Prevention of Pregnancy and Sexually Transmitted Infections

When is the Conception Window?

5 days before ovulation through the day of ovulation (6 day window)

What is the Most Common STI in the United States?

HPV - human papilomavirus

What Are the Pharmacist-Administered Vaccines or STI Prevention?

HPV vaccine and Hep B Vaccine

What are the Long-Term Complications of Hep B?

• hepatits

• cirrhosis

• hepatic carcinoma

• death

What Materials are External (Male) Condoms?

• latex

• polyurethane

• polyisoprene

• lamb secum

Info on Latex Condoms

• most common

• protects against STIs and pregnancy

• latex is degraded by oil-based lubricants

Info on Polyurethane Condoms

• less elastic

• not degraded by oil-based lubricants

• prevents STIs and pregnancy

Info on Polyisoprene Condoms

• only recommended in patients with latex allergies

Info on Lamb Secum Condoms

• only prevents pregnancy

• does not protect against STIs

Info on Condoms in General

• FDA regulates them as medical devices

• they are required to have an expiration date

Info on Spermicide on Condoms

• API: nonoxynol-9

• not more effective at preventing STIs

• not recommended due to risk of irritation

What Type of Lubricants/Products are Safe to Use with Latex Condoms?

• water/silicone-based lubricants

• contraceptive foams/gels

• glycerin

• water

• saliva

What Type of Lubricants/Products are NOT Safe to Use with Latex Condoms?

• topical oils

• edible oils

• hemorrhoidal ointments

• petroleum jelly

• vaginal creams

• hand and body/suntan lotion

Info on Structure of Internal (Female) Condoms

• FC2 is the only type available

• made of synthetic latex (nitrile)

• contains 2 rings connected with sheath in the middle

• inner ring covers cervix like a diaphragm

Info on Use of Internal (Female Condoms)

• one-time use

• more expensive then male external condoms

• lower breakage rate than external condoms

• higher slippage rate than external condoms

Info on Vaginal Spermicides

• API: nonoxynol-9

• do not prevent STIs

• surface-acting agents that immobilize and kill sperm

• come in a variety of formulations

• when used alone, spermicides carry a high rate of usage-related failure

Info on Gel and Foam Spermicides

• insert full dose near cervix

• immediate onset of action

• lasts for 1 hours after application

Info on Suppository Spermicide

• inserted near cervix

• 10-15 min onset time

• last for ~3 hours

Info on Film Spermicide

• placed near cervix

• ~15 min onset time

• lasts for ~24 hours

Info on Sponge Spermicide

• moisten with tap water

• insert against cervix

• immediate onset

• lasts ~24 hours

What is the OTC Hormonal Contraceptive Pill?

• Brand: Opill

• API: Norgestrel 0.075mg

Directions for Opill (Norgestrel)

• take 1 tablet by mouth once a day (same time every day)

• if 3 or more hours from scheduled dose, consider it a missed dose

• take as soon as possible and use backup contraceptive for 48 hours after missed dose

Contraindications for Opill (Norgestrel)

• preganancy

• breast cancer history

• liver disease

• undiagnosed irregular vaginal bleeding

Drug Interactions with Opill (Nogrestrel)

• other hormal contraceptives

• anti-seizure meds (decreases BC effectiveness)

• St. John’s Wort (decreases BC effectiveness)

• antiretroviral meds (decreases BC effectiveness)

Common Side Effects from Opill (Norgestrel)

• irregular vaginal bleeding

• breast tenderness

• nausea

• headaches

What is the OTC Emergency Contraception Pill?

• API: Levonorgestrel 1.5mg single use tablet

• Brands: Aftera, My Choice, Julie, Plan-B One Step

Dosing on OTC Emergency Contraception Pill

single dose taken within 72 hours (3 days) after unprotected intercourse or contraceptive failure

Efficacy of OTC Emergency Contraception Pill

• effective up to 120 hours (5 days) after intercourse

• efficacy decreases over time (100% within 3 days to 50% at 5 days)

• may not be as effective in patients with BMI ≥ 26 kg/m²

Mechanism of Action for OTC Emergency Contraception Pill

• suppresses ovulation by stopping or delaying release of egg from ovary

• will not affect an implanted embryo or increase risk of malformations in event of pregnancy

Common Adverse Effects of OTC Emergency Contraception Pill

• nausea (25%)

• vomiting (5%)

  • if pt vomits within 1-2 hours after dose, they should repeat dose

How does the OTC Emergency Contraception Pill Affect the Menstrual Cycle?

• may cause period to be early or late

• if menstruation has not occured more than 21 days after use of EC product, take pregnancy test

What are Fertility Awareness-Based (FAB) Methods?

• contraceptive methods that do not use a chemical or physical barrier to prevent conception

• use different techniques to determine the female’s fertile phase of the mentrual

What are the Different Fertility Awareness-Based (FAB) Methods?

• calendar method

• cervical mucus method

• symptothermal method

• lactational amenorrhea method

Positives to Fertility Awareness-Based (FAB) Methods

• no health risks to couple or fetus (should pregnancy occur)

• lower cost

• religious views on contraceptive use

Negatives to Fertility Awareness-Based (FAB) Methods

• lack of STI protection

• lower efficacy compared to other contraceptive methods

• requirement of abstinence or other forms of contraceptives during fertile period