pharma II test IV contraceptives

  1. new FDA approval containing ethinyl estradiol, drospirenone and levomefolate calcium
  2. contains norethin drone aetate and only 10 mcg of ethinyl estradiol
    Lo Loestrin Fe
  3. 4-phase OC containing estradiol valerate and dienogest, taken on a 26-day active hormone/2-day placebo cycle
  4. excess of this causes
    breast tenderness
    cyclic weight gain
    suppression of lactation
    poor contact lens fit
  5. deficiency of this causes
    early or midcycle BTB
    increased spotting
    hot flushes
    atrophic vaginitis
  6. excess of this causes
    noncyclic weight gain
    breast regression
    decreased menstruation
    increased appetite
    vaginal candidiasis
  7. deficiency of this causes
    Late BTB
  8. headaches early to mid-cycle means what and how to fix
    • estrogen excess
    • use low estrogen OC - alesse, lo-ovral
  9. early to midcycle spotting and BTB means what and how to treat
    • estrogen deficiency
    • OC with higher estrogen - demulen
  10. vaginal candidiasis means what
    progesterone excess
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. which progestins have less androgenic activity
    greater improvement in acne
    • desogestrel
    • norgestimate
  18. which progestin is synthetic with antiandrogenic and antimineralcorticoid activity (useful in HTN)
    improves symptoms associated with premenstrual dysphoric disorder, hirsutism and acne
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 4 enzyme inducers that could interact with birth control
    • rifampin
    • barbiturates
    • carbamazepine
    • phenytoin

    use backup for one full cycle after DCing the above
  31. Gabby comes in and wants to know if there is a birth control that will not be affected by the antibiotic she is on
  32. 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
  33. 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
Card Set
pharma II test IV contraceptives
pharma II test IV contraceptives