Transcript Phar-Contraceptives

Contraceptives
&
Hormone
Replacement
Therapy
by Minwen, Chitra, & Ahmed
Contraceptives & Hormone Replacement
Therapy
Contraceptive - Birth Control
Types and methods:
Barrier methods - prevent sperm from entering the uterus
• condoms, diaphragms, cervical caps, spermicides, contraceptive sponges
Hormonal method
Emergency contraceptives
Intrauterine devices
Sterilization - permanent form of birth control via surgery to prevent either a woman from getting
pregnant or a man from releasing a sperm
•Tubal ligation (for women)— cuts, ties or seals
the fallopian tubes, which blocks the path between
ovaries & the uterus & prevent sperm to reach &
fertilize the egg nor can egg reach the uterus.
• Vasectomy (for men)—cuts, closed, or blocks
the vas deferens, the path between the testes &
the urethra.
**more effective than female sterilization!!
Hormonal Methods
Regulates or stops ovulation, thusprevents pregnancy.
Can be introduced into the body through several methods:
•Combined oral contraceptives - Combo of synthetic estrogens & progestins
•Progestin-only pills - Interfere with ovulation or sperm function
•Contraceptive patch-(Ortho Evra) thin plastic patch stick to skin & release hormones into
blood stream for 3 weeks
•Injectable birth control-Depo-Provera (DMPA-depo medroxyprogesterone acetate) Injection
of progestin every 3 months
•Vaginal rings-thin flexible ring inserted into vagina & delivers combo of synthetic estrogen
(ethinyl estradiol)
•Implantable rods—Matchsticksize, flexible, plastic inserts under
skin of a woman’s arm for up to 5
years & release progestin
(Implanon releases
etonorgestreal), (Jadelle releases
levonorgestrel-FDA app. &
levonorgestrel releasing Sino
Implant)
Emergency Contraceptives
Pills (ECP’s)
Levonorgestreal 1.5mg
•Are hormonal pills taken either as single dose or 2 doses 12
hrs apart
•They are intended for the used in event of unprotected sex
•If the pill is taken prior to ovulation, the pill can delay or
inhibit ovulation for 5 days to allow sperm to become inactive
•They also cause thickening of cervical mucus & interfere with
sperm function
•It should be taken ASAP after semen exposure.
•It should not be used as a regular contraceptive
•Pregnancy can occur if pills are taken after ovulation or if
there is semen exposure in the same cycle.
Intrauterine Method (IUD)
IUD is a T-shaped device inserted by a health
care professional into the uterus to prevent
pregnancy & effectively function for several
years as needed or can be removed if
contraception is desired.
•A copper IUD (ParaGard) FDA app for 12 yrs.—releases a
small amount of copper in the uterus & caused an
inflammatory reaction that prevent sperms to reach &
fertilize egg. Should fertilization of an egg occurs, the
device prevents the fertilized egg to implant into the uterus
lining. It is not recommended for women with pelvic,
uterine or cervical disorders
•A hormonal IUD (Mirena a levonorgestreal-releasing IUD)
FDA app. for 5 yrs.—releases a progestin hormone in the
uterus & caused thickening of the cervical mucus which
inhibits sperms from reaching or fertilizing the egg. It also
thins the uterine lining & prevent ovaries from releasing
eggs.
5
Hormone-Replacement Therapy
(HRT or HT)
• AKA Menopausal hormone therapy (MHT)
• Serving to alleviate menopausal symptoms and boost hormone levels
• Helps restore balance in a woman’s body after her ovaries have stopped
producing estrogen and progestin
• Prevent osteoporosis(very effective but not used as prevention along due
to its severe adverse effects)
• Does NOT protect against pregnancy
• If prescribed in the LOWEST dose required, HT is a safe and effective
option for SHORT-TERM use (up to five years) for the treatment of
moderate to severe menopausal symptoms.
• Long term HRT is not recommended and should be consulted with a
physician.
3 Types of HRT for
Women
1. Estrogen therapy (ET)
• involve the use of estrogen alone
• typically prescribed to women who no
longer have uterus
2. Combination of estrogen and progestin
(EPT)
• progestin helps protect the uterus’
lining from endometrial cancers.
3. Cyclical HRT (sequential HRT) - for
women who have menopausal
symptoms but still have their periods.
Two types:
• monthly HRT: for women with regular
period
• three-monthly HRT: for women with
irregular period
Routes of
Administration
Oral - tablets, via hepatic first-pass effect
Transdermal
•Patches.
•Creams or gels
•Nasal sprays
•Local devices such as the progestogenreleasing Mirena® coil.
•The oestrogen-releasing vaginal ring.
HRT is not for Women with or with a
history of
•Breast cancer
• Heart disease
• Liver disease
• Blood clotting problem
• Non-menopausal
Side effects Associated with
Prolong Use
(more than 5 years) of HT
•
Venous thromboembolism (VTE, usually associated HT
that is taken orally, transdermal estrogen may be safer)
•
Irregular bleeding (experienced by 40% of patients;
usually stops within 12 months)
•
IBreast tenderness
•
Nausea
•
Headache
•
Heart attack
•
Stroke
•
Breast cancer
•
Bloating (Usually caused by ET, symptoms can often be
treated by changing the dosage).
•
Reduce the risk of developing diabetes(Estrogen can
positively impact glucose and insulin metabolism;
improved the glycemic control and serum lipoproteins)
•
Reduce the risk of osteoporosis
•
Reduce the risk of colorectal cancer
**HRT should is not recommended for disease prevention
purpose along.
**Smoking causes the body to make less estrogen.
4/8/2016
HRT & Oral Health
•Oral contraceptives lead to
increased risk for dry socket
and postoperative pain after
extraction of a third molar.
•Oral contraceptives interfere
with blood clotting.
•Oral contraceptives may lower
the pain threshold
•Studies show MTH reduces
tooth loss and gingivitis with
•However, many studies show
increase gingivitis with the use
of Oral Contraceptive
MOA of HRT
• Estrogen acts by diffusing through the cell
membranes and binding to estrogen receptors to
activate it
• Activated receptor binds to specific DNA sequences,
eliciting hormone response
• oral contraceptives underwent first-hepatic
metabolism
• Smaller dosage is required for transdermal route
because it avoids the first-hepatic effect
• Conjugated estrogen allows the drug to be
metabolized in the GI tract rather than undergoing
extensive first-hepatic effect
4/8/2016
Drug Interations
• Tobacco smokers on HT have an increase risk
of stroke
• Estrogen reduce the effect of oral
anticoagulants
• Estrogent may inhibit the metabolism of
benzodiazepines, resulting in increased serum
levels of benzodiazepines
• Broad spectrum antibiotics decrease the
effect of oral contraceptive
• Phenytoin may decrease the estrogen effect
4/8/2016
References
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http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
https://www.google.com/search?q=barrier+methods+of+contraceptives&espv=2&source=lnms&tbm=isch&sa
=X&ei=OL_dU7apGc6cyATRtIGQCw&ved=0CAYQ_AUoAQ&biw=1706&bih=970&dpr=0.75#imgdii=_
http://www.nichd.nih.gov/health/topics/contraception/conditioninfo/Pages/types.aspx#barrier
http://www.fda.gov/drugs/drugsafety/informationbydrugclass/ucm135318.htm
http://www.nhlbi.nih.gov/whi/whi_faq.htm
http://www.womenshealth.gov/menopause/symptom-relief-treatment/menopausal-hormone-therapy.html
http://menopauseandu.ca/factsheets/HT08.pdf
http://menopauseandu.ca/therapies/hormone-therapies_e.aspx
http://menopauseandu.ca/resources/Menopause_JOGC-Jan_09.pdf
http://circ.ahajournals.org/content/115/7/840.full.pdf+html
http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Menopause_hormone_replacement_therap
y
http://www.nature.com/bdj/journal/v194/n8/full/4810032a.html
Weinberg, Mea A. Theile Cheryl M. Fine James B. Oral Pharmacology for the Dental Hygienist. New York: Julie
Levin Alexander, 2013. Print