Self Care Exam Iii Emergency Contraception

Front 1

Women Obtaining Abortions Who Reported Contraceptive Use, by Year

Back 1

1987= 51%
1994= 58%
2000= 54%

Front 2

emergency contraception background

Back 2

Approximately 50% of pregnancies are unintended and nearly 50% of these unplanned pregnancies result in abortion

Emergency Contraception
Use may avoid 1.5 of 3 million unintended pregnancies
Preventing close to 700,000 abortions

Increased awareness among women ages 18-44 years old

Awareness among teenagers (Ages 15-17)
53% Boys
62% Girls

Physician- patient education

Front 3

If Plan B is taken within 72 hours of unprotected intercourse, it can reduce the chance of pregnancy by approximately how much?

Back 3

90%

Front 4

emergency contraception

Back 4

“A therapy for women who have had unprotected sexual intercourse, including sexual assault.” –ACOG

Front 5

defining EC

Back 5

EC is the “morning after pill”
Used as a back-up method of birth control
Combination of estrogen and progestin OR progestin alone
Can be used as a safe and effective method to prevent pregnancy when:
--Unprotected sex
--Birth control failure or misuse of method
--Forced sex

Front 6

contraception

Back 6

Method used to prevent pregnancy

Front 7

abortion

Back 7

Spontaneous or induced termination of pregnancy

Front 8

contraception methods

Back 8

hormonal
barrier
EC?

Front 9

abortion

Back 9

medical RU-486
surgical

Front 10

EC vs Abortificient

Back 10

Two possible options
EC does not cause an abortion
EC may cause an abortion
-->
Ultimately, the definition of EC is dependent on each individual’s respective beliefs

Front 11

EC vs. Abortifacient
possible mechanism

Back 11

Preventing/delaying ovulation
Interfering with fertilization (Changes in cervical mucous)
**Interfering with implantation **

EC does not affect an existing pregnancy

Front 12

EC is taken after unprotected sex

Back 12

Most effective within 24 hours
Is recommended within 72 hours
Can be used up to 120 hours

Front 13

Three options for EC

Back 13

Plan B or Plan B One-step (FDA approved- Progestin only option)
Yuzpe method (Combination estrogen and progestin)
Copper IUD insertion

Front 14

Plan B: Progestin-Only EC

Back 14

First line option
--High efficacy- 85-95% within 48 hours
--Reduced side effects compared to Yuzpe
Possible mechanism of action
--Inhibition of ovulation
--Interfering with fertilization or implantation
Recommended dose and administration

Front 15

Plan- B

Back 15

Plan B: (0.75mg)
First Dose: Take one tablet within 72 hours of unprotected intercourse
Second Dose: Take remaining tablet 12 hours after first dose
Plan B One-step: Take one tablet
(1.5mg)

Front 16

Plan - B
side effects

Back 16

Nausea- 25%
Vomiting- 5%

Front 17

Yuzpe regimen

Back 17

First line option
Highest efficacy within 24 hours- 77%
Common side effects
Nausea- 50%
Vomiting- 25%
Possible mechanism of action
Inhibition of ovulation
Interfering with fertilization or implantation
Recommended dose and administration

Front 18

Copper IUD for EC

Back 18

Second line option
Estimated failure rate 0.1% (based on 8,400 post-coital insertions)
Mechanism(s) of action
Impairs fertilization
Alters sperm motility and integrity
Impairs implantation

Front 19

patient counseling for EC

Back 19

How to take EC
Expected side effects
Approximately 98% bleed within 21 days of EC
If no menses after 3 weeks, need to rule out pregnancy
Patient Education
Contraceptive use
STD Counseling
Patient follow up

Front 20

Controversies with EC

Back 20

Access to EC
Pharmacy Access (For patients < 17 or <18 depending on the state)
Nine (9) states currently allow women to obtain EC from a pharmacist without seeing a physician
WA, CA, AK, NM, HI, ME, NH, MA and VT
Availability “Behind the Counter”
Changes in Contraceptive behavior or STI rates

Pharmacist’s right to refusal

Front 21

In the News- Refusal by Pharmacists to Dispense Emergency Contraception

Back 21

Article by Wall et. al. highlighting that a pharmacist’s right to refusal is not justified

Unified response from the National Pharmacy Organizations:
--Incomplete analysis
--Contemporary pharmacy practice
--Professional deliberation

Front 22

Pharmacist's code of ethics

Back 22

A pharmacist respects the covenantal relationship between the patient and pharmacist
A pharmacist promotes the good of every patient in a caring, compassionate and confidential manner
A pharmacist respects the autonomy and dignity of each patient
A pharmacist acts with honesty and integrity in professional relationships
A pharmacist maintains professional competence
A pharmacist respects the values and abilities of colleagues and other health care professionals
A pharmacist serves individual, community and societal needs
A pharmacist seeks justice in the distribution of health resources

Front 23

Pharmacist's right of refusal
arguments in favor

Back 23

Pharmacists can and should exercise independent judgment
Professionals should not forsake their morals as a condition of employment
Conscientious objection is part of democracy

Front 24

Pharmacist's right of refusal
arguments against

Back 24

Pharmacists choose to enter the profession with duties
EC is not an abortifacient
Pharmacist’s objection will affect a patient’s health
Refusal may lead to discrimination

Front 25

American Pharmacists Association (APhA) Policy on Pharmacist Conscience Clause

Back 25

Recognizes the individual pharmacist’s right to exercise conscientious refusal and supports the establishment of systems to ensure the patient’s access to legally prescribed therapy without compromising the pharmacist’s right of conscientious refusal.

Joint statement from APhA, ACCP, ASHP and the Academy of Managed Care Pharmacists:
Pharmacists have the right to “step away” but not “stepping in the way” of patient care by providing access to a safe alternative.

Front 26

OTC Plan B and pharmacies

Back 26

Pharmacy Requirements
Plan B must be kept behind the counter
Proof of age is required for purchase- ID
If the patient doesn’t have an ID
Pharmacists are encouraged to refer the patient to a health care practitioner or clinic
No additional documentation is required by law

Front 27

Pharmacist's role

Back 27

Understanding what EC is and the options available
Be familiar with both sides of the issue
Arguments in favor vs. arguments against a pharmacist’s right to refusal
Patient confidentiality

Education
Be proactive!!