Phar 461 - Non Oral Contraceptives (Part 1/2)

Front 1

What are the various contraceptive methods and devices used by Canadians today?

Back 1

1) Male Condoms

2) Oral Contraceptives

3) Withdrawal method

4) Male Sterilization

5) Female Sterilizations

6) Rhythm Method

7) Contraceptive Film

Front 2

What is the chance of pregnancy with no method of contraception?

Back 2

85% per year

Front 3

What are the trends in birth rates and pregnancy outcomes in Canada?

Back 3

Birth rates began to greatly decline in 1960's, and continued to decline through the last half of the 20th Century until 2000. After 2000 they slowly began to increase.

Birth rates have declined dramatically in women under the age of 30 but have risen in women in their 30's and for the first time in 2005, women aged 30-34 accounted for the largest proportion of births in Canada and continue to do so.

Teen pregnancy rate is significantly lower than the US, England and Wales.

Front 4

What are the trends in Abortion rates in Canada?

Back 4

in 1997 induced abortion rate peaked and was most common outcome of teen pregnancy. The rates have declined in general since 1997,

By 2013 # of IA were lower than they were in 1990. Overall abortion rates is currently lower than other developed countries

Front 5

What is the effect of age on Fertility?

Back 5

Fertility does decline rapidly with age, especially after the age of 35.

Front 6

What are the uses of Lubricants and Moisturizers?

Back 6

1) Relieve vaginal dryness associated with meds and low estrogen levels during peri-menopause, menopause, post partum period

2) Reduces friction with genital tissues

3) Reduces risk of condom breakage and increase comfort during sexual intercourse

Front 7

What are the types of Lubricants?

Back 7

1) Water

2) Oil

3) Silicon

Front 8

Why are Oil based lubricants not recommended?

Back 8

1) Petroleum based and other oils destroy latex upon contact with condoms, diaphragms and the protective coatings around some IUDs

2) Oils can be irritating, difficult to remove and coat the inside of the vagina/rectum providing a breeding ground for pathogenic bacteria

Front 9

What are the components of Water based Lubricants?

Back 9

1) Glycerin

2) Hydroxyethyl Cellulose

3) Proylene Glycol

Front 10

What are popular brands of Water based Lubricants?

Back 10

KY Jelly, Kama Sutra, Aqualube, Astroglide, ID and Wet

Front 11

What are the popular brands of Silicon Lubricants?

Back 11

KY Intrigue, ID Millenium, Jo, Sliquid and Wet Platinum

Front 12

What are the advantages of Water based Lubricants?

Back 12

1) Relative Low Cost

2) Easily washes away with water

3) Most widely available on market

Front 13

What are the advantages of Silicon based Lubricants?

Back 13

1) Ideal for underwater

2) Constant reapplication not necessary

3) Available in variety of consistencies

Front 14

What are the disadvantages of Water based Lubricants?

Back 14

1) Glycerin may exacerbate yeast infections

2) Tendency to dry out during use

3) Incompatible with sexual activity occurring in water

Front 15

What are the disadvantages of Silicon based Lubricants?

Back 15

1) May leave an oily residue on skin/fabric

2) More expensive

3) Not all silicon products compatible with Latex

Front 16

What are the differences between Vaginal Lubricants and Vaginal Moisturizers?

Back 16

1) Lubricant is not absorbed into the skin, but moisturizer is absorbed into the skin

2) Onset of Lubricant is immediate but the moisturizers is delayed onset

3) Duration of action of Lubricant is temporary but moisturizer is 3-4 days

Front 17

When is the Vaginal Lubricant appropriate for?

Back 17

Midlife women with issues of vaginal dryness only associated with sexual activity

Front 18

When is the Vaginal Moisturizer appropriate for?

Back 18

Midlife women with issues of vaginal dryness not limited to sexual activity

Front 19

"Barrier methods are the ONLY methods that help to prevent transmission of STIs" True or False?

Back 19

TRUE

Front 20

What are the Barrier methods of Contraception?

Back 20

1) Spermicides

2) Male Condoms

3) Female Condoms

4) Diaphragm & Cervical Cap

5) Contraceptive Sponge

Front 21

What is the failure rate of Spermicides?

Back 21

15-29%

Front 22

What is the failure rate of Male Condoms?

Back 22

2-15%

Front 23

What is the failure rate of Female Condoms?

Back 23

5-21%

Front 24

What is the failure rate of Diaphragm?

Back 24

6-16%

Front 25

What is the failure rate of Cervical Cap?

Back 25

14-29%

Front 26

What is the failure rate of Contraceptive Sponge?

Back 26

9-20% (less effective in parous women [i.e. given birth before] 20-24%)

Front 27

What is the failure rate of Female Sterilization?

Back 27

0.50%

Front 28

What is the failure rate of Male Sterilization?

Back 28

0.15%

Front 29

What is the MOA of Spermicides as a barrier method?

Back 29

Spermicides act as Surfactants that destroy the sperm cell membrane by altering the lipid layer so that the spermatozoon becomes permeable and swells with breakage of plasma and acrosomal membranes

Front 30

What are the components of Spermicides formulation?

Back 30

1) Nonoxynol-9

2) Lactic Acid

3) Menfegol

Front 31

"N-9 spermicides are available without Rx in foams, jellies and films" True or False?

Back 31

TRUE

Front 32

What are the advantages of Foams?

Back 32

Disperses quickly and effective immediately

Front 33

What are the advantages of Jellies?

Back 33

Can be used for lubrication and effective immediately

Front 34

What are the advantages of Film?

Back 34

Discreet and easy to carry,

Not as messy as other dosage forms.

Front 35

What are the disadvantages of Foams?

Back 35

Messy

Front 36

What are the disadvantages of Jellies?

Back 36

Leakage is a problem; only available on internet

Front 37

What are the disadvantages of Film?

Back 37

Needs 15mins to melt and disperse to become effective

Front 38

"Foams, Jellies and Films are all effective up to 3 hours following insertion" True or False?

Back 38

False; Foams and Jellies are effective 1hr following insertion while Film is effective up to 3 hours following insertion

Front 39

What is ContraGel Green?

Back 39

Marketed as a green, natural alternative to N-9 spermicides.

THE ONLY GEL ON Pharmacy shelves

Front 40

What is the MOA of ContraGel Green?

Back 40

Some evidence that lactic acid reduces pH of vagina reducing sperm mobility

Front 41

What are the indications for Spermicides?

Back 41

Recommended as an adjunct with other methods of contraception and are important contributors to the efficacy of the contraceptive device (sponge, male condom, diaphragm and cervical caps)

Front 42

What are the main concerns with Spermicides?

Back 42

1) N-9 spermicides may increase genital irritation or cause epithelial disruption leading to easier transmission of HIV and other STIs

2) Used N-9 spermicides are associated with increased risk of E.coli UTIs (due to alteration of vaginal flora)

3) Women who are uncomfortable touching their genital area will be uncomfortable using spermicides

4) High failure rate, should not be used alone

Front 43

What is the Invisible Condom?

Back 43

A liquid gel containing microbicides and surfactants that hardens when exposed to body temperatures and then breaks down and liquifies after several hours

Front 44

What are the counselling points for spermicide use?

Back 44

1) Must be inserted high into the vagina to cover the cervix before intercourse

2) Use the applicator provided

3) Wait recommended time between insertion and intercourse

4) Insert additional spermicide with EVERY act of intercourse

5) DO NOT wash away the spermicide or douche for at least 6 hours after sexual intercourse

Front 45

What are the advantages of Spermicides?

Back 45

1) 90-99% effective if combined with condoms, diaphragms/caps

2) Widely available

3) Inexpensive and convenient to carry and use

4) Helps lubricate the vagina

5) Safe to use when menstruating

Front 46

What are the disadvantages of Spermicides?

Back 46

1) only 75-80% effective in preventing pregnancy when used alone

2) Loses effectiveness after about 30-60mins (second dose required if intercourse has not occurred)

3) Allergic reactions to chemicals

4) Does not provide adequate protection against STIs

5) Increased risk of UTIs

6) Genital irritation could lead to easier transmission of HIV

7) May have unpleasant odor/taste

Front 47

What are the indications for Male Condoms?

Back 47

1) Prevention of Pregnancy

2) Prevention of STI & Cervical Dysplasia

Front 48

What are the four types of Male Condoms?

Back 48

1) Latex

2) Polyurethane

3) Polyisoprene

4) Lambskin

Front 49

What are the advantages of Latex Condoms?

Back 49

Cheap (0.50-1.00$ per condom),

Most popular type

Front 50

What are the disadvantages of Latex Condoms?

Back 50

Cannot be used by those sensitive/allergic to latex or with oil based lubricants

Front 51

What are the advantages of Polyurethane Condoms?

Back 51

1) Transmits more heat, more sensitive

2) Can be formulated to feel thinner than they actually are

3) Less Constricting fit

4) More resistant to detoriation

5) Compatible with oil based lubricants

6) Can be used by those allergic to latex

Front 52

What are the disadvantages of Polyurethane Condoms?

Back 52

1) More expensive

2) Higher frequency of breakage and slippage

Front 53

"Latex condoms offer better protection against pregnancy than Polyurethane" True or False?

Back 53

TRUE

Front 54

What are brands of Polyurethane male condoms?

Back 54

Durex Avanti, Trojan Supra Bareksin

Front 55

What are the advantages of Polyisoprene Condoms?

Back 55

1) Similar to latex in terms of cost and preventing pregnancy & transmission of STIs but fewer medical events

2) Similar to Polyurethane in terms of warm feel

3) More stretchy & resistant to breakage than Polyurethane

Front 56

What are common brands for Polyisoprene Condoms?

Back 56

Lifestyles SKYN, Durex brands

Front 57

What are the disadvantages of Lambskin Condoms?

Back 57

1) $3-4 each

2) Not recommended because lack of protection against STIs

3) Cannot be used by those with a lanolin sensitivity

Front 58

What are the instructions for using a Condom? (10)

Back 58

1) Put a drop or two of water based lubricants inside the condom

2) Place the rolled condom over the tip of the penis, leaving a half-inch space at the tip of the condom to collect semen

3) If NOT CIRCUMCISED pull back the foreskin before rolling on the condom

4) Pinch the air out of the reservoir tip with one hand

5) Unroll the condom over the penis with the other hand

6) Smooth out any air bubbles

7) Lubricate the outside of the condom

8) Remove penis slowly from the vagina after ejaculation before penis softens. Hold the rim of the condom against the base of the penis to prevent spillage

9) Throw condom away - Do NOT RE-USE

10) Wash the penis with soap and water before further contact

Front 59

What are the common causes of Condom Breakage?

Back 59

1) Rough Handling

2) Use of Oil based lubricants

3) Incorrect storage & usage after expiry date

Front 60

What do you counsel a patient to do if the Condom breaks?

Back 60

1) Penis should be withdrawn quickly and a new condoms replaced

2) Immediately insert spermicidal foam or gel if available. If NOT available then wash both penis and vagina with soap and water (DO NOT DOUCHE)

3) Emergency Contraceptive within 120 hours -recommended