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27 Cards in this Set
- Front
- Back
Women Obtaining Abortions Who Reported Contraceptive Use, by Year
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1987= 51%
1994= 58% 2000= 54% |
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emergency contraception background
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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 |
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If Plan B is taken within 72 hours of unprotected intercourse, it can reduce the chance of pregnancy by approximately how much?
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90%
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emergency contraception
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“A therapy for women who have had unprotected sexual intercourse, including sexual assault.” –ACOG
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defining EC
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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 |
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contraception
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Method used to prevent pregnancy
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abortion
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Spontaneous or induced termination of pregnancy
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contraception methods
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hormonal
barrier EC? |
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abortion
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medical RU-486
surgical |
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EC vs Abortificient
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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 |
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EC vs. Abortifacient
possible mechanism |
Preventing/delaying ovulation
Interfering with fertilization (Changes in cervical mucous) **Interfering with implantation ** EC does not affect an existing pregnancy |
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EC is taken after unprotected sex
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Most effective within 24 hours
Is recommended within 72 hours Can be used up to 120 hours |
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Three options for EC
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Plan B or Plan B One-step (FDA approved- Progestin only option)
Yuzpe method (Combination estrogen and progestin) Copper IUD insertion |
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Plan B: Progestin-Only EC
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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 |
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Plan- B
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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) |
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Plan - B
side effects |
Nausea- 25%
Vomiting- 5% |
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Yuzpe regimen
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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 |
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Copper IUD for EC
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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 |
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patient counseling for EC
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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 |
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Controversies with EC
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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 |
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In the News- Refusal by Pharmacists to Dispense Emergency Contraception
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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 |
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Pharmacist's code of ethics
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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 |
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Pharmacist's right of refusal
arguments in favor |
Pharmacists can and should exercise independent judgment
Professionals should not forsake their morals as a condition of employment Conscientious objection is part of democracy |
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Pharmacist's right of refusal
arguments against |
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 |
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American Pharmacists Association (APhA) Policy on Pharmacist Conscience Clause
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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. |
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OTC Plan B and pharmacies
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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 |
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Pharmacist's role
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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!! |