OTC Exam 3: Reproductive and General Disorder

Treatment of choice for primary dysmenorrhea

NSAIDS

• Ibuprofen (motrin) - 1.2g

• Naproxen Sodium (aleve) - 0.66g

If dose is maximized, the patient can go to next option, if nothing works then refer

PMS Symptoms

Mild Physical

• Breast tenderness, bloating, lower backache, food cravings

Mood

• Irritability, emotional liability, lowered mood, increased energy or creativity

Exclusions for PMS

• Severe, uncertain symptom pattern, symptoms coincide with contraception or hormone

• Contraindications to caffeine/pamabron

• Anxiety, depression or other psychological disorders that go beyond the expected

Midol Complete

(PMS)

Caffeine (60), Acetaminophen (500mg), Pyrilamine maleate (15mg)

(PMS)

Pamprin Multi-symptom

(PMS)

Pamabron (25mg), Acetaminophen (500mg), Pyrilamine maleate (15mg)

(PMS)

Vulvovaginal candidiasis (VVC)

- Clinical Presentation:

• Thick, white (“cottage cheese”) discharge

• No odor, normal pH

• Vaginal erythema, irritation, itching, dysuria

Exclusions for VVC

• Recurrent infection, severe, predisposing illness/ medications, pregnancy, < 12 y/o, first VVC episode

Non-Treatment for VVC

• Yogurt Consumption

• Sodium bicarbonate sitz bath

Gyne- Lotrimin 7 Cream, Mycelex-7 Cream

(VVC)

clotrimazole 1%

(VVC)

Gyne-Lotrimin 3

(VVC)

clotrimazole 2%

(VVC)

Vagistat-1, Ointment 1 day, Monistat- 1 day

(VVC)

tioconazole 6.5%

(VVC)

Monistat 3 Cream

(VVC)

Miconazole nitrate 4%

(VVC)

Monistat 7 Cream

(VVC)

Miconazole nitrate 2%

(VVC)

Vagisil Anti-itch, Vagisil Max Strength

*Only treat symptoms, not fungus

(VVC)

Benzocaine-resorcinol

(VVC)

Exclusions for Atrophic vaginitis

• Severe vaginal dryness, dyspareunia

• Vaginal bleeding

• Not localized symptoms

• Symptoms not relieved by lubricants

• Symptoms of menopause (hot flashes)

Vaginal Lubricants (Atrophic vaginitis)

• Water-soluble - can be used with condoms and diaphragm

• Oil based - do not use with sexual barrier methods

  • Avoid petroleum jelly

Prevention of Toxic Shock Syndrome (TSS)

• Can’t be treated,

  • If occurs must refer and avoid use of NSAIDS

• Avoid tampon use (especially heavy-absorbents)

  • Do not use for more than 24h

  • Change 4-6x a day, at least every 6h

• Use sanitary pads

• Women at risk should avoid:

  • Tampons, IUD, cervical calps, diaphragms, contraceptive sponges

    • Especially if within 12 weeks of childbirth

Condoms

• Protects from STI/HIV and Pregnancy

• Male condoms

  • Latex and Lambskin

    • Lambskin does NOT stop STI

Spremicide

• Only protects from Pregnancy

• Used in combination with diaphragm and sponge

• Active ingredient: Nonoxynol-9

Contraceptive Sponge

• Only protects from Pregnancy

• Increases risk of candidiasis and TSS

• Not-reusable, must remain in place for at least 6h

• 24h Protection

Progestin-Only Contraceptive

MOA: Suppresses ovulation, thickens cervical mucus, interferes with transport of sperm (creates hostile environment for sperm)

Brand: Norgestrel-Opill

• Not to be used as an emergency contraceptive

Emergency Contraception

Plan B One Step, Ella, Yuzpe, Copper IUD, Next Choice One Dose/MyWay, Take Action

Candidate for Emergency Contraception

• Women who had recent unprotected sex (within 120h)

• Failure of current methods of contraception

Candidate for Routine Contraception

• Patient desires method that does not require action at time of coitus