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new FDA approval containing ethinyl estradiol, drospirenone and levomefolate calcium
beyaz
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contains norethin drone aetate and only 10 mcg of ethinyl estradiol
Lo Loestrin Fe
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4-phase OC containing estradiol valerate and dienogest, taken on a 26-day active hormone/2-day placebo cycle
natazia
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excess of this causes
breast tenderness
cyclic weight gain
nausea
edema
bloating
HTN
migraine
suppression of lactation
poor contact lens fit
depression
estrogen
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deficiency of this causes
early or midcycle BTB
hypomenorrhea
increased spotting
hot flushes
atrophic vaginitis
dyspareunia
estrogen
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excess of this causes
noncyclic weight gain
breast regression
decreased menstruation
increased appetite
fatigue
depression
vaginal candidiasis
progesterone
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deficiency of this causes
Late BTB
amenorrhea
hypermenorrhea
progesterone
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headaches early to mid-cycle means what and how to fix
- estrogen excess
- use low estrogen OC - alesse, lo-ovral
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early to midcycle spotting and BTB means what and how to treat
- estrogen deficiency
- OC with higher estrogen - demulen
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vaginal candidiasis means what
progesterone excess
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what if sally missed 1 OC dose (of her monophasic birth control) anytime in her cycle
take missed OC immediately and next OC at regular time
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what if sue miss 2 doses (of her monophasic birth control) during the first two weeks of the cycle
take 2 OCs daily for the next 2 days then resume taking OCs on regular schedule
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what if bertha missed 2 doses (of her mononphasic birth control) in the third week of her cycle
- sunday start: 1 tab per day until Sunday, then start new pack on sunday
- back-up method for 1 week
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what if magdeline missed 3 or more doses (of her monophasic birth control) anytime in her cycle
- dispose the remaining OCs and begin new OC
- if no more missed days use back-up for 1 week
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what if gwen missed 1 pill (of her triphasic birth control) anytime in her cycle
- take the missed pill as soon as remembered
- take the next dose as scheduled time
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what if candy missed 2 or more doses (of her triphasic birth control) anytime in her cycle
- throw out the missed pills
- take next dose at the scheduled time
- use back-up method for 7 days
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which progestins have less androgenic activity
greater improvement in acne
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which progestin is synthetic with antiandrogenic and antimineralcorticoid activity (useful in HTN)
improves symptoms associated with premenstrual dysphoric disorder, hirsutism and acne
drospirenone
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is there an option of OC for someone who is breast feeding and doesn't want a decrease in production of milk or someone > 35 yo and smokes?
- progestin only pills "minipills"
- micronor
- nor-QD
- ortho micronor
- camila
- errin
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3 disadvantages of progestin only pills
- irregular menses
- generally less effective
- increased need for compliance
- use backup for at least 48h if pill is late by > 3 hours
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what if jeniffer wanted an injectable contraceptive that was highly effective and didn't want to mess with the daily task of taking a pill
how often would she need to get the injection
- medroxyprogesterone acetate - 150mg
- IM - depo provera
- SC - depo subQ provera
- every 12 weeks +/- 2 weeks, > 14 weeks requires a negative pregnancy test to restart
original start needs a negative pregnancy test and initiated 5 days of onset of menses
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what are 5 advantages to using depo-provera
- scanty or no menses
- decreased menstrual cramps
- eliminates midcycle pain in the abdomen
- decreased risk of endometrial & ovarian cancer and pelvic inflammation
- may reduce seizure frequency
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what if a lady comes in wanting recommendations for birth control and you notice she has tegretol on her medicine profile
depo - provera --> may reduce seizure frequency
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what if edna comes in asking about dep-provera and its adverse effects
- return of fertility can be delayed for 6-12 months after last injection
- BBW - increased risk of bone loss after 2 yrs of use
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delilah comes in and is concerned about the increased risk of bone loss from the depo-provera she is taking
- tell her to take
- 1000mg of Ca
- 200mg of vitamin D
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Hally comes into the pharmacy and wants birth control that is effective for 3 yrs, but could change her mind and decide to get pregnant at anytime. She is not obese and could actually stand to gain 2.8 pounds a year, and doesn't tolerate estrogen very well
implanon
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Ginger comes in and wants a patch birth control method. She just received a negative pregnancy test and said she could start it this sunday or the 1st day after menses. Ginger also likes to swim and take baths often
ortho evra
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ginger comes in after applying the ortho-evra and wonders if her large aunt could use it as well? she also states the patch fell off after going hiking, about a day and a half ago
- less effective in women > 90kg
- < 24 hours just reapply
- > 24 hours start a new patch and use backup for 7 days
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Olivia comes to the pharmacy and inquires about NuvaRing. duration, return to fertility and removal during encounters
- inserted and left in place for 3 weeks followed by 1 ring free week
- excellent cycle control and rapid return to fertility
- may be removed during encounters but if longer than 3 hrs (lucky) use backup for 7 days
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4 enzyme inducers that could interact with birth control
- rifampin
- barbiturates
- carbamazepine
- phenytoin
use backup for one full cycle after DCing the above
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Gabby comes in and wants to know if there is a birth control that will not be affected by the antibiotic she is on
POP's
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Gina comes to the pharmacy and is frazzled about last night and would like some suggestions
- progestin only - plan B - within 72h
- q12h x2 or single 1.5mg tab
- yuzpe (estrogen & progesterone)
- 2 doses, could consist of up to 6 tabs
- IUDs - insert within 120h
- Ella - ulipristal acetate
- 2nd gen anti-progestin
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After taking her emergency contraception Marge said she threw up an is concerned, not only about this but wonders if anything else could go wrong
- happens in 30-66% of cases and may last for 2 days
- if it is after 2 hours of first dose don't repeat
if menses does not start 21 days after EC do a pregnancy check
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