4 Types of cocs Estrogen and progesterone. Combination of two hormones: High dose: 50 micrograms of E2Low dose (most common):30-35micro grams of E2Monophasic, biphasic, triphasic.
5 Mechanism of action Primary mechanism: ovulation inhibition. Prevent LH surge and ovum growth.Other mechanism: fertilization prevention.Creates hostile media for the sperm through changing the cervical mucus.
6 Metabolism of hormones. C OCs are metabolized in the liverC OCs are excreted in the kidney.
7 characteristics SAFE use Daily uptake. Common side effects. ADVANTAGESSAFE useReversible S/EProtection from PIDNon contraceptive benefitDISADVATAGEDaily uptake.No STD protectionCommon side effects.
8 Pharmacist roleEnable the patient to feel empowered and in control of her life.Refer to the physician.Provide complete instruction in the use of the method.
9 COCs What shall you ask about? Prescription. Age. Smoking status. Medication history.
10 DRUGS AND THE PILLANTI CONVULSANTS.ANTIBIOTICS.
11 Does she have or ever had: Very bad headaches.Liver problems.Heart disease or thrombolic disorder.Cancer.Diabetes.Unexpected bleeding from the vagina between periods.
12 Explain what COC does to her body. State the possible and common side effects.Explain when shall she stop her pills and inform her physician immediately.
13 Be prepared to answer her questions Any concernIs it safe? yesWhat should I do if I miss a pill?Will I gain weight on the pill? noWhat if I become pregnant? Stop it immediatelyHow soon can I get pregnant after stopping the pill? After stopping the pill maximum after 6 months
14 Management of side effects. Remember:Most side effects are minor.Patient should stop the pill immediately when she develops one of the following symptoms:Abdominal pain.Chest pain.Headache.Eye( blurred vision, brief loss of vision)Sharp leg pain.
15 Does the pill cause cancer? no Does it cause infertility? noDoes it cause birth defects? noDo I need a rest period? noWould it decrease my sex drive? noDoes it build up in my body? no
16 When to start?Any time provider is reasonably sure the woman is not pregnant.First 5 days of menstrual cycle.After day 5, use backup method for 7 days.Postpartum:Not breast feeding: delay 3 weeks.Breast feeding: delay 6 months.
17 Missed pills Take missed pill as soon as remembered Missed 1 or 2 active pillsTake missed pill as soon as rememberedKeep taking other pills on scheduleNo backup method needed
18 Miss 3 or more active pills, or start pack 3 or more days late. Take the missing pill as soon as remember.Continue daily pill taking as usual +use back up method for next 7 days.Count number of active pills remaining in pack.7 or more active pills left in the packfewer than 7 active pills left in the pack.finish active pills.Take hormone-free break.finish active pills.Discard inactive pills.start new pack immediately.
19 EASY TO REMEMBER.IF YOU MISS 1 OR 2 PILLS TAKE A PILL AS SOON AS YOU REMEMBER, NO NEED FOR EXTRA PRECAUTIONS.IF YOU MISS 3 OR MORE PILLS, TAKE A PILL AS SOON AS YOU REMEMBER, CONTINUE FOR AT LEAST 7 DAYS, THEN USE BACK UP MEASURES FOR AT LEAST 7 DAYS.
20 Non-menstrual problems Action\managementAny client concernProvide counselingIf side effects persist and are unacceptable to client:If possible, switch pill formulation or switch to another methodDizziness, nauseaReassure client:Usually diminish over timeNausea and vomitingTake pills with food or bedtimeWeight changeCounsel about healthy eating habits and exersize
21 Bleeding problems problem Action\management Unexplained vaginal bleeding or amenorrheaAssess cause ( consider pregnancy or disease)Action based on assessmentBreakthrough bleedingReassure client: reinforce correct pill takingIf side effects persist and are un acceptable to client:Switch to another methodProlonged bleedingAdminister non-steroidal anti-inflammatoryUse pills with more potent progestinAmenorrheaReassure client:No medical treatment necessary
22 Contra-indications no Do you think you could be pregnant? yes Do you have high blood pressure?Do you have diabetes?Have you ever had stroke, blood clot in you leg, or other heart problems?Do you have breast mass, or known breast disease?
23 noDo you have liver disease, hepatitis, jaundice, gallbladder disease?yesDo you have migerane headaches?Do you have abnormal vaginal bleeding?Are you breast feeding?Are you above 35yrs and smoke>15 cigarettes per day?Are you going for a major surgery soon?
24 POPsWhat shall you ask about?Prescription.Age.Medication history.
25 Are you sure you are NOT pregnant? Do you have breast cancer?
26 Explain what POP does to her body. How shall she take it.State the possible and common side effects.Explain when shall she stop her pills and inform her physician immediately.
27 Be prepared to answer her questions Any concernIs it safe? yesWhat should I do if I miss a pill?Will I gain weight on the pill? noWhat if I become pregnant? Stop it immediatelyHow soon can I get pregnant after stopping the pill? After stopping the pill
28 Does the pill cause cancer? no Does it cause infertility? noDoes it cause birth defects? noDo I need a rest period?noWould it decrease my sex drive? noDoes it build up in my body? no
29 Missed pills3 or more hours, take the pill and use condoms for 48 hoursMore than 24 hours, take 2 pills in the same day, use condoms for 2 weeks2 missed pills, take 2 pills per day for 2 days, use condoms 2 weeks
30 IUDs What a pharmacist should know? Difference between copper & hormonal IUD.Common S/E.When to refer to the physician.