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Chapter 53

Chapter 53. Contraceptives. Drug Overview. Combination Estrogen and Progestin Oral monophasic ethinyl estradiol and norethindrone ethinyl estradiol and levonorgestrel ethinyl estradiol and norgestrel ethinyl estradiol and ethynodiol diacetate ethinyl estradiol and desogestrel

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Chapter 53

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  1. Chapter 53 Contraceptives

  2. Drug Overview • Combination Estrogen and Progestin • Oral monophasic • ethinyl estradiol and norethindrone • ethinyl estradiol and levonorgestrel • ethinyl estradiol and norgestrel • ethinyl estradiol and ethynodiol diacetate • ethinyl estradiol and desogestrel • ethinyl estradiol and drospirenone • ethinyl estradiol and norgestimate • mestranol and norethindrone

  3. Drug Overview • Combination Estrogen and Progestin (cont’d) • Oral biphasic • ethinyl estradiol and norethindrone • ethinyl estradiol and desogestrel • Oral triphasic • ethinyl estradiol and norethindrone • ethinyl estradiol and norgestimate • ethinyl estradiol and levonorgestrel

  4. Drug Overview • Combination Estrogen and Progestin (cont’d) • Oral–extended cycle • levonorgestrel/ethinyl estradiol • Contraceptive patch • ethinyl estradiol and norelgestromin • Intravaginal ring • ethinyl estradiol and etonogestrel ring

  5. Drug Overview • Progestin-only • Emergency contraception • levonorgestrel • Progestin-only oral contraceptive (POP) • norethindrone • norgestrel • Progestin-only injection • medroxyprogesterone

  6. Drug Overview • Progestin-only (cont’d) • Progestin subdermal implants • etonogestrel • Intrauterine device  • levonorgestrel • Nonhormonal • IUD • ParaGard

  7. Drug Overview • Indications • Prevention • Treatment • Unlabeled Uses

  8. Mechanism of Action • Interference with the Hypothalamic-Pituitary-Ovarian Feedback Loop • Cervical Mucus Effects • Endometrial Effects

  9. Treatment Principles • Standardized Guidelines • Brigham and Women’s Hospital: Contraception and family planning: a guide to counseling and management, Boston, 2005 • Contraception for women aged over 40 years, J Fam Plan Reprod Health Care 31:51-63, 2005 • American Academy of Pediatrics: Emergency contraception, Pediatrics 116:1026-1035, 2005 • Available at www.managingcontraception.com/cmanager/publish

  10. Treatment Principles • Evidence-Based Recommendations • Cardinal Points of Treatment • Individualization • Consideration of PMH • Adherence • Clinical considerations of choice • Noncontraceptive benefits • Side effects • STI prevention

  11. Treatment Principles • Pharmacologic Treatment • Combined oral contraceptive pills (COCPs) • First-day start • Sunday start • When to take the pill • Extended-cycle pills • Transdermal system • Vaginal ring

  12. Treatment Principles • Pharmacologic Treatment (cont’d) • Emergency contraceptives • Progestin-only pills (mini-pills) • Subdermal implants • depomedroxyprogesterone injection (DMPA) (Depo-Provera) • Timing of injections • Backup method

  13. Treatment Principles • Pharmacologic Treatment (cont’d) • Intrauterine device • Modifying treatment • How to Monitor • Patient Variables • Age over 35 years • Family history breast or ovarian cancer • Pregnancy and lactation • Migraine

  14. Treatment Principles • Patient Education • Combined oral contraceptive and progestin-only pills • Progestin-only pills • STI prevention • Adverse effects

  15. Combined Oral Contraceptive Pills • Contraindications • Warnings • Precautions • Pharmacokinetics • Adverse Reactions • Drug Interactions • Drugs that reduce efficacy of COCPs • Drugs that may reduce efficacy of COCPs

  16. Combined Oral Contraceptive Pills • Drug Interactions (cont’d) • Drugs that may increase estrogen effects • Drugs that may have altered pharmacokinetics with concomitant COCP administration • Dosage and Administration • Other Drugs in Class

  17. Other Drugs in Class • ethinyl estradiol and drospirenone (Yasmin, Yaz) • Contraindications • Warnings • Hyperkalemia • Progestin Emergency Contraception (Plan B) • Contraindications

  18. Other Drugs in Class • Progestin-Only Oral Contraceptives • Adverse effects • Drug interactions • Transdermal System • Vaginal Ring • Intrauterine Devices • Additional contraindications

  19. Other Drugs in Class • depomedroxyprogesterone injection (Depo-Provera or DMPA) • Warnings • Precautions • Adverse effects • Drug interactions

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