Unit 3 contraceptives PHARM

what makes Lybrel special

first COC with - CONTINUOUS USE --> NO menstrual periods

what do many women who use Lybrel report experiencing

spotting and bleeding - unpredictable bleeding so like a random period out of nowhere

Seasonale was the first COC approved for

extended cycles - meaning period every 3 months

what does the cycle look like for Seasonale

84 days active and then 7 placebo

difference between Seasonale and Seasonique/LoSeasonique

Seasonique/LoSeasonique replaced placebo with low dose EE

- to cause less spotting and shorter, lighter periods compared to Seasonale

What product is made of Drosperinone & Estetrol

Nextstellis

Nextstellis contains

a progestin w/ antimineralocorticoid

new estrogen

what are Nextstellis theoretical advantages

longer half life would cause

the more specific estrogen would cause

less breakthrough bleeding

decreased thromboembolic risk

Yasmin and Yaz contain what

a progestin with antimineralcorticoid activity

what gives Yasmin/Yaz its diuretic effect

Drosperinone - it has antimineralocorticoid

what COCs are known for causing less water weight gain than others

Yasmin/Yaz

difference between Yasmin and Yaz

the # of placebo pills

Yasmin has 7 = longer period

Yaz has 4 = shorter periods

what is the most common side effect of COCs

unscheduled spotting/bleeding

other side effects of COCs

weight changes

headaches

if a patient experiences headaches with one COC that will not go away after 3 cycles, what product should they switch to?

no evidence points to other pills helping

if you miss 3 active pills during the first 3 weeks, what should you do?

throw out the rest of the pack

start a new one that same day

- use back up

may miss period until they hit placebo of the next pack

if you missed 1 active pill, you should

take 1 active pill ASAP and then continue taking pills daily

if you missed 2 active pills in a row during first 2 weeks. Do this

take 2 pills on the day you remember and 2 pills the next day

then use backup

if you miss 2 active pills in a row during the THIRD week

throw out the rest of the pill pack and start a new pack the same day

use backup

Managing missed pills

following package insert is geared to which users

pills w/ at least 20mcg EE

1st day start users

what is the only antibiotic shown to decrease contraceptive efficacy

rifampin

what herbal product should not be used with COCs

St John's wort

Sunday Start users goal is to have

period free weekends

First day start pill initiation comprises of

taking 1st pill on 1st day of next period

4 contraindications for COCs

previous VTE or risk for VTE

hormone sensitive cancers

liver issues

misc - pregnant and hypersensitivity

COCs health complications

VTE

increased BP

gallbladder disease

hepatic neoplasms

what are the disadvantages of COCs

daily administration

prescription required in most states

no protection from STIs

Advantages of COCs

effective

rapid reversibility

reduces PMS symptoms

improve acne

How do COCs work

suppression of ovulation

thickening cervical mucus

what does of EE is considered low dose

anything between 35mcg -20mcg

how are monophasic COCs different from biphasic, triphasic, quadriphasic COCs

monophasic provide the exact same amount of estrogen and progestin each day

five effects of progestin

Estrogenic

androgenic

Antiandrogenic

Glucocorticoid

Antimineralocorticoid

4 general mechanisms of contraception

prevent sperm from entering vagina/cervix

prevent egg from entering area if fertilized

prevent implantation

fertility awareness