1. Pharmacy 1, Training & drug information center
Family planning
Arwa al khatib
Pharmacy 1, Training & drug information center

2. Non hormonal methods
Natural method.
Barrier method
Mechanical

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

4. 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.

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 liver
C OCs are excreted in the kidney.

7. 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.

8. 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.

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

10. DRUGS AND THE PILL
ANTI 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 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

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? 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

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 pills
Take missed pill as soon as remembered
Keep taking other pills on schedule
No 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 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.

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\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

21. 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

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. 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?

24. POPs
What 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 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

28. 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

29. 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

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