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Clinical Pharmacy > Emergency Contraception > Flashcards

Emergency Contraception Flashcards

1
Q

What are the indications for using emergency contraception?

A
  • when no contraceptives have been used

- when a contraceptive method may have failed

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2
Q

What is the efficacy of emergency contraceptives?

A

80%

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3
Q

What is the mechanism of action of the levonorgestrel in plan B?

A
  • it interferes with ovulation (prevents or delays ovulation is taken before ovulation)
  • affects muscle contractility of the fallopian tubes, impairing oocyte transport and concentration of glycodelin A (an inhibitor of sperm binding)
  • does not affect the endometrium or sperm implantation
  • it delays the way that ova travels down the fallopian tubes and delays the sperm binding
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4
Q

Does plan B interfere with an established pregnancy?

A
  • no
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5
Q

When in the cycle is taking plan B ineffective?

A
  • when it is taken the day of or after ovulation
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6
Q

Does levonorgestrel have an effect if the sperm and the egg have already met?

A

no, it does not

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7
Q

In which subset of patients is levonorgestrel less effective?

A
  • if the woman is weighing from 165 to 176 lbs – not at all effective for women weighing over 176 lbs
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8
Q

The effectiveness of levonorgestrel is dependent on the time it is taken after intercourse. What are the time frames and efficacies of this?

A

< 24 hours: 95%
25-48 hours: 85%
49-72 hours: 58%

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9
Q

What is the dose of levonorgestrel in plan B?

A

2 tablets of levonorgestrel 0.75 mg to be taken together for a single dose of 1.5 mg as soon as possible after unprotected sex

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10
Q

What are the adverse effects associated with using levonorgestrel?

A

nausea, vomiting, cramps, fatigue, breast tenderness

for nausea can take dimenhydrinate 30 minutes prior

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11
Q

When should a patient see a physician after taking levonorgestrel if they have not has their period?

A

21 days after

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12
Q

If vomiting has occurred less than _____ after taking the pill, then tell the patient that it is important that they take another 2 pills of levonorgesterol

A

2 hours

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13
Q

What is considered to be the most effective form of emergency contraception?

A

copper IUD

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14
Q

How long after unprotected sex can the copper IUD be inserted to still have benefits as an emergency contraceptive

A

7 days

- can remain in the uterus for 30 months after insertion

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15
Q

What is the mechanism of action of the copper IUD as an emergency contraceptive?

A
  • causes inflammation of the uterus, as well as the copper ions are toxic to the sperm and oocyte
  • it inhibits implantation
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16
Q

What is the mechanism of action of uliprisal acetate as a method of emergency contraceptive?

A
  • inhibits or delays folicular rupture when given prior to the LH surge
    • ineffective if given on day of the LH surgery (ovulation)
    • endometrium is not affected
  • requires an rx
  • single dose of 30 mg, to be taken as soon as possible within 5 days after unprotected intercourse
  • more effective than levonorgestrel especially at day 4 or 5
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17
Q

Ulipristal acetate may have less efficacy in women with a BMI over what?

A

35 kg/meter squared

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18
Q

What is the dose of medication in the Yuzpe method?

A
  • 2 doses of 100 mcg ethinyl estradiol and 0.5 mg levonorgestrel given 12 hours apart
    • it is less effective and more SE versus levonorgestrel and ulipristal
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19
Q

What is so finicky about yuzpe method?

A
  • have to be taken exactly 12 hours apart
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20
Q

What is contained in mifegymiso?

A

200 mg of mifepristone (oral) and 800 micrograms of misoprostol which is taken 24 to 48 hours after mifepristone

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21
Q

Mifegymiso is indicated for pregnancy termination up to _____

A

49 days

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22
Q

What are the advantages associated with using a male condom?

A
  • acts as a mechanical barrier
  • prevents against STIs
  • pregnancy prevention
  • convenient, widely available, easy to use
  • used only when needed
  • no systemic effects
  • inexpensive
  • discreet
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23
Q

What is the disadvantage of using a male condom?

A
  • requires motivation to use and practice for proper use
  • may reduce sensitivity
  • may interfere with an erection
  • may deteriorate in storage or when oil based lubricants are used
  • allergies or sensitivity to latex in some women
  • there is a typical failure rate of 18%
24
Q

What kind of lubricants can latex condoms be used with?

A

with oil based lubricants

25
Q

What kind of condoms are used for individuals with latex allergies?

A
  • polyurethane or polyisoprene
26
Q

Are condom breakage and slippage more common in latex or polyurethane?

A

more common in polyurethane – polyisoprene is a synthetic version of latex and is softer and more stretchy

27
Q

What kind of lubricants can be used with polyurethane and polyisoprene condoms?

A

water based lubricants

28
Q

What comprises a female condom?

A

nitrile sheath with 2 flexible rings

29
Q

How should a female condom be disposed of?

A
  • need to squeeze and twist the outer ring before standing up to keep the semen inside of the condom
30
Q

What are the advantages of using a female condom?

A
  • can be inserted 8 hours prior to intercourse
  • safe to use with a latex sensitivity
  • no deterioration when exposed to oil based lubricants
  • has a longer shelf life than male condoms
31
Q

What are the disadvantages of using female condoms?

A
  • typical failure rate is 21%
  • no data for nitrile polymer regarding efficacy and prevention
  • more expensive than male condoms
  • fit is affected by the vaginal anatomy
  • difficult to insert
32
Q

What is the most commonly used spermicide

A

nonoxynol-9 - this destroys sperm

33
Q

What does frequent use of spermicide sometimes lead to?

A
  • may lead to irritation and lesions on genital mucosa (which may increase risk of transmission of infections) -inflamed, open skin increased STI transmission
34
Q

Spermicide use should be avoided in the case of what?

A

if multiple acts of daily intercourse

35
Q

Spermicide gels should be used with a ____ or _____-

A

diaphragm or cervical cap

36
Q

How should contraceptive foam be used?

A
  • VCF foam - insert 1 applicator full no more than 1 hour prior to each act of intercourse
37
Q

How should contraceptive film be used?

A
  • should be inserted 15 minutes (up to 3 hours) before intercourse
  • one film should be use per act
38
Q

How many times can you use a contraceptive sponge?

A
  • single use
39
Q

What are the timeframes that patients should be aware of when using a contraceptive sponge?

A
  • inserted up to 24 hours before intercourse
  • must be left in the vagina for at least 6 hours after the last act of intercourse
  • should remain for no more than 30 hours in the vagina (risk of TSS increases after 30 hours)
  • mechanism of action:
    • provides a physical barrier to sperm
    • absorbs the sperm
    • contains a spermicide
40
Q

What are the advantages of contraceptive sponges?

A
  • 12% failure rate in nulliparous women
  • 24% failure rate in parous women
  • one size fits all
  • 24 hours of protection
    • protection begins right away
    • no need to change with repeated acts of intercourse
    • can be used with male condoms
41
Q

What are the disadvantages of contraceptive sponges?

A
  • contraindicated in those with allergies or sensitivity to spermicidal
  • difficulty in removing
    • must remain in the vagina for at least 6 hours after intercourse
    • must not be left in the vagina for over 30 hours
  • recommended to avoid in those with a history of TSS
  • increased changes of urinary infections
  • no protection from HIV
    • sponge may damage vaginal tissue and increase chances of HIV transmission
42
Q

What are the contraindications of using a sponge or spermicide?

A
  • being at high risk of HIV
  • being HIV positive, or having AIDS due to increased chance of transmission to uninfected sexual partners
  • allergy to nonoxynol-9
  • history of TSS
  • inability to correctly insert
  • repeated UTIs
  • full term delivery (within 6 weeks), recent abortion (spontaneous or induced), vaginal bleeding
43
Q

Describe the diaphragm being used as a contraceptive?

A
  • diaphragm is an intravaginal barrier used with gel (used with spermicidal gel)
  • woman has to be fitted for this, and then an rx is written for the woman
44
Q

What are the three types of diaphragms that are available in Canada?

A
  1. Milex wide seal silicone
  2. Milex arcing
  3. Caya SILCS
45
Q

What is the steps for properly using a diaphragm?

A
  • insert up to 2 hours prior to intercourse
    • additional acid-buffering lubricant needed to be inserted with an applicator for repeated acts of intercourse or if more than 2 hours since diaphragm is inserted an intercourse has not yet occurred
  • must remain in place for a minimum of 6 hours after intercourse
  • must be removed before 24 hours after initial insertion
  • wash with warm water and mild soap
46
Q

What are the advantages of diaphragm?

A
  • 12% failure rate
  • can be inserted up to 6 hours prior to intercourse
  • easier to insert than the cervical cap
  • can be used during menstruation
  • can be re-used for subsequent acts of intercourse
  • re-usable for several years
47
Q

What are the disadvantages of using a diaphragm?

A
  • higher risk of UTIs
  • required practice to insert prior to first time use
  • risk of TSS
48
Q

What hormone is used to detect pregnancy?

A
  • use human chorionic gonadotropin (HCG)
  • detected in blood or urine after 6-8 days after conception
  • highest concentration between 9 am - 12 pm
  • concentration doubles every 2 days, peaks in 60-70 days
  • initial tests use urine, then confirmed with a blood test
49
Q

What are the concentrations of HCG after conception?

A
  • after 1 week: 5 mlU/ml
  • peaks at 100000 mlU/ml
  • blood tests can detect levels at 1 mlU/ml
  • urine tests can detect levels at 20 to 100 mlU/ml
50
Q

False negative tests can occur up to ____ days after insemination

A

17

51
Q

What are some other errors that can lead to false results?

A
  • expired test kit
  • no following time recommendations
  • testing too early
  • testing too late
  • soap residue, blood or protein in urine sample
  • cloudy, pink or red urine
  • strong urine odour
  • warm or hot water rinsed of surface before or after the sample
  • use of fertility drugs
52
Q

Low levels of what during perimenopause and menopause may result in vaginal dryness?

A

estrogen

53
Q

Decrease in estrogen can cause what?

A
  • thinning of the vaginal tissue
  • loss of collagen support
  • increased vaginal pH
  • reduced production of vaginal lubrication even with sexual arousal
54
Q

What is considered perimenopause?

A

when menopause has not quite occurred - less than 1 full year that a woman has not had her period

55
Q

What is the difference between a vaginal lubricant and a vaginal moisturizer?

A

Lubricants: used for vaginal dryness, dyspareunia and comfort with condom use
- used during intercourse
Moisturizers: replens contains bioadhesive polymers that bind to vaginal epithelium and provide water and electrolytes to cells
- longer duration of action compared to lubricants (2 to 3 days)
- used on a routine basis - not immediately before intercourse

Clinical Pharmacy (24 decks)

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