ORAL CONTRACEPTIVES,ORAL CONTRACEPTIVES, contraceptives, vels, pharmd, ORAL CONTRACEPTIVESPPT,ppt,note,ORAL CONTRACEPTIVES,ORAL CONTRACEPTIVESnotes

1. Department of Pharmacy Practice
Vels University

2.  Birth control pills (oral contraceptives) are prescription
medications that prevent pregnancy.
 Birth control (contraceptive) medications contain
hormones (estrogen and progesterone, or progesterone
alone).
 Birth control pills may also be prescribed to reduce
menstrual cramps or prevent anemia.
 Some women experience various levels of side effects
of birth control pills.

3.  Hormonal birth control medications prevent pregnancy through
the following ways:
 By blocking ovulation (release of an egg from the ovaries), thus
preventing pregnancy
 By altering mucus in the cervix, which makes it hard for sperm to
travel further
 By changing the endometrium (lining of the uterus) so that it cannot
support a fertilized egg
 By altering the fallopian tubes (the tubes through which eggs move
from the ovaries to the uterus) so that they cannot effectively move
eggs toward the uterus

5.  Birth control (contraceptive) medications contain
hormones (estrogen and progesterone, or
progesterone alone).
 The medications are available in various forms, such
as pills, injections (into a muscle), topical (skin)
patches, and slow-release systems (vaginal rings,
skin implants, and contraceptive-infused intrauterine
devices

6.  Choosing which estrogen and progesterone dose, type, and
administration method is
 Highly patient specific, meaning that the choice greatly
depends on factors unique to an individual.
 General goals are to choose a product that provides good
menstrual cycle control with the fewest adverse (side) effects
and to use the lowest hormone dose possible.
 After beginning birth control medications, it may be
necessary to adjust the dose or to choose a different product.

7.  Estrogens
 Ethinyl estradiol
 Mestranol
 Progesterones
 Norethynodrel
 Norethindrone
 Norethindrone acetate
 Norgestimate
 Desogestrel
 Ethynodiol diacetate
 Norgestrel
 Levonorgestrel
 Drospirenone

8.  Combination contraceptives, that is,
contraceptive medications containing both
estrogen and progesterone, are the most
effective means for contraception with the
exception of surgical sterilization.
 Several types of combination birth control pills
exist, including monophasic pills, biphasic pills,
triphasic pills, and 91-day-cycle pills.

9.  Monophasic pills have a constant dose of both
estrogen and progestin in each of the
hormonally active pills throughout the entire
cycle (21 days of ingesting active pills).
 Several of the brands listed above may be
available in several strengths of estrogen or
progesterone, from which doctors choose
according to a woman’s individual needs.

10.  Biphasic pills typically contain 2 different
progesterone doses.The progesterone dose
is increased about halfway through the cycle.

11.  Triphasic pills gradually increase the dose of
estrogen during the cycle (some pills also
increase the progesterone dose).
 Three different increasing pill doses are
contained in each cycle.

12.  Levonelle 1500 (one step)
 Contains high dose progesterone
(levonorgesterel)
 One 1500mcg tablet taken as soon as
possible after unprotected
intercourse (up to 72 hours after)
 Preferably within 12 hours, no later
than 72 hours

13.  Dependent on point in the menstrual
cycle
 Either prevents or delays ovulation,
prevents fertilisation or prevents
implantation of the fertilised egg into
the uterus.
 Clinical opinion is that EHC is not an
abortifacient

14.  These pills are monophasic birth control pills that have been
approved for use on a daily basis for 84 days without
interruption.
 Users have fewer scheduled menstrual cycles (only 1 period
every 3 months).
 Data from clinical trials show that many women, especially in
the first few cycles of use, have more unplanned bleeding
and spotting between the expected menstrual periods than
women taking conventional combination birth control pills.

15.  Medroxyprogesterone acetate (Depo-Provera)
 Use:
 The first injection is given within 5 days following the onset of
menstruation.
 After that, an injection is needed every 11-13 weeks.
 Side effects:
 Since progesterone is the only hormonal ingredient, estrogen-related
side effects are avoided.
 A side effect unique to this method of birth control is that most
women eventually stop having their periods.
 Depo-Provera may last in the body for several months in women who
have used it on a long-term basis and can actually delay the return to
fertility after stopping the drug.
 Approximately 70% of former users desiring pregnancy conceive
within 12 months, and 90% of former users conceive within 24 months.
Other side effects include weight gain and depression.

16.  Norelgestromin/ethinyl estradiol (Ortho Evra)
 The topical patch may be applied to clean, dry skin on the shoulders, upper
arms, buttocks, or abdomen.
 It should not be applied to red or inflamed areas of the skin or in areas where
tight clothing may rub.
 The patch may be less effective in women weighing more than 198 pounds
(90 kg).
 Use:
 A new patch is applied on the same day of the week, each week for 3 weeks in
a row.
 The first patch is applied either on the first day of the menstrual period or on
the Sunday following menses.
 On the fourth week, no patch is applied.
 Menstruation should begin during this time.
 This 4-week period is considered 1 cycle.
 Another 4-week cycle is started by applying a new patch following the 7-day
patch-free period.

17.  Side effects:
 Side effects are similar to other birth
control agents containing both estrogen
and progesterone.
 Effects include menstrual irregularities,
weight gain, and mood changes.
 Other specific side effects include a skin
reaction at the site of application and
problems with contact use

18.  Norethindrone (Nor-QD)
 Progesterone-only pills (POPs), also known as mini-pills, are not used
widely in the United States.
 Less than 1% of users of oral contraceptives use them as their only
method of birth control.Those who use them include women who are
breastfeeding and women who cannot take estrogen.
 Use:
 POPs are ingested once daily, every day.
 POPs may be started on any day, and there are no pill-free days or
different-colored pills to track.
 Since progesterone is the only hormonal ingredient, estrogen-related
side effects are avoided.
 However, since POPs do not include estrogen, they have a higher failure
rate.
 Users must take this pill at the same time daily for greatest
effectiveness.

19.  Etonogestrel/ethinyl estradiol (NuvaRing)
 Use:
 The ring is self-inserted into the vagina.
 The vaginal ring must be inserted within 5 days of the
onset of the menstrual period, even if bleeding is still
occurring.
 During the first cycle, an additional method of
contraception, such as male condoms or spermicide,
is recommended until after the first 7 days of
continuous ring use.
 The ring remains in place continuously for 3 weeks.
 The ring is then removed for 1 week.
 Menstruation should begin during this week.
 The next ring is inserted 1 week after the last ring was
removed.

20.  Side effects:
 A vaginal ring may not be suitable for women
experiencing vaginal irritation or ulcerations.
 A ring may be accidentally expelled, for
example, when it has not been inserted
properly, during tampon removal, or while moving the
bowels or straining, especially with severe
constipation.
 If this occurs, the vaginal ring can be rinsed with cool
to lukewarm (not hot) water and reinserted promptly.
 If the ring is not replaced within 3 hours of
expulsion, then a backup method, such as male
condoms and spermicide, should also be used
following reinsertion of the ring for at least 7 days.

21.  Women with the following conditions should not use estrogen-
containing birth control medications:
 Allergy to any component of the product
 History of blood clot disorders
 History of stroke or heart attack
 Heart valve disease with complications
 Severe hypertension
 Diabetes that causes blood vessel problems
 Poorly controlled diabetes
 Severe headaches (for example, migraines)
 Recent major surgery with prolonged bed rest
 Breast cancer
 Liver cancer (or liver disease)
 Uterine cancer or other known or suspected estrogen-
dependent cancers
 Unexplained abnormal bleeding from the uterus
 Jaundice during pregnancy or jaundice with prior hormonal
contraceptive use

22.  The effectiveness of COC, POP and EHC
will be reduced by interaction with drugs
that are enzyme inducers
 Broad spectrum antibiotics may reduce
effectiveness of COC by altering the
bacterial flora of the bowel

23.  Certain drugs can decrease the effectiveness of
combination-type birth control pills by decreasing the
drug concentration in your system (impaired
enterohepatic recirculation or hepatic induction).This can
result in pregnancy.
 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.

24.  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.
 This product can affect the results of certain lab tests (e.g., thyroid).
Inform all laboratory personnel that you use this drug.
 Birth control pills may significantly intensify the effects of alcohol.
 Consult your doctor or pharmacist about this. Do not start or stop any
medicine without doctor or pharmacist approval.

25.  Nausea, breast tenderness, fluid retention,
weight gain, acne, breakthrough bleeding,
missed periods, headaches, depression, anxiety,
change in vision, other mood changes, and
lower sexual desire.
 Additionally, the following more serious side
effects may occur:
 Thromboembolism (blood clots)
 Breast cancer
 Cervical cancer
 Benign liver tumors
 Diabetes

26.  Smoking cigarettes while using this medication
increases your chance of having heart
problems.
 Do not smoke while using this medication.
 The risk of heart problems increases with age
(especially in women greater than 35 years of
age) and with frequent smoking (15 cigarettes
per day or greater).

27.  If overdose is suspected, contact your local
poison control center or emergency room
immediately.
 Symptoms of overdose may include nausea
and vomiting.
 Females may experience vaginal bleeding.

28.  Missed dose advice differs and depends on the
brand used, and the number of doses missed.
 Refer to the product package information for
advice on missed doses. Ask your doctor or
pharmacist if you have any questions.

29.  Store at room temperature between 59 and 86
degrees F (between 15 and 30 degrees C) away
from moisture and sunlight.
 Do not store in the bathroom.