotic!
anticoagulant interaction:
increases clotting factors
INR will go down, may have to increase the warfarin dose |
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|
Term
| what to do when a pill is missed |
|
Definition
MISSED 1 DOSE:
take as soon as remembered or take 2 tablets the next day
MISSED 2 IN WEEK 1 OR 2:
take 2 tablets as soon as remembered or take 2 tablets the next 2 days
an additional method of contraception should be used for 7 days after missed dose
MISSED 2 IN WEEK 3:
continue dose of 1 tablet per day until Sunday, then discard the rest of pack, and start a new pack that same day
OR
current pack should be discarded and new pack should be started that same day
an additional method of contraception should be used for 7 days after missed dose
MISSED 2 (PROGESTIN ONLY):
take one of the missed doses, discard the other, and take daily dose at usual time
MISSED 3 OR MORE:
continue dose of 1 tablet daily until Sunday, then discard the rest of pack, and start a new pack that same day
OR
current pack should be discarded, and a new pack should be started that same day
an additional method of contraception should be used for 7 days after missed dose
MISSED 3 OR MORE (PROGESTIN ONLY):
current pack should be discarded
use another form of birth control until menses appears or pregnancy is ruled out |
|
|
Term
| additional indications for oral contraceptives |
|
Definition
COC/POP induced improvements in menstrual symptoms:
fewer cramps/less pain
less flow or fewer days
more predictable menses
elimination of ovulation pain
non-contraceptive benefits of COC (other COC indications):
pelvic inflammatory disease - infection of the uterus, fallopian tubes, and other reproductive organs of the female reproductive system; usually caused by STD (chlamydia, gonorrhea); causes severe cramping; COC can help with the pain of PID
premenstrual dysphoric disorder (PMDD) - more severe PMS; moodiness is very severe, depression, cry uncontrollably, social isolation, suicidal ideation
dysmenorrhea/menorrhagia - heavy periods, irregular periods; taking COC will decrease period flow and make periods more predictable
endometriosis - lining of the endometrium is inflamed causing severe cramping; taking COC decrease the build up of the lining and decrease pain
polycystic ovarian syndrome (PCOS) - multiple cysts on the ovaries, can cause severe cramping; taking COC will decrease the cramping
acne vulgaris - certain products are proven to make acne better; contain LOW androgen component to decrease acne; acne is improved in many women by using estrogen-dominant, low androgen COCs; brand names include: Ortho Tri-Cyclen, Estrostep, Yasmin, Yaz |
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|
Term
|
Definition
ovarian:
risk decreased by 50% after 5 years
lasts for 10-20 years after pill is DC'd
endometrial:
same as ovarian
breast:
controverisal
strong family history of gene must be considered |
|
|
Term
|
Definition
Yasmin = 3 mg drosperinone/30 mcg EE
first COC in US to contain drosperinone
drosperinone is a synthetic sprionolactone analog
indicated for acne
monophasic:
3 mg drosperinone and 30 mcg EE per tablet
21 active yellow tabs; 7 inert white tabs per cycle
take at the same time each day
initiate therapy on day 1 of menstrual cycle or first Sunday after start of menstrual cycle or quick start
drosperinone:
its anti-mineralocorticoid activity counteracts the aldosterone-stimulating effects of estrogens
estrogen-induced Na and water retention is reduced -> less increase in blood pressure, less weight gain
more favorable effects on HDL and LDL than other progestins
potential for hyperkalemia |
|
|
Term
|
Definition
YAZ = 3 mg drosperinon/20 mcg EE
indicated for PMDD and acne
contains drosperinone like Yasmin
24/4 dosing regimen (extended):
24 days of hormone containing tablets and 4 days of placebo
shorter bleed time
decreased PMS, decreased cramping |
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|
Term
| meds to avoid (or use with caution and proper monitoring) while taking Yasmin or Yaz |
|
Definition
ACE inhibitors
ARBs
K sparing diuretics
K supplements
aldosterone antagonists
NSAIDs
not contraindicated, but have to monitor K levels |
|
|
Term
| Loestrin 24 Fe clinical pearls |
|
Definition
24 active "white" pills
take for week 1, 2, 3 and 1st part of week 4
4 brown pills containing iron
shorter, lighter periods without blood tests (no potassium monitoring) |
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Term
| Femcon Fe clinical pearls |
|
Definition
1st chewable birth control approved by FDA May 2006
may be chewed, followed by full glass of water OR swallowed whole
21 active + 7 reminders
all 7 pills contain 75 mg of ferrous fumarate |
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|
Term
|
Definition
Beyaz = drospirenone/EE/levomefolate calcium
28 day pack:
drospirenone/EE/levomefolate x 24 days
levomefolate x 4 days
levomefolate is a metabolite of folic acid
folic acid is to prevent neural tube defects that can occur in babies of mothers with low folic acid levels
all women of child bearing age should be taking folic acid as a supplement |
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|
Term
| Seasonale clinical pearls |
|
Definition
monophasic COC:
0.15 mg levonorgestrel
30 mcg EE
91 day regimen:
84 active pills followed by 7 inactive pills
women will get a period 4 times a year
Seasonale has more incidence of break through bleeding |
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|
Term
| Seasonique clinical pearls |
|
Definition
same 4 periods/year as Seasonale
levonorgestrel 0.15 mg and 30 mcg EE (84 days), 10 mcg EE (7 days)
proposed less break through bleeding with Seasonique |
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|
Term
|
Definition
Lybrel = 90 mcg levonorgestrel/20 mcg EE
1st and only low dose COC taken 365 days of the year
no scheduled menstrual period
high incidence of breakthrough bleeding or spotting (esp. during first 3 months of use) |
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|
Term
| Ortho Evra clinical pearls |
|
Definition
weekly transdermal patch
apply one patch weekly for 3 weeks
week 4 patch free
apply same day each week
apply to clean, dry skin,
BUTTOCK
ABDOMEN
UPPER OUTER ARM
UPPER TORSO (BACK)
fold prior to disposal, don't flush
rotate areas the patch is applied
at the beginning of each cycle can apply to the same area again
can alternate to different areas of the body
extra adhesive can be removed with baby oil
same CI/efficacy as OCP
time of day patch is changed does not matter
each patch will suppress ovulation up to 9 days
if it has been no more than 9 days since the patch was changed it is okay
if it has been more than 9 days they should put on a new patch and use back up for 7 days
if it has been more than 7 days since they have put on a patch, put one on and use backup for 7 days
new patch start day if more than a week between patches
starting the patch:
first day within 24 hours of menses
OR
Sunday after menses, even if not finished, need 7 day back up
label warnings:
60% higher systemic estrogen exposure; AUC greater
higher steady state and 25% lower peak concentration (compared to 35 mcg EE OCP)
increases risk associated with estrogen - clotting, VTE
ortho evra and body weight:
less effective in women who weight >/= 198 lbs (90 kg)
enhanced metabolic clearance rate in women > 90 kg
increased absorption of hormones into body fat = decreased absorption of the hormones into the circulation (longer time to reach steady state)
ortho evra is not recommended in patients weighting > 90 kg |
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|
Term
| NuvaRing vaginal clinical pearls |
|
Definition
flexible, combined hormonal ring
same CI/efficacy as OCP
insert ring for 21 days, 7 days ring free
FIRST TIME USER:
insert between days 1-5 of menstrual cycle
if inserted days 2-5 need 7 day back up
increased compliance
may store at room temperature, avoid extreme heat for up to 4 months
provides protection for up to 35 days
if it has been more than 35 days since inserted, take it out and start a new ring; use backup for 7 days
dispose in trash can
cannot be out for more than 3 hours a day
if > 3 hours during week 1 or 2 reinsert and use back up for 7 days |
|
|
Term
|
Definition
NuvaRing 10.6 +/- 2.5
COC oral 21.9 +/- 2.9
Ortho Evra 35.8 +/- 5.5
NuvaRing has the lowest AUC of estrogen; the patch as the highest estrogen AUC
when someone is stopping NuvaRing to get pregnant it usually happens faster than those taking the patch
KNOW WHAT HAS THE LOWEST ESTROGEN AUC |
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|
Term
| Depo-Provera IM injection clinical pearls |
|
Definition
medroxyprogesterone acetate
MOA:
inhibits ovulation
thickens cervical mucus
thins endometrial lining
dosage regimen:
150 mg deep IM injection in upper arm or buttock every 12 weeks (2 week grace period)
for 1st injection, give withing the 1st 5 days of cycle if not breastfeeding, if not use back up for 7 days
for breastfeeding women it has to be at least 6 weeks postpartum
side effects:
unpredictable bleeding
weight gain - 20 lbs weight gain in 3 months is average; more weight gain in women who are not obese
decreased bone mineral density (black box warning)
depression
unpredictable bleeding that may never decrease
effectiveness:
depends on patient's compliance
with good compliance can be just as effective as COC even though it only contains progesterone |
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|
Term
| discontinuing oral contraceptives/return of fertility |
|
Definition
average ovulation delay = 1-2 weeks
Depo-Provera can take up to 18 months (should not be used in a patient that wants to get pregnant soon) |
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|
Term
| intrauterine contraceptives |
|
Definition
"reversible sterilization"
immediate return of fertility after removal
1) Mirena - levonorgestrol releasing
plastic, flexible device inserted in uterus
inserted within 7 days of menses onset OR 6 weeks postpartum
provides protection up to 5 years
lighter periods or none
uterine cramps, bleeding
MD check placement 1-3 months after insertion and annually
the only patients that this product was studied in where those who have had at least one child
rare complication: can go through the uterus
if someone was to get pregnant on Mirena they are at risk for ectopic pregnancy (progesterone component); can burst the fallopian tube
2) Paraguard - copper releasing
prevents sperm from reaching and fertilizing the egg
no hormones avoids weight gain and mood swings |
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|
Term
| 2 types of emergency contraceptive pills |
|
Definition
combined oral contraceptive pills (COCs)
YUZPE method: have to take 4-5 pills to get enough progestin component to prevent pregnancy; at the same time you are getting a lot of estrogen (causes a lot of ADRs - nausea, headache, vomiting, clotting); not FDA approved
progestin-only contraceptive pills (POPs)
most common
ex) Plan B |
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Term
|
Definition
abortifacient: FALSE
harms developing fetus: FALSE
prevents or delays ovulation
prevents pregnancy from occurring
if pregnancy has occurred it will not harm the fetus
EC prevents implantation by delaying or preventing ovulation |
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|
Term
|
Definition
PREVENT PREGNANCY
not an abortifacient, does not disrupt an implanted pregnancy
if taken before ovulation, EC disrupts normal follicular development and maturation, blocks LH surge, inhibits ovulation
alter endometrium to help inhibit implantation (proposed)
may affect tubal transport of sperm or ova if taken after ovulation (proposed)
works the best if taken before ovulation
will not disrupt a current pregnancy |
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|
Term
| Plan B emercency kit clinical pearls |
|
Definition
2 white tablets of levonorgestrel 0.75 mg (each)
1 tablet within 72 hours of unprotected sex then 1 tablet 12 hours later
may take both at the same time
stops 89% of pregnancy if taken within 72 hours
95% if used within 24 hours
effectiveness is greater the sooner it is taken
Plan B is available without prescription for patients 17 years or older
prescription required for patients 16 years old and younger
DOES NOT WORK IF PREGNANT
prevents or disrupts ovulation and fertilization
NOT effective once fertilization or implantation occurs
Patient Education:
may notice changes in menstrual bleeding after taking Plan B
if menses is delayed more than 1 week, pregnancy should be suspected
common ADRs:
nausea, abdominal pain, fatigue, headache, menstrual changes, dizziness, breast tenderness, vomiting and diarrhea
if they vomit within 2 hours, should take another pill |
|
|
Term
| One-step Plan B clinical pearls |
|
Definition
levonorgestrel 1.5 mg
take within 72 hours of unprotected sex
same SE as 2 step Plan B |
|
|
Term
|
Definition
ulipristal acetate 30 mg
progesterone agonist/antagonist
selective progesterone receptor modulator (SPRM)
delays or inhibits ovulation
can prevent pregnancy up to 120 hours after intercourse
same SE as Plan B
when taken before the LH surge ovulation is delayed by 5 days in 100% of women; when taken after the LH surge ovulation is delayed in 8% of women
overall, 60% effectiveness
after 72 hours with Ella the effectiveness is the same as at 24 hours |
|
|
Term
|
Definition
~20 different COCs that can be used as EC
take 1st dose withint 72 hours, then follow with 2nd dose 12 hours later
nausea (~50%); vomiting (~19%)
may pre-treat with antiemetic
NOT RECOMMENDED!! |
|
|
Term
|
Definition
levonorgestrel vs. COCs
levonorgestrel more effective
levonorgestrel less side effects (no estrogen)
Plan B is the better choice!! |
|
|
Term
| when in cycle should EC be offered? |
|
Definition
at any time during the cycle
worry about effectiveness of Ella in the 2nd half of the cycle |
|
|
Term
| how many times a year can a women use ECPs? |
|
Definition
|
|
Term
| if patient is pregnancy, will EC affect the fetus or pregnancy? |
|
Definition
| no, the hCG will overtake the other hormones |
|
|
Term
| starting contraceptives after EC use |
|
Definition
should start regular method immediately
COCs: may start next day with 7 day backup method or wait for next menses
POPs: start on 1st day of menses
start barrier methods immediately, if preferred method
Ella: when restarting contraceptives (since it is a PR antagonist) there could be competition; the hormonal contraceptive could have decreased effectiveness (use 7 day backup no matter when they start!) |
|
|
Term
| pharmacist's right to refuse |
|
Definition
| the Health Care Right of Conscience Act states that not all people have the same moral or religious beliefs about what actions are medically acceptable and therefore issues state policy that Illinois will protect the right of conscience for any person who refuses to deliver, dispense, or pay for , or arrange a medical procedure, device, or other medical service if it conflicts with their personal moral or religious beliefs |
|
|
Term
| Sexual Assault Survivors Emergency Treatment Act of Illinois |
|
Definition
hospitals must have approved plan for sexual assault victims
oral and written information about EC |
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|
