Oral Contraceptives

Medroxyprogesterone acetate (given as intramuscular injection of microcrsytals each injection lasts 3 months)

Name the ingredient in Depo-Provera injection.

The 21-tablet dosing consists of a combination preparation taken for 21 days followed by 7 days without any drug such that withdrawal bleeding occurs (usually within 3 days of not taking it). New cycle is started again and taken for 21 days, and 7 days off, etc. Day one is first day of menses

Describe the 21-day dosing of combination oral contraceptives.

The 28-tablet dosing consists of a combination preparation taken for 21 days followed by 7 inactive tablets In other words, take one tablet a day without interruption.

Describe the 28-day dosing of combination oral contraceptives.

Large doses of estrogens alone or in combination with progestins may prevent pregnancy after unprotected intercourse. Must be taken within 72 hours after intercourse Mechanism is probably to prevent implantation by altering endometrium in the uterus...So prevents IMPLANTATION

Describe the mechanism of action of Plan B Postcoital contraception (estrogens, progestins)

Used after implantation of fertilized ovum has occurred. Taken within 50 days of last menses. Mechanism is to block progesterone action leading to endometrial shedding. Conceptus is then detached from uterine wall. Its abortion

Describe the mechanism of action of RU-486 Antigestation (progesterone antagonists).

Progesterone(1) decreases pituitary luteinizing hormone and (2) alters endometrium to prevent implantation of fertilized ovum

Describe the mechanism of action of progesterone-only oral contraceptives known as the "mini-pill".

Estrogens and progestins decrease the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Inhibition of FSH and LH result in the inhibition of ovulation. So again, Inhibit ovulation Due to suppression of FSH and LH output from pituitary gland Lower levels of FSH results in minimal follicular development

Describe the mechanism of action of the combination oral contraceptives.

Cigarette smoking increases the risk of cardiovascular side effects from oral contraceptive use. The risk is most serious in women over 35 years of age and who smoke 15 or more cigarettes daily.

Describe the warnings associated with the combination oral contraceptives.

Transdermal patch Ortho-Evra (ethinyl estradiol and norelgestromin transdermal patch) Worn for 7 days and replaced on day 8 and day 15. Day 22 begins a patch-free week

What is "Ortho-Evra" ?

Ethinyl estradiol Levonorgestrel One active tablet per day for 84 consecutive days, followed by one low dose estrogen tablet per day for 7 days.

What is "Seasonale" ?

Also act directly on cervix and uterus Cervical mucous becomes thick, less abundant Thus, implantation of fertilized ovum does not occur in endometrium Also, thick mucous may inhibit sperm penetration

What is a secondary mechanism of action seen in combination oral contraceptives?

1. Combination oral contraception ( estrogens, progestins) 2. Progestins-only contraception (progestins) 3. Postcoital contraception (estrogens, progestins) 4. Antigestation (progesterone antagonists)

What are the four classes of oral contraceptives?

Mifepristone (RU 486), Mifeprex

What is an example of Antigestation (progesterone antagonists) contraceptive?

Risk of venous thrombosis is 2 to 6 fold in oral contraceptive users. Increase in blood pressure over time in 1% to 5% of users. Usually the increase is small.

What is the major (most serious) adverse effect of oral contraceptives?

Relies on actions of progesterone content Progesterone (1) decreases pituitary luteinizing hormone and (2) alters endometrium to prevent implantation of fertilized ovum

What is the mechanism of action of Depo-Provera injection?

ESTROGENIC AND PROGESTERONE (PROGESTINS)

___________ and _________________prevent ovulation and are the ingredients in birth control pills.

1. Decreased incidence of fibrocystic disease of the breast 2. Decreased incidence of acute pelvic inflammatory disease 3. Decreased incidence of functional ovarian cysts 4. Decreased incidence of uterine fibroid adenomas

List 4 health benefits of oral contraceptives taken long term.

1. Nausea 2. Vomiting 3. abdominal cramps, bloating 4. edema 5. breakthrough bleeding 6. breast tenderness 7. mental depression (these are all early effects that go away over time with continued use)

List the seven minor adverse effects of oral contraceptives.

ESTROGENS AND PROGESTERONES

List the two types of hormones in the combination oral contraceptives.

Micronor (28-day pill regimen) Depo-Provera injection

List the types of contraceptives containing progestins only?

Developed to avoid adverse effects of estrogen (weight-gain, fluid-gain, breast soreness) Has slightly higher failure rate Has higher incidence of menstrual disturbances

What are some of the pros and cons to using a progesterone-only oral contraceptive known as the "mini-pill"?

The clinician should (considering the possibility of an unwanted pregnancy): 1. Advise the patient of the potential risk of the antibiotic's reducing the effectiveness of the OC 2. Recommend that the patient discuss with her doctor the use of an additional nonhormonal means of contraception

State the ADA's position on antibiotic interference with oral contraceptives.