Transcript Chapter 16 Cholinesterase Inhibitors

Chapter 62
Birth Control
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
Birth Control
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Interfering with the reproductive process at
any step from gametogenesis to nidation
(implantation of a fertilized ovum)
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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Safety
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Difficult to assess
A large quantity of our data was gathered
when birth control was used in higher doses
than are used today
Effectiveness vs. safety
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Selecting a Birth Control Method
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Consider:
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Effectiveness
Safety
Personal preference
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Oral Contraceptives
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Mechanism: inhibit ovulation
Classification (two main categories)
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Combination oral contraceptives (OCs)
• Estrogen and progestin
Progestin-only OCs
Three major subgroups of combination OCs
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Monophasic
Biphasic
Triphasic
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Combination Oral Contraceptives
(OCs): Adverse Effects
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Thromboembolic disorders
Hypertension
Cancer
Teratogenic effects
Abnormal uterine bleeding
Use in pregnancy and lactation
Benign hepatic adenoma
Glucose intolerance
Other adverse effects
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Noncontraceptive Benefits of OCs
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Decrease risks of ovarian cancer,
endometrial cancer, ovarian cysts, pelvic
inflammatory disease, benign breast disease,
iron deficiency, anemia, and acne
Favorable effect on menstrual cycles
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Reduced cramps; lighter, shorter, more
predictable flow
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Combination Oral
Contraceptives—Drug Interactions
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Drugs and herbs that reduce the effects of
OCs
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Rifampin
Ritonavir
Antiepileptic drugs
St. John’s wort
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Combination Oral
Contraceptives: Drug Interactions
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Drugs whose effects are reduced by OCs
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Drugs whose effects are increased by OCs
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Warfarin
Insulin
Oral hypoglycemics
Several agents, including theophylline, tricyclic
antidepressants, diazepam, and chlordiazepoxide
Drugs that elevate potassium should be
avoided by patients on yasmin (Yaz)
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Combination Contraceptives with
Novel Delivery Systems
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Transdermal contraceptive patch
Vaginal contraceptive ring
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Long-Acting Contraceptives
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Subdermal etonorgestrel implants
Depot medroxyprogesterone acetate (MPA)
Intrauterine devices
Spermicides
Barrier devices
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Condoms: male and female
Diaphragm
Cervical cap
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Drugs for Medical Abortion
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Mifepristone (RU 486) with misoprostol
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Blocks uterine progesterone receptors
Adverse effects
• Bleeding
• Cramping
• Nausea
• Vomiting
• Diarrhea
• Headache
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Drugs for Medical Abortion
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Methotrexate with misoprostol
Prostaglandins: misoprostol, carboprost,
dinoprostone
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Emergency Contraception
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Contraception implemented after intercourse
Following rape, failed contraception, or failure
to use contraception
Plan B
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2 high-dose tablets of levonorgestrel (progestin)
1 tablet within 72 hours and another 12 hours later
Alternatives to Plan B
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