Contraception Pharm

four general mechanisms of contraception 

prevention of sperm getting to the area of fertilization 

prevention of the egg entering area of fertilization

prevention of implantation

fertility awareness 

dose of ethinyl estradiol that constitutes a low-dose combination oral contraceptive

low dose = 20-35 mcg

ultra low dose = <20 mcg

difference between mono phasic, biphasic, triphasic, and quadriphasic COC

the number and type of active pills in each pack

mono-phasic = all 21 active pills are the same with 7 placebo pills

biphasic = 2 different forms of active pills, 2 days of placebo

triphasic = each week is a different combination

quadphasic = 4 diff combinations

5 pharmacologic categories of effects of progestins in COC

estrogenic

androgenic

antiandrogenic

glucocorticoid

antimineralcorticoid

MOA of hormonal contraception

prevents ovulation by tricking the body into thinking its already pregnant 

#1 = suppression of ovulation

• also thickens cervical mucus 

advantages and disadvantages of COC

advantages = effective, rapidly reversible, reduces PMD and PMS symptoms, helps acne

disadvantages = daily administration, requires a Rx, no protection against STIs, drug interactions with enzyme inducers

4 general areas of FDA contraindications for COC

pre-established increased risk of VTE or previous VTE

hormonally sensitive cancer (estrogen dependent) 

hepatic risk

pregnancy 

how and when to start COC

first day start = on first day of period

sunday start = on first sunday of menses (period free weekends)

what to do in event of missed dose of COC

reference package insert

determine what kind of pill it is →

• if missed 1 active pill = take ASAP and continue taking daily pill 

determine when it got missed →

• missed 2 active pills in a row during first two weeks (leading up to ovulation) take 2 pills on day you remember and 2 pills the next day = use backup for 7 days

• missed 2 active pills in a row during third week = throw out current pack and start a new pack = use backup for 7 days

• missed 3 or more at any time during first three weeks = throw pack away and start another one immediately = use a back up for 7 days 

side effects associated with hormonal contraception

unscheduled vaginal bleeding

weight changes

headaches

health complications - VTE, increased BP, gallbladder disease, hepatic neoplasms

Yasmin/Yaz compared to other COC

contains progestin with antimineralcorticoid activity

Yasmin = 7 placebo pills

Yaz = 4 placebo pills = less bleeding 

Nexstellis compared to other COC

has newer estrogen in it that is more specific for ovulation receptors  = fewer systemic side effects

very costly compared to generic versions 

Seasonale, Seasonique, LoSeasonique compared to other COC

seasonale = approved for extedned cycle borth control pill = 4/yr periods

Seasonique and LoSeasonique = low dose EE to cause less spotting 

Lybrel compared to other COC

approved for continuous use = no menstrual periods 

Vaginal ring - description, advantages, disadvantages

soft flexible ring that is inserted vaginally for 21 days ad taken out for 7 unless meant for reuse

advantage = once 21 days instead daily, slow steady release of hormones, rapidly effective and reversible

disadvantage = same risk of MI & VTE, ring expulsion, foreign body sensation

Patches - description, advantages, disadvantages

transdermal that sticks on skin for a weekly regimen

advantages = weekly, rapidly reversible

disadvantages = same risk for VTE and MI, skin discrepancies, skin reactions, breast symptoms, wet makes it fall off 

POPs (minipills) - MOA, advantages, disadvantages 

#1 inhibits ovulation → also thickens cervical mucus 

advantages = less risk for VTE and HTN, simple regimen, very reversible 

disadvantages = more menstral irregularities, vulnerable efficacy

• 3 hours late is missed dose and need to take ASAP and use backup for 2 days

DMPA-IM depot medroxyprogestrone acetate imnjection

injection every 3 months

advantages = lower failure rate bc nothing to do

disadvantages = not rapidly reversible - 10 months to get 50% fertility

nexplanon - description, advantages, disadvantages 

single matchstick sized insert under skin containing progestin that lasts for 3 years

advantages = non regular user activity, discreet, reversibility in 6 weeks

disadvantages = insertion complications,

IUD - description, advantage, disadvantage

ParaGard - copper IUD = impairs sperm function

Mirena/Skyla/Liletta/Kyleena - levonorgestrel IUD system = thickens cervical mucus, inhibits sperms survival, suppresses endometrium, suppress ovulation in some

advantages = highly effective, cost effective over time (years)

disadvantages = irregular bleeding, insertion pain, perforation, expulsion, ectopic pregnancy, string problems, 

spermicides - advantage and disadvantage

advantage = non systemic effect, on demand use, lubricating, no Rx

disadvantage = messy, timing, irritation, higher failure rates 

Phexxi (pH gel) - description, advantages, disadvantages

a nonhormal vaginal gel that acidify vagina so sperm cannot survive

advantage = may decrease STI, better efficacy rate than spermicide, non-systemic effect

disadvantage = time, expensive, single use, no use w hx UTI, burning and itching 

relative efficacy of contraceptives by 1-year failure rates 

emergency contraception

copper wire IUD = impairs implantation - 99.9% w 5 days

1.5mg levonorgestrel = delay ovulation - 89% w 72 hr

Ulipristral (Ella) = delays ovulation - 98-99% w 120 hr