How to respond to missed doses or changing of contraceptive types from one to
another? - For products that use a 28-day cycle, the following
... [Show More] recommendations
from the Centers for Disease Control apply:
• If one or more pills are missed in the first week, take one pill as soon as possible
and then continue with the pack. Use an additional form of contraception for 7
days.
• If one or two pills are missed during the second or third week, take one pill as
soon as possible and then continue with the active pills in the pack but skip the
placebo pills and go straight to a new pack once all the active pills have been
taken.
• If three or more pills are missed during the second or third week, follow the same
instructions given for missing one or two pills but use an additional form of
contraception for 7 days.
For combination OCs that use an extended or continuous cycle, up to 7 days can be
missed? - with little or no increased risk for pregnancy provided that the pills had
been taken continuously for the prior 3 weeks.
If one or more doses is missed or taken greater than 3 hours after the scheduled
dose, the following guidelines apply: - -If one pill is missed, it should be taken as
soon as remembered and backup contraception should be used for at least 2 days.
The pills should be resumed as scheduled on the next day.
-If two pills are missed, the regimen should be restarted and backup contraception
should be used for at least 2 days.
-If two or more pills are missed and no menstrual bleeding occurs, a pregnancy test
should be done.
Types of contraceptives and which would be best for specific patient scenarios -
Combination OCs should be avoided by women with certain cardiovascular
disorders (see later) as well as by women older than 35 years who smoke. For
women in these categories, an alternative method (e.g., diaphragm, progestin-only
pill, or IUD) is preferable.For women who engage in coitus frequently, OCs or a long-term method (e.g.,
Nexplanon, Depo-Provera, IUD) are reasonable choices.
when sexual activity is limited, and if individual has multiple partners use of a
spermicide, condom, or diaphragm may be more appropriate. Because barrier
methods combined with spermicides can offer some protection against STDs (as
well as providing contraception)
If adherence is a problem (as it can be with OCs, condoms, and diaphragms),
usterm-16e of a long-term method (e.g., vaginal contraceptive ring, IUD,
Nexplanon, Depo-Provera) can confer more reliable protection.
What effect does CYP450 inhibitors or inducers have on OCs? o Recall examples
of CYP450 inhibitors and inducers from NR565 (Chapter 4 in textbook) o How
does this impact prescribing of OCs? - Inhibitors: Inducers:
Acyclovir Carbamazepine
Ciprofloxacin Phenobarbital
Ethinyl estradiol Phenytoin
Fluvoxamine Primidone
Isoniazid Rifampin
Norfloxacin Ritonavir
Oral contraceptives Tobacco
Zafirlukast St. John's wort
Zileuton
As a rule, high-estrogen OCs are reserved for women taking drugs that induce
P450.
drugs that interact with oral contraceptives? - Products that induce hepatic
cytochrome P3A4 can accelerate OC metabolism and thereby reduce OC effects.
indications are reduced OC blood levels, such as breakthrough bleeding or
spotting. If these signs appear, it may be necessary to either (1) increase the
estrogen dosage of the OC, (2) combine the OC with a second form of birth control
(e.g., condom), or (3) switch to an alternative form of birth control.
can decrease the benefits of warfarin and hypoglycemic agents. May require
increased dosage
OCs can impair the hepatic metabolism of several agents, including theophylline,
tricyclic antidepressants, diazepam, and chlordiazepoxide. Can cause toxicity. if
Toxicity occurs dosage may have to be reduced.Prevention of osteoporosis with hormone replacement therapy - prevention of
osteoporosis requires lifelong HT, and hence the risk for harm is higher.
labeling of HT products currently must carry the following advice: When this
product is prescribed solely to prevent postmenopausal osteoporosis, approved
nonestrogen treatments should be carefully considered. Furthermore, HT should be
considered only for women with significant risk for osteoporosis, and only when
that risk outweighs the risks of HT. Of course, all women (not to mention men)
should practice primary prevention of bone loss by ensuring adequate intake of
calcium and vitamin D, performing regular weight-bearing exercise, and avoiding
smoking and excessive alcohol use.
- When and when not to use progestin for hormone replacement therapy and why -
Use:
-Treatment of moderate to severe vasomotor symptoms associated with menopause
• Treatment of genitourinary syndrome of menopause
• Prevention of postmenopausal osteoporosis
Not use:
heart disease
dementia
alzeheimers disease
- Local vs. systemic estrogen options and why one would be chosen over the other
- Intravaginal: Estrogens for intravaginal administration are available as inserts,
creams, and vaginal rings. The intravaginal inserts (Imvexxy, Vagifem, Yuvafem),
creams (Estrace Vaginal, Premarin Vaginal), and one of the two available vaginal
rings (Estring) are used only for local effects, primarily treatment of vulval and
vaginal atrophy associated with menopause.
The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot
flashes and night sweats) as well as local effects (e.g., treatment of vulval and
vaginal atrophy).
Parenteral: Although estrogens are formulated for intravenous (IV) and
intramuscular (IM) administration, use of these routes is rare. IV administration is
generally limited to acute, emergency control of heavy uterine bleeding. [Show Less]