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. What would you like to do?
how can you make the pill more effective?
decrese the length of hormone free interval ( no placebo pills)
birth control pills decreaswe incidence of endometrial CA and decrease PID. True or false?
what is the clinical relevancy of higher bioavailability birth control pills like levonorgestrel?
- % drug available in the blood stream is what makes it prevent pregnancy and decreases person to person variation
- longer half life= larger saftey margin for missed pills BUT more SE
what vitamen enhances estrogen and must be limited when taking birth control pills?
vitamin C take no more than 500mg daily
what drugs decrease effectiveness of birth control pills?
- barbituates (phenobarb & primidone)
- St. John's Wart
how do broad spectrum antibiotic, antifungal and antiparasitics affect birth control pills?
they don't only rifampin and griselofulvin and the anti-seizure meds
Low dose oral contraceptives are anti-adrogenic . they do not induce male pattern balness, or cause excessive hair growth, clitoral enlargment, deepening of the voice or increase sebum production but they do improve 2 troublesome conditions.
acne and hirsutism
what is the most important factor when evaluating the effect of Oral Contraceptive's on acne and other androgenic conditions/
- Free testosterone
- only 4 approved
- estrocept, yaz, beyaz, and tricyclen
- yaz and beyaz are approved for PMDD
what other conditions are Yaz and Beyaz approved to treat?
PMDD and acne
what is a low dose pill?
- those containg less than 50mcg of EE
- most contain 10-35mcg and come in monophasic, biphasic or triphasic which refers to the dose of estrogen & progesterone taken daily. monophasic is same dose of each daily.
what is a biphasic pill?
- ortho 10/11
- contains a fixed dose of EE and increasing dose of norethindrone.
low estrogen dose pills contain how much EE and for whom are they ordered?
10-25mcg EE use for perimenopausal wome to relieve hot flashes and protect against pregnancy. not HRT.
refering to CDC contraindications if client gets migraines without aura and is <35 can they have the pill?
what category do we refer to gyn for birth control?
3 & 4.
postpartum script for pill what is the rule for women not breast feeding?
- 21-42 days with no DVT risk catagory 2 (benefit>risk)
- >42 days catagory 1 (no risk)
(unacceptable risk do not prescribe) catagory 4:< 21 days regarless if breastfeeding or not.
what is the rule for birth control in breast feeding women
- (benefit>risk) category 2 : >1month Postpartum
- (risk may be >benefit)catagory 3: <1 month postpartum
- (unacceptable risk do not prescribe) catagory 4:< 21 days regarless if breastfeeding or not.
what must u know when prescribing pill?
- clotting disorders?
- migraine hx
do you need a pelvic to prescribe birth control?
what is the number one risk for endometrial CA?
what are some of the good "SE" of oral contraceptives?
- prevention of bone loss
- prevention of fibrocystic breast disease
- prevention of PID
- prevention ectopic pregnancy
- treatment of acne, hitsutis, perimenopausal sx, PMDD
should oral contraceptive be used to treat existing functioal ovarian ciysts?
NSAID compliment Oral contraceptive used to treat primay dysmenorrhea. true or false?
isn't there an increased resk of breast CA if you use birth control?
no, not even when there is familial hx of breast CA.
don't oral contraception make you gain wieght?
nope! you might gain or you might loose or you might stay the same. that was true with the older higher dose pills but not anymore.
so what are the disadvantage to the pill?
- doesn't protect against STD's still need to use barrier (condom)
- must take it daily and regularly for it to be effective
- they are expensive
- takes 3 months to stop the spotting, no period hard to tell about pregnancy.
- can cause n & V, headaches, increased depression, decrease libido (change to 1st gen progesterone to fix libido issue)
- increased cervical ectopy which increases STD risks
client on pill complains of nausea, bloating, breast tenderness, headache and has an increased BP what is going on? Oh she also has fatigue, acne, decreased libido, breast tenderness, increased size of breast is moody and her cholesterol levels are off!
- too much estrogen!
- and too much progesterone
what is considered late breakthrough bleeding?
after day 14
what are adrogen side effects related to in the pill, estrogen or progestin?
what are the sign of too much progesterone (androgen)?
- increased appetie/weight gain
- acne/oily skin
- decreased libido
- bigger boobs that hurt
- increased LDL and decreased HDL
when people have new onset breakthrough bleeding wether they are smokers or not what should you check for?
What would you like to do?
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