315 Exam 3 Reproductive Health

Opill

progestin only oral contraceptive. Contains 0.075mg of norgestrel. Does not contain estrogen. Taken every day, 99% effective. Useful for those unable to take estrogens. Preferred contraceptive for breast-feeding patients. Not age restricted.

Opill Drug interactions

Effectiveness is reduced by drugs like phenytoin, carbamazepine, barbiturates, rifampin, efavirenz, and Saint John’s Wort.

When to use Opill

Current or history of breast cancer, known or suspected pregnancy, unexplained vaginal bleeding.

Important Opill Counseling points

Take at the same time every day. Administer continuously with no interruption between packs. May be started on any day of the month. Use non-hormonal backup for the first 48 hours, or if vomiting/diarrhea occur within first 4 hours of dose. Does not protect against STIs.

Emergency Contraception Mechanism of Action

Levonorgestrel is a synthetic form of progesterone which inhibits ovulation from occurring. It also interferes with fertilization, sperm immobilization by altering uterine pH, preventing implantation by disrupting the uterine lining, and thickening of cervical mucus. It may also prevent fertilization of released egg or attachment of egg to uterus.

Important Emergency Contraception Counseling Points

If BMI is 26 or greater, effectiveness of the nonprescription EC products may be reduced, but do not withhold products. Do not use if allergic to levonorgestrel. Does not protect against HIV/AIDs or other STIs. Do not use if already pregnant, it will not terminate an existing pregnancy. Do not use for regular birth control. Most efficacious in the first 72 hours but can be used up to 120 hours. Repeat dose if patient vomits within 1-2 hours after taking initial dose.

Side effects of emergency contraception

Nausea, Vomiting, breast tenderness, abdominal pain, cramping, headache, menstrual changes, tiredness, diarrhea, dizziness

Ulipristal Acetate

Ella. Prescription Only. A 30mg tablet taken within 5 days of contraceptive failure or lack of contraception use. It is a progesterone agonist/antagonist. Side effects include HA, nausea, abdominal pain, fatigue, and dizziness.

HPV Vaccine

Ages 9+. Recommended for ages 11-12 and catch-up vaccines recommended for all persons through age 18 years if not adequately vaccinated.

HPV Dose interval series

Ages 9-14: 2 dose series at 0, 6-12 month.

Age 15+: 3 dose series at 0, 1-2 months, 6 months.

If the vaccination schedule is interrupted, the series does not need to be restarted

Hepatitis B Vaccine

3 dose series (children, and 18+): 0, 1 month, 6 months

2 dose series (18+): 0, 1 month

Bacterial Vaginosis (BV)

Thin, watery, off-white, green, gray, tan discharge may have a fishy odor or foamy discharge. Not self care. Need Rx clindamycin or metronidazole.

Trichoniasis

Malodorous, yellow-green discharge, pruritis, or no symptoms. Not self care. Rx metronidazole or tinidazole.

Vulvovaginal Candidiasis (VVC)

Self-Care. Common characteristics include itching, and white thick discharge that looks like cottage cheese. Also known as a yeast infection it is the second most common vaginal infection after BV. Uncommon before a woman’s first period. Recurrent infections are considered to be 4 or more infections within one year.

VVC Causes

Most cases are caused by C.albicans. Pregnancy, high-dose estrogen oral contraceptives, and estrogen replacement therapy may increase risk. Elevated pH during menstruation may predispose.

VVC Risk factors

Women with diabetes with poor glycemic control, women who have used broad spectrum antibiotics. Immunosuppressive therapy or conditions like HIV may increase frequency. Increased frequency with onset of sexual activity.

Goals of VVC Treatment

Relieve symptoms, eradicate infection, reestablish normal vaginal flora

VVC Self Treatment Criteria

Vaginal symptoms are infrequent, at least one previous diagnosed episode of VVC, mild to moderate symptoms that are consistent with those of VVC, if measured vaginal pH of <4.5

VVC Exclusions

Pregnant, <12 years old, fever, lower abdominal pain, back pain, shoulder pain, predisposing medications like corticosteroids or antineoplastics, predisposing medical conditions like diabetes or HIV, recurrent VVC (>3 infection per year or 2 in one month)

General VVC therapy

Imidazole product. Available as vaginal creams, suppositories, and tablets.

Butoconazole Nitrate Products

2% cream inserted everyday for 3 days. Apply to vulva prn for itching

Clotrimazole

1% creams inserted once a day for 7 days. 100mg tablet inserted once a day for 7 days. 2% cream inserted everyday for 3 days.

Miconazole Nitrate

1200mg supp: Insert once for one day.

200mg supp: insert once a day for three days

100mg supp: insert once a day for seven days

4% cream: Insert everyday for 3 days

2% Cream: insert everyday for 7 days

Tioconazole

6.5% ointment: insert once a day for once day

VVC Complimentary therapies

Lactobacillus preparations, douches, tea tree oil, gentian violet, boric acid

Applying VVC Products

Start at bedtime, wash and dry area, gently insert applicator, push applicator plunger to apply product, remove the applicator, recap and clean it, may wear a sanitary pad.

Side effects of VVC products

Vulvovaginal burning, itching, and irritation. Drug interactions are unlikely but it could interact with warfarin

Vagisil Screening Kit

Detects pH of vaginal secretions. pH of 4.5 or lower suggests yeast infection. pH >5 can suggest BV or trichomoniasis

UTI exclusions

Strong/persistent need to urinate, yet only a small amount will pass, burning sensation when urinating, urine is cloudy or contains blood, strong odor, pain in back or lower abdomen, n/v or patient feels ill

Phenazopyridine

Uristat, Prodium, AZO. Used to relieve pain, burning, urgency, frequent urination, and discomfort caused by irritation of the lower urinary tract.

AZO Counseling

Should only be used for up to 2 days of 12 tablets, then contact MD. Side effects include GI upset, urine may appear orange/red.

AZO Directions

2 tablets 3 times a day with meals. Max is 12 tablets a day.

Methenamine

Used to relieve pain and urinary tract discomfort. It acts as both an analgesic and antibacterial. Take 2 tablets by mouth 4 times a day. Not meant to treat UTIs need to contact MD.

Oxytrol

First OTC therapy for an overactive bladder. 18+. Indicated for symptoms of urge incontinence, urgency, and frequency. Each patch provides relief up to 4 days.

Dysmenorrhea

Cramps. Primary causes are abnormal uterine activity without pelvic disease. Secondary causes are endometriosis, pelvic inflammatory disease, fibroids, etc. Cramps can be sharp, throbbing, dull, nauseating, burning or shooting. Can cause n/v, dizziness, diarrhea, fatigue, HA. Usually begins within 12 hours or on first day, can last 24-72 hours.

Dysmenorrhea exlusions

Severe cramps or profuse bleeding, dysmenorrhea after age 25, pain >24 hours before menses, use of intrauterine contraceptive (IUD), history of: PID, infertility, ovarian cysts, endometriosis, pelvic pain in the absence of menstrual period, irregular period, active GI disease of bleeding disorder, intolerance or non-response to NSAIDs.

Dysmenorrhea treatment

Heat therapy, regular exercise, smoking cessation, rest. NSAIDs (start before cramps happen), analgesic combo (diuretics like caffeine + pyrilamine), magnesium, Omega-3s, Vitamin D3, Fenugreek, Valerian, Ginger, Estrogen Contraceptives