University:
West Coast University
Course:
PHAR 837 | IPC Infectious Diseases I
Academic year:

2024
Views:

371

Pages:

113
Author:

Asal A.

Women’s Health: Contraception and Menopause Objectives      Epidemiology   “Perfect use” vs “Typical Use”   ask she will effective nec of these Most effective ↓ failure Rate - - - - - Non-hormonal methods:           By Pre-class Question  a.Male condom Hormonal Contraception: Benefits          Deny Its not only for Pregna Current Methods of Hormonal Contraception to     111    I longed Hormonal Contraceptive: Mechanism of Action  noisy     LARC Long Acting Reversible Contraceptive IUD Implant Needtoknow all ofthese IUD only progestin IUD youhaveto gotoprodder'soffice cangetpregnantimmedthsotter Copper IUD     Copper IUD – Adverse Effects   as information  toomuchcopper LNG IUD LNG = levonorgestrel IUD Comparison knowthis LNG amount Duration of use Size Mirena 52 mg 5 years 32x32 mm Skyla 13.5 mg 28x30 mm Liletta 52 mg 3 years s 6 years Kyleena 19.5 mg 5 years 28x30 mm Copper 0 10 years 32x36 mm t 32x32 mm LNG IUD - Adverse Effects     Contact MD if:       Exam son'tusewhen Breastfeeding progestin breastfeeding g Talking Points on IUD vs CHC estrogens  MIKsupply      we only Pre-class Quiz Question 1  b.Copper IUD longestafter 2nd M Etonorgestrel Implant (Nexplanon)       If Etonorgestrel Implant (Nexplanon)    Reversible Contraception (not long-acting) Progestin Only Contraceptives  dot migraineFlash w light progestinonly DMPA Injectionwe   II    so DMPA density Marrow Bore   Me Counseling Points for DMPA    Don'tthickening so Pills Progestin-only  at NeBleeding • • • • • • • • • • • • • • • Aygestin Camila Deblitane Errin Heather Incassia Jencycla Jolivette Lyza Nora-BE Norlyda Norlyroc Ortho Micronor Sharobel Tulana Progestin properties   Adoogenic ace hairgrowth wagintgain a au_ pup age Pre-class Question  MM c.Injection or “shot” losers DMPA angatorshot Combined Hormonal Contraceptives Combined Hormonal Contraceptive Pills   Ethinyl estradiol    Combined Hormonal Contraceptive Pills        progestin and estrogen ionbe congid Monophasic contraceptives Same amount of hormones in all active tablets Example regimens: 21 tablets 1 mg norethindrone/35 mcg EE + 7 inert tablets 24 tablets 3 mg drospirenone/20 mcg EE + 4 inert tablets 84 tablets 0.15 mg levonorgestrel/30 mcg EE + 7 inert tablets Relative EE Varying amount of hormones in active tablets Example regimens: Egon 10 tablets norethindrone 0.5 mg/35 mcg EE +11 tablets norethindrone 1 mg/35mcg EE + 7 inert tablets “standard” 21 tablets 1 mg norethindrone/50 mcg EE + 7 inert tablets High 21 tablets 1 mg norethindrone acetate/20 mcg EE + 7 inert tablets Low 24 tablets 1 mg norethindrone acetate/10 mcg EE + 2 tablets 10 mcg EE + 2 tablets 75 mg ferrous fumarate Ultra-low Bothestrgeinand progestin Vaginalme Ring      Yearlong Vaginal Ring    Vaginal Ring     Transdermal Patch        Transdermal Patch (Xulane) Side Effects: Hormonal Contraception Progestin-Related jung •Bloating •Anxiety •Irritability •Depression •Menstrual irregularities •Reduced libido ja Estrogen-Related • Breast tenderness • Nausea • Vomiting • Headaches • Elevated blood pressure (rare) Eth pyo Managing Adverse Effects Estrogenic Excess Nausea, vomiting Bloating Hypertension Migraines Progestogenic Deficiency Early cycle breakthrough bleeding Increased spotting Atrophic vaginitis Vasomotor symptoms (hot flashes) imy Increase in breast size Edema Increased appetite Deficiency Late cycle breakthrough bleeding Depression, fatigue Hypertension Hypoglycemia symptoms Libido decrease Mood swings, depressive thoughts, Urinary tract infection Uterine enlargement Uterine fibroid growth Breast tenderness, fullness, growth of hormone sensitive mammary neoplasms Excess Vaginal yeast infections Hypomenorrhea Insomnia (symptoms of (symptoms of estrogen opposition) unopposed estrogen) Androgenic Excess Acne Edema Hirsutism Cholestatic jaundice Libido increase Oily scalp and skin Rash and pruritis Selecting a Contraceptive   an combined Serious AE of CHC havetogotoEBrightaway wept “ACHES” A – Abdominal Pain • mesenteric or pelvic vein thrombosis C – Chest Pain • pulmonary embolism or myocardial infarction H – Headaches • Stroke E – Eye Problems • Stroke or retinal vein thrombosis S – Severe leg pain • Deep vein thrombosis When to Start CHC    Pre-class Question  a.Injection or “shot” progestion b.Implant progestwnonly c.Vaginal ring d.LNG IUD Gonlyprogesten Pre-Class Question  a.Patch b.Vaginal ring c. Combined oral contraceptives (COC) d.Injection or “shot” CDC MEC    Safety/Risk Categories safe 1 Method can be used without restriction 2 Don't useit Advantages generally outweigh theoretical or proven risk Method usually not recommended unless 3 other, more appropriate methods are not available or not acceptable 4 Method not to be used providers D Ph • • • • • • Cu-IUD: copper-containing intrauterine device LNG – IUD: levonorgestrel-releasing intrauterine device Implant: etonorgestrel implant DMPA: depot medroxyprogesterone acetate POP: progestin-only pill CHC: combined hormonal contraceptives injectors shot Spillpatching US Medical Eligibility Criteria 2016 7 0 SSRI Depot Angela Popo Daippo aim LNG MD Mobutu noticed art eveythgotey selfadminster popIDMPA IHC more… Angela NIcontraindication more… Angela Herpreference EdminsterorDoctor's office more… Angela I’d rather just take a pill… bop ctsoptions Jess implants pop sits Jess nothing Jess Implant popCHE pillpathrig I’m really busy with school. Is there something I don’t have to take everyday? implant14 her I rigipodonlyfor Brandie any VD ing IftheyhadDUIin thepastavoid anythingwestrgen T import pript POP atccpi.IM bloodthinner office providers PA UD s ImplantDm selfordmister PAPA pop Comparing Hormonal ContraceptivesProgestin Only versus CHC        HE Protection from Pregnancy Immediately: •Copper T IUD After 7 Days: to •LNG IUS •Implant •Pills •Patch •Ring •Injectable Don't the startanythingon first dayof period Exam General Risk Factors for VTE   3 u  5  7  a Practice Case  t What are Samantha’s risk factors for VTE? a) b) c) d) His Bat she's not patch Contraception for Women with BMI >30    Women > 40 years of age  no DI Avoid estrogen Ets  t Comparing Hormonal ContraceptivesEfficacy with Typical Use         California Pharmacy Practice: Self-administered Hormonal Contraception Pharmacists’ Role in Contraception Care  exam CHC self admister  Pop DM PA Slide adapted from materials developed by K. Besinque, PharmD HC Protocol Requirements    Slide adapted from materials developed by K. Besinque, PharmD HC Protocol Requirements • Documentation of services and notification to primary care provider • Medication profile • Patient to provide PCP contact info or may decline • Referral as needed • for preventative care & screenings • for ineligible patients • for long-acting reversible contraceptives • Training before implementation • complete one hour of continuing education program from a board-approved provider regarding HC and application of US MEC (recent graduates excepted) Required for Hormonal Contraception? Pregnancy test Not required Pelvic exam Not required Pap smear Not required STI screening Not required Leeman L. Obstet Gynecol Clin N Am. 2007 Required to Furnish Hormonal Contraception Medical history Blood pressure Self-screening tool REQUIRED MSD Eon Procedural Steps for Furnishing Self Administered Hormonal estrogen Contraception HighBP we Avoid E Jenny Jenny Eon Non-contraceptive Uses of Hormonal Contraceptives a menstrualcycle ponydung Harel, Zeev. "Dysmenorrhea in adolescents and young adults: an update on pharmacological treatments and management strategies." Expert opinion on pharmacotherapy 13.15 (2012): 21572170. Cochrane Database Syst Rev. 2015 Apr 30;(4):CD002126. doi: 10.1002/14651858.CD002126.pub3. Non-contraceptive Uses of Hormonal Contraceptives v   Szarewski A, von Stenglin A, Rybowski S. Women’s attitudes towards monthly bleeding: results of a global population-based survey. Eur J Contracept Reprod Health Care 2012;17:270-83. Lopez LM, Kaptein AA, Helmerhorst HM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database Syst Rev 2012;2:CD006586. and Edelman A, Micks E, Gallo MF, et al. Continuous or extended cycle vs. cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev 2014;7:CD004695. Non-contraceptive Uses of Hormonal Contraceptives 3 a periodsmoreton daye    is Non-contraceptive Uses of Hormonal Contraceptives u   013.50 Emergency Contraception   Hormonal contraceptives act in the hypothalamic-pituitary-gonadal axis to prevent pregnancy by inhibiting ovulation Summary Many different forms of hormonal contraceptives are available to meet the various needs of women Hormonal contraceptives have potential benefits beyond the prevention of pregnancy hot and toy fasho system's more Vasomotor symptomsand yo Volvovaginalsymptoms painduring Menopause intercourse localize Definitions  or Doperiod   Clinical Presentation  t  2 s s painfulintercourse Clinical Presentation  i  Treatment  Hormone Replacement Therapy (HRT)     menupusalhormonal Approved Indications for MHT o  2 3  therapy Eyed puttreatmalt don't MHT Benefits       jointpain  toDon'thaveotyras Indications For systemic use Treatment of moderate-to-severe vasomotor symptoms (ie, moderate-to-severe hot flashes) For intravaginal use (low systemic exposure) Treatment of moderate-to-severe symptoms of vulvar and vaginal atrophy (ie, moderate-to-severe vaginal dryness, dyspareunia, and atrophic vaginitis) Contraindications Absolute contraindications Undiagnosed abnormal genital bleeding Known, suspected, or history of cancer of the breast Known or suspected estrogen- or progesterone-dependent neoplasia Active deep vein thrombosis, pulmonary embolism, or a history of these conditions Active or recent (eg, within the past year) arterial thromboembolic disease (eg, stroke, myocardial infarction) Liver dysfunction or disease Relative contraindications Elevated blood pressure Hypertriglyceridemia Impaired liver function and past history of cholestatic jaundice Hypothyroidism Fluid retention Severe hypocalcemia Ovarian cancer Exacerbation of endometriosis Exacerbation of asthma, diabetes mellitus, migraine, systemic lupus erythematosus, epilepsy, porphyria, and hepatic hemangioma tpooseston estrogen Citation: Chapter 98 Hormone Therapy in Women, DiPiro JT, Yee GC, Posey L, Haines ST, Nolin TD, Ellingrod V. Pharmacotherapy: A Pathophysiologic Approach, 11e; 2020. Available at: https://accesspharmacy.mhmedical.com/ViewLarge.aspx?figid=228344549&gbosContainerID=0&gbosid=0&groupID=0§ionId=228344524&multimediaId=undefined Accessed: March 13, 2021 Copyright © 2021 McGraw-Hill Education. All rights reserved Criteria for using hormone therapy   Estrogen    Estrogen Dosage forms   Eombl A A Estrogen Adverse Effects Breast Tenderness Weight Gain Fluid Retention Headache – some migraines are estrogen-related • Nausea • GI upset • Decreased libido • • • •   Estrogen Effects on Lipids Contraindications      Eton Transdermal estrogen    Transdermal estrogen    Patient Education on Patch    Progestin     MHT: Continuous vs Cyclic an Continuous  Cyclic     ***Please refer to the provided handout for complete list of therapeutics*** itself by estrogen Menopause Hormonal Therapy  • For symptomatic menopause    Vaginal estrogen    Topical Vaginal Products: Creams/Tablets Vagifem (estradiol) 25mcg/tablet     • Initial Dose: 1 tablet INV daily x2wks • Maintenance Dose: 1 tablet INV TIW Vaginal Cream Administration TOPICAL VAGINAL PRODUCTS: ESTRING® (VAGINAL RING)  Achee   a pop DMPA Patient Education - Nonpharmacologic        Symptom/Condition Vasomotor symptoms Summary Statement(s) Estrogen therapy (± progestogen) is the most effective therapy, including consequences of vasomotor symptoms such as sleep quality, irritability, difficulty concentrating, and quality of life Vulvovaginal symptoms Estrogen therapy is the most effective treatment for moderate-to-severe vulvovaginal symptoms. Local therapy is recommended for sole vaginal symptoms; progestogen generally not indicated Sexual function Low-dose local estrogen therapy may improve lubrication, blood flow and vaginal sensation; however, MHT is not recommended as treatment for other problems of sexual function (eg, libido, orgasmic response) Osteoporosis Standard-dose MHT reduces postmenopausal osteoporotic fractures (hip, vertebral, and nonvertebral) and many systemic MHT products are approved for prevention of osteoporosis. MHT is not indicated for treatment. Benefits of MHT dissipate when discontinued Coronary heart disease Estrogen only therapy may reduce CHD risk when initiated in newly menopausal women (age 50-59 years). Estrogen + progestogen therapy initiated between ages 50 and 59 years or within 10 years of menopause does not appear to increase CHD risk. Women initiating therapy after 10 years since menopause have an increased risk of CHD. MHT is not recommended any time for coronary protection Stroke Increased risk of ischemic stroke (not hemorrhagic) exists with estrogen only and estrogen + progestogen use. VTE Increased risk of VTE with oral MHT across all ages. Risk increases with personal risk factors including obesity, previous history of VTE, presence of Factor V Leiden mutation. The type of progestogen may impact risk. Transdermal formulations appear to have lower VTE risk than oral formulations

Women’s Health: Contraception And Menopause

Related Documents

Recommended Documents

Description

Related Documents

Free up your schedule!

Take 5 seconds to unlock