EXAM 4- Madras

DO NOT HAVE TO KNOW BRAND AND GENERICS

What hormones main job is to stabilize endometrial lining and control cycle?

estrogen

What hormone is mainly responsible for efficacy of hormonal contraception?

progestin

Which progestin has anti-androgenic activity?

drospirenone (4th gen)

What’s the difference between monophasic, biphasic, triphasic, and four-phasic CHC’s?

• monophasic- same amount of estrogen and progestin throughout the entire cycle

• biphasic- 2 doses throughout cycle

• triphasic- 3 doses throughout cycle

• four-phasic- 4 doses throughout cycle

If you are ≥____kg or ______lbs, DO NOT USE TRANSDERMAL CONTRACEPTIVE PATCH.

If you are ≥90 kg or 198 lbs, DO NOT USE TRANSDERMAL CONTRACEPTIVE PATCH.

Drospirenone has the risk of what ADRs?

• hyperkalemia

• amenorrhea

What are the names of the oral contraceptives that come in pill form? (JUST RECOGNIZE NAMES)

• Yaz

• Yasmin 28

• Beyaz

• Safyral

• Natazia

• Seasonale, Seasonique, LoSeasonique

• Quartette

• Amethyst

• Nextstellis

If an oral contraceptive (birth control) has drospirenone in it, what drugs might interact with it and lead to high potassium?

• ACE inhibitors

• ARBs

• potassium sparing diuretics

Beyaz birth control has what additional vitamin in it?

Folic acid (levomefolate calcium)

Safyral birth control has what additional vitamin in it?

folic acid

Natazia birth control cannot be used with what CYP?

CYP 3A4 inducers

What are some examples of CYP 3A4 inducers?

• phenytoin

• carbamazepine

• rifampin

When do you want to start Combined oral contraceptives? (aka birth control pills)

• sunday after the start of menses or

• 1st day of menses or

• quick start method

What is the purpose of taking the inert tablets in a birth control pack? (aka the pills with nothing in them)

for COMPLIANCE!

In CHC’s that are extended cycle you take the pill for ≥_____ continuous days then placebo or estrogen for 7 days.

84

True or False: pts. taking extended release CHC’s have fewer periods than those who take regular CHC’s

true

What are the names of 3 extended cycle birth controls/oral contraceptives?

1. Seasonale

2. Seasonique

3. LoSeasonique

Seasonale or Seasonique are pills containing a combination of what two hormones?

EE and levonorgestrel

How many periods do pts. on Seasonale or Seaonique (extrended cycle bc) have?

1 PERIOD EVERY SEASON (think SEASONale= 1 perioid a SEASON)

Brand name Amethyst birth control causes how many periods?

NONE- NO PERIOD AT ALL

How often do you take Amethyst?

CONTINUOUSLY

Nextstellis is a combination of what two hormones?

Drospirenone and esterol

Is Nextstellis extended release?

no

WHAT ARE THE C/I OF Nextstellis?

• do not use if ≥35 YO and smoke

• thromboembolic disease (stroke, DVT, PE)

• migraine w/ aura

• Co-administration with Hep C drugs

How often is the contraceptive transdermal patch applied?

once a week for 3 weeks, no patch the 4th week

Should transdermal contraceptive patches be reapplied to the same location?

no- rotate sites

What are the C/I of contraceptive transdermal patches?

• women >35 who smoke

• BMI ≥ 30kg/min²

With the contraceptive transdermal patch you are more likely for what ADR? Why is this?

clotting- BC MORE ESTROGEN IN THE PATCH THAN ANY OTHER FORM

Names of the 2 contraceptive transdermal patches:

• Twirla

• Xulane

What are the names of the 2 vaginal contraceptives?

• NuvaRing

• Annovera

How long is the Vaginal Contraceptive kept inside? When is it taken out?

insert vaginally for 3 weeks, take out the 4th week

Do you douche or should you ever douche in general?

do NOT douche

How long can a NuvaRing be used and how long can a Annovera ring be used?

Nuvaring- get new one every time you take out

Annovera ring- can be reused for 1 year

With Annovera you want to avoid any lubricates, suppositories, etc. with what ingredient?

OIL

If there is EARLY bleeding/spotting (days 1-9) that’s bc there is low _____________.

estrogen

WHAT IS THE CONTRAINDICATION FOR ALL COMBINED HORMONAL CONTRACEPTIVES (CHC’s)?

Age ≥35 and smoke ≥15 cigarettes/day

(know age AND # of cigarettes)

PRACTICE:

Which of the following is NOT a condition in which estrogen should not be used in?

a. PE

b. DVT

c. immobilization

d. Wilson’s disease

d

WHAT SPECIFIC ANTIBIOTIC SHOULD NEVER BE USED WITH ORAL CONTRACEPTIVES?

Rifampin

Do oral contraceptives prevent STDs?

no (duh)

“Minipills” and Drospirenone only contain what hormone? What is their dosage form?

• ONLY progestin

• oral

If you forget to take your "Minipills” >___ hours you will need ANOTHER form of birth control for ____ days.

If you forget to take your "Minipills” >3 hours you will need ANOTHER form of birth control 2 days.

WHAT ARE THE DOSES for Depo-Provera SQ and IM?

SQ- 104 mg

IM- 150 mg

What are the ADRs of Depo-Provera?

• amenorrhea

• weight gain

• alopecia/no hair growth

Depo-Provera has a delayed return in fertility for about ____ months.

10

What is the BOXED WARNING of the Depo-Provera shot?

decrease bone density

What is the first and only FDA approved OTC DAILY oral contraceptive?

Opill/ Norgestrel (reminder this is NOT EMERGENCY CONTRACEPTIVE)

What allergy do you need to watch for in Opill?

yellow dye

Postpartum (after you have a baby) you should avoid CHC for ___ days.

21

What are the names of some IUDS? (just recognize)

• Paraguard

• Mirena

• Kyleena

• Liletta

• Skyla

How long does each of the IUDs last?

• Paraguard- 10 years

• Mirena- 8 years

• Kyleena- 5 years

• Liletta- 8 years

• Skyla- 3 years (3 letters in SKY= 3 years)

How does each of the IUDs effect menstrual bleeding? (increase/decrease)

• Paraguard- increase

• Mirena- decrease

• Kyleena- decrease

• Liletta- N/A

• Skyla- decrease

A Paragard IUD is made of what material?

made of copper

What are the C/I of Paragard Copper IUD?

• pregnancy

• PID

• postpartum

• Wilson’s disease (increase in copper)

What dosage form is Nexplanon? How long does it last?

• subdermal implant

• 3 years

Plan B (OTC) should be taken no later than _______ hours after unprotected sex.

72

What is the name of the prescription only oral emergency contraceptive? It can taken with how many days of unprotected sex?

• name: Ulipristal (Ella)

• TAKEN WITHIN 5 DAYS

What are some nonhormonal contraception forms?

• Phexxi (rx spermicide)

• Diaphragm

• FemCap (cervical cap)

• Today Vaginal Sponge

• Male condoms

• female condoms

• vaginal spermicides

What nonhormonal contraception forms DO NOT protect against STDs?

• Phexxi

• Diaphragm

• FemCap

• Today Vaginal Sponge

• Vaginal Spermicides

(basically everything except condoms)

What nonhormonal contraception forms DO protect against STDs?

• Male condoms

• female condoms

Vulvovaginal Candidiasis (VVC) is also known as a __________________. What is the signs/symptoms?

yeast infection

sym:

• Thick, whitish vaginal discharge with NO ODOR

• itching, redness

Do you have to treat the sexual partner for Candidal infections?

no

Do fungal vaginal infections in general alter pH?

no they dont—- no pH increase

What are the 2 categories of VVC?

1. uncomplicated: infrequent episodes (≤3 episodes/yr), mild-moderate symptoms, non immune compromised

2. complicated: recurrent infections (>4 infections/yr), severe symptoms, anyone w/ DM, pregnant, immunosuppressed, etc.

MUST KNOW #’s

What are the criteria to self-treat VVC?

NOTE: MUST HAVE ALL 3 TO SELF-TREAT!!!

1. infrequent vaginal symptoms (≤3 episodes/yr and no vaginal infection within previous 2 months)

2. at least 1 episode of VVC in past that was medically diagnosed

3. mild-moderate symptoms

How is complicated VVC treated?

PRESCRIPTION

• “azole antifungals” (clotrimazole, miconazole, tioconazole)

How is uncomplicated VVC treated?

OTC

• 7, 3, or 1 day regimens

What is the cause of atrophic vaginitis? What is the main symptom?

• cause: decrease in estrogen

• main symptom: DRYNESS

What is the self-treatment for atrophic vaginitis? What are some examples of products?

TX: VAGINAL LUBRICANTS

• tx for mild/moderate symptoms

• examples: K-Y, astroglide, replens, etc.

• may need to use water-based if using latex condom or diaphragm

PRACTICE from class:

A 25 YO female presents to the community pharmacy w/ mild signs symptoms consistent with vulvovaginal candidiasis. She is asking you for your advice. Upon further questioning, you discover this is the FIRST TIME she has had these signs and symptoms and has never seen a physician yet. Which of the following would be the most appropriate recommendation?

a. miconazole cream once a day for 7 days

b. ticonazole ointment once a day for 1 day

c. benzocaine ointment once a day for 5 days

d. refer to a physician

d- BC THIS IS HER FIRST TIME!!!! NOT ELLIGABLE FOR SELF-TX