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While there is no time that is 100% fool proof to miss pills, missed pills on
either side of the placebo week is the highest risk.
Week 4 is the week of the placebo, highest risk when you are on either side,
not on period and on either side of week 4 since hormones will either out of
the body or is before in week 3 which could allow the egg to release into
uterus
HG is a 30 year-old woman who just had a baby. She has been prescribed the
progestin-only mini-pill, Camila. Her physician told her that she will use this
type of birth control pill until she is done breastfeeding her baby. Which of the
following counseling points on the "mini pill" should be relayed to the patient?
A young female enters the pharmacy. She asks for the best over-the-counter
option to protect against sexually transmitted infections (STIs). Which of the
following represents the best option for STI protection?
Latex male condom
Consistent and correct use of male latex condoms, or female condoms, can
reduce (though not eliminate) the risk of STI transmission.
If a patient finds that she cannot tolerate estrogen for any reason, which
products might be used as alternatives?
Depo-Provera
MH has entered the pharmacy to get emergency contraception (EC) for his
girlfriend. Which statements regarding EC are correct? (Select ALL that
apply.)
If the period is more than a week late, a pregnancy test should be taken.
There is no age restrictions to purchasing EC over-the-counter
Emergency contraception is a form of contraception that prevents pregnancy
after sexual intercourse.
The levonorgesterel EC formulations are indicated for use up to 3 days (72
hours) after unprotected intercourse.
Plan B One Step and generic formulations contain one 1.5 mg tab of
levonorgesterol. There are no age restrictions to purchase these products
over-the-counter.
Phenobarbital and phenytoin are CYP2C19 inducers and dec. Triliptal levels.
Phenobarbital is also CYP2B6, 2C9 inducers, CYP2C19 substrate
Phenytoin inducer 2C9, 2C19, 3A4, CYP2C19 substrate
RW has started to use the oral contraceptive Ortho Tri-Cyclen. Which medical
conditions should the pharmacist screen for to make sure the use of this
medication is safe for RW?
Hypertension
Clots
JG has just received a NuvaRing at the pharmacy. It is a good choice for her
because she sometimes forgets to take the pill. Counseling points for the
NuvaRing should include all of the following recommendations:
The ring is refrigerated at the pharmacy but can be kept at room temperature
by the patient for up to 4 months. It should be inserted on the first day of
menstrual bleeding. Leave it in for 3 weeks then have a period of 7 days with
nothing then insert again when menstration begins.
What is the primary reason that Yaz and Yasmin became best-selling drugs
(and this reason could also be considered a "side effect" of the drug)?
They cause less wt. gain. (due to K sparing)- less bloating-water comes off-
weight down
Refer to p. 638 of the 2017 RxPrep Course Book. These formulations, and
others, that contain drospirenone are popular because they have less
bloating, acne, weight gain and other PMS symptoms. Drospirenone does
have a higher clotting risk however than other progestins.
Refer to p. 642 of the 2017 RxPrep Course Book. Folic acid is necessary to
prevent neural tube defects in the fetus.
Most pills (including these formulations) are started on the Sunday following
the period. Other options are to start on the 1st day of menses or using the
"quick start" method (start as soon as pills are obtained and use a back-up
method for 7 days.
This medication can cause hot flashes, which can make the user feel sweaty
and flushed.
The medication is a selective estrogen receptor modulator.
The medication can increase the chances of a multiple birth.
Luteinizing hormone
Ovulation predictor test kits are used to increase the chances of pregnancy; if
positive, the luteinizing hormone (LH) surge has occurred and it is best to
have intercourse the day of the LH surge and for two days afterwards.
Ortho-Novum 7/7/7
As indicated by the name, the Ortho-Novum 7/7/7 has three different weeks
of hormone levels; they change over time.
She can use OTC meclizine one hour before she use the EC.
The usual recommendation for nausea from the EC pills is OTC meclizine
(Bonine, Dramamine "Less Drowsy") but the catch is that these are sedating
and, if the patient is going to drive home from the pharmacy, it may be
unsafe.
NSAIDs (ibuprofen [Motrin, Advil], naproxen [Aleve and others] when taken long-term
and daily for treatment of arthritis or other problems)
Potassium supplementation
Heparin
Aldosterone antagonists
When the placebo period is shortened or low dose estrogen is given during
the placebo period, then physical and emotional withdrawal symptoms are
improved. Many women experience low mood when they have swings in
hormone levels and certain formulations can help stabilize mood.
Less estradiol and short placebo (4 days).
The patch is not recommended for women over 198 pounds due to lower
efficacy. The patch is linked to a higher risk of blood clots than low-dose oral
contraceptives.
"Cycle" in the name indicates changing hormone dose. The POPs have the
same dose of a progestin only, taken daily.
Estrogen can cause nausea, breast tenderness, bloating and weight gain in
any formulation (for contraception or hormone therapy). If she finds this
method useful for contraception, it may be a good option to use a formulation
with lower estrogen content to reduce side effects.
Certain medications used with birth control pills can reduce the contraceptive's efficacy.
Which of the following medications, if taken with birth control pills, could cause this
problem and require back-up contraception or a different method of contraception with
long-term therapy? (Select ALL that apply.)
Drugs that may cause this effect include: many antibiotics (e.g.,
cephalosporins, chloramphenicol, macrolides, penicillins, tetracyclines,
sulfas), aprepitant, bexarotene, bosentan, dapsone, griseofulvin, certain HIV
protease inhibitors (e.g., amprenavir, nelfinavir, ritonavir), modafinil,
nevirapine, rifamycins (e.g., rifampin), many seizure medications (e.g.,
barbiturates, carbamazepine, phenytoin, primidone, topiramate), St. John's
wort. Ask your doctor if you should use additional reliable birth control
methods while taking any of the drugs mentioned above while also taking
birth control pills. Before using this medication, tell your doctor or pharmacist
of all prescription and non-prescription/herbal medications you may use,
especially of: thyroid hormone drugs, certain benzodiazepines (e.g.,
diazepam, chlordiazepoxide), prednisone-like drugs, certain antidepressants
(e.g., tricyclics), beta-blockers (e.g., metoprolol), "blood thinners"
(anticoagulants such as warfarin), insulin.
The EC will not affect her future fertility, cause birth defects or terminate an
established pregnancy.
EC will not end an existing pregnancy or cause birth defects. EC contains the
same hormones as regular birth control pills, and women's bodies also
produce these hormones naturally during pregnancy. Exposure to EC does not
threaten an existing pregnancy.
Which of the following are correct statements concerning missed pills with an
estrogen-progestin birth control pill formulation?
A young woman went on a weekend trip with her boyfriend and forgot her pill packet.
She missed taking her birth control pills during days 18th-20th. The woman has come
into the pharmacy to get her next month's packet, which is ready for pick-up. Choose the
correct advice the pharmacist should relate to the patient:
Do not use the placebo week (or sugar or dummy pills); go ahead and
begin the new packet.
Because: If two or more consecutive pills have been missed > or equal to 48
hours were pills should have been taken.
If hormonal pills were missed in the last week of the cycle (18-20 th):
Omit the hormone-free interval by finishing the hormone pills in the current
pack and start new pack next day. Since next day begin on 21 st, go ahead and
use new packet. Use backup contraception or avoid intercourse for 7 days..
Consider EC if missed pills were during the 1 st week and unprotected
intercourse occurred in the previous 5 days.
Estrogen products should be avoided in this patient because of her age and
her smoking status.
The FDA requires that the patient package insert be dispensed every time the
patient receives the medication. There is a boxed warning to avoid estrogen
products in patients > 35 years of age who smoke. Missed pills are a common
cause of unintended pregnancies.
A woman is using Alesse combination oral contraceptive pills. She does not
enjoy getting a monthly menstrual cycle and has heard about new pill
formulations where you get less periods. Choose the formulation/s which
results in menstruation once every 3 months: (Select ALL that apply.)
Oral contraceptives with "Tri" or "Cycl" in the name usually indicate triphasic
pills.
A patient has vomited out the first dose of Plan B One Step (1.5 mg). The
pharmacist should tell her to retake the dose (after taking anti-nausea
medicine first) if she has vomited within this time period after having taken
the EC tablet/s:
2 hours
If the patient vomits within two hours after taking levonorgestrel pills, she
should take an anti-emetic and then take another full dose of levonorgestrel.
RW has started to use the oral contraceptive Sprintec 28. Which of the
following medications would not interact with oral contraceptives?
Levofloxacin
Levofloxacin does not interact with birth control pills. Use back-up (condoms
and spermicide) while using an interacting medication.
Patients must take the pill at the same time of day; if three hours have
elapsed from the regular scheduled time, back up is needed for 48 hours
after taking the late pill. If a dose is missed, and sexual intercourse has taken
place, pregnancy could result, and the patient may desire emergency
contraception.
A young female enters the pharmacy. She is using birth control pills. She asks
if she is protected against HIV and other STIs. Which advice should be
provided?
The method that has 100% success at preventing HIV and sexually
transmitted diseases is abstinence.
Birth control pills, patches and rings are intended to prevent pregnancy. They
do not protect against transmission of HIV (AIDS) or other sexually
transmitted diseases (STIs), including chlamydia, genital herpes, genital
warts, gonorrhea and syphilis. Barrier methods decrease the risk of
transmission but abstinence is the only method that is 100% effective.
ACHES stands for Abdominal pain, Chest pain, Headaches, Eye problems,
Sweling and/or aching in the legs and thighs