Pharmacy 1, Training & drug information center Family planning Arwa al khatib Pharmacy 1, Training & drug information center 06-5510417

Non hormonal methods Natural method. Barrier method Mechanical

Hormonal contraceptives Types: Pills Implants. Injections. Iucd coated.

Types of cocs Estrogen and progesterone. Combination of two hormones: High dose: 50 micrograms of E2 Low dose (most common):30-35micro grams of E2 Monophasic, biphasic, triphasic.

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.

Metabolism of hormones. C OCs are metabolized in the liver C OCs are excreted in the kidney.

characteristics SAFE use Daily uptake. Common side effects. ADVANTAGES SAFE use Reversible S/E Protection from PID Non contraceptive benefit DISADVATAGE Daily uptake. No STD protection Common side effects.

Pharmacist role Enable the patient to feel empowered and in control of her life. Refer to the physician. Provide complete instruction in the use of the method.

COCs What shall you ask about? Prescription. Age. Smoking status. Medication history.

DRUGS AND THE PILL ANTI CONVULSANTS. ANTIBIOTICS.

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.

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.

Be prepared to answer her questions Any concern Is it safe? yes What should I do if I miss a pill? Will I gain weight on the pill? no What if I become pregnant? Stop it immediately How soon can I get pregnant after stopping the pill? After stopping the pill maximum after 6 months

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.

Does the pill cause cancer? no Does it cause infertility? no Does it cause birth defects? no Do I need a rest period? no Would it decrease my sex drive? no Does it build up in my body? no

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.

Missed pills Take missed pill as soon as remembered Missed 1 or 2 active pills Take missed pill as soon as remembered Keep taking other pills on schedule No backup method needed

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 pack fewer 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.

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.

Non-menstrual problems Action\management Any client concern Provide counseling If side effects persist and are unacceptable to client: If possible, switch pill formulation or switch to another method Dizziness, nausea Reassure client: Usually diminish over time Nausea and vomiting Take pills with food or bedtime Weight change Counsel about healthy eating habits and exersize

Bleeding problems problem Action\management Unexplained vaginal bleeding or amenorrhea Assess cause ( consider pregnancy or disease) Action based on assessment Breakthrough bleeding Reassure client: reinforce correct pill taking If side effects persist and are un acceptable to client: Switch to another method Prolonged bleeding Administer non-steroidal anti-inflammatory Use pills with more potent progestin Amenorrhea Reassure client: No medical treatment necessary

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?

no Do you have liver disease, hepatitis, jaundice, gallbladder disease? yes Do 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?

POPs What shall you ask about? Prescription. Age. Medication history.

Are you sure you are NOT pregnant? Do you have breast cancer?

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.

Be prepared to answer her questions Any concern Is it safe? yes What should I do if I miss a pill? Will I gain weight on the pill? no What if I become pregnant? Stop it immediately How soon can I get pregnant after stopping the pill? After stopping the pill

Does the pill cause cancer? no Does it cause infertility? no Does it cause birth defects? no Do I need a rest period?no Would it decrease my sex drive? no Does it build up in my body? no

Missed pills 3 or more hours, take the pill and use condoms for 48 hours More than 24 hours, take 2 pills in the same day, use condoms for 2 weeks 2 missed pills, take 2 pills per day for 2 days, use condoms 2 weeks

IUDs What a pharmacist should know? Difference between copper & hormonal IUD. Common S/E. When to refer to the physician.