YAFI Online Programming // Disease State Management and Drug Therapy

Changing Perspectives on Contraceptives

The Pharmacist's Guide to Prescribing and Counseling on Birth Control 

Educational Objectives

After participating in this activity, pharmacists will be able to:

  • Discuss methods of birth control, including hormonal contraceptives
  • Identify appropriate options for contraception based on patient characteristics
  • Distinguish each FDA-approved contraceptive product by the symptoms they address and side effects they may produce
  • Maximize the pharmacist's role in identifying birth control misuse, prescribing appropriate hormonal contraceptives, and counseling patients accordingly

After participating in this activity, pharmacy technicians will be able to:

  • Discuss the basic facts about hormonal birth control
  • Acquire reputable sources for patients who have questions about birth control
  • Recognize over-the-counter and prescription drugs that may affect birth control effectiveness
  • Infer when to refer patients to the pharmacist for recommendations

Session Offered

Release Date: December 15, 2018

Expiration Date: December 14, 2021

Course Fee

$7 for pharmacists

$4 for pharmacy technicians

Session Codes

18YC87-TAB62 Pharmacist

18YC87-YXZ84 Pharmacy Technician

Accreditation Hours

2.0 hours of CE

Abstract

About 28% of women of reproductive age do not have reasonable access to prescription contraceptives. Seven states and the District of Columbia currently allow pharmacists to prescribe contraceptives to women; this number is growing. Combined hormonal contraceptives (CHC) are available in many forms. Progestin-only pills are also available for women with medical conditions excluding them from CHC use or unable to tolerate estrogens. Pharmacists can make recommendations based on patients' needs and experiences and prescribe where state law allows. Additional contraceptive options are available over-thecounter. Pharmacy teams are positioned to recognize women who would benefit from referral to another healthcare provider for longer-acting alternatives, and those needing over-the-counter or emergency contraceptives. Hormonal contraceptives rely heavily on adherence; missed doses can lead to birth control failure, resulting in unintended or mistimed pregnancy. Pharmacists should be able to counsel women on what to do in the event of a missed dose and recommend emergency contraceptives in the event of contraceptive failure. With proper education and training, pharmacy teams will be comfortable with prescribing hormonal contraceptives from the pharmacy where allowable.

Accreditation Statements

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission

ACPE UAN:
0009-0000-18-087-H01-P
0009-0000-18-087-H01-T

Grant funding: None

Cost: $7 for pharmacists, $4 for pharmacy technicians

Initial Release Date: December 15, 2018
Expiration Date: December 14, 2021

To obtain CPE credit, visit the UConn Online CE Center

Use your NABP E-profile ID and the session code 18YC87-TAB62 for pharmacists or 18YC87-YXZ84 for pharmacy technicians to access the online quiz and evaluation.

First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Mon- itor within 72 hours of completing the requirements.

For questions concerning the online CPE activities, email joanne.nault@uconn.edu

Faculty

Kelsey Giara, Pharm.D, is a community pharmacist at CVS and freelance medical writer based in Pelham, New Hampshire.

Faculty Disclosure

Dr. Giara has no actual or potential conflicts of interest associated with this article.

Disclosure of Discussions of Off-label and Investigational Drug Use

This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Content

Introduction

More than 67 million women of reproductive age live in the United States (U.S.). Of those women, 19 million lack reasonable access to a public clinic with the ability to provide prescription contraceptives.1 The Centers for Disease Control and Prevention (CDC) reports that hormonal methods requiring a prescription (pill, patch, ring, and injection) prevent pregnancy more effectively than those available over-the-counter (male/female condom, spermicide) and methods such as withdrawal or fertility-awareness.2 Access to effective birth control prevents unintended and mistimed births. Between 1991 and 2015, the teen birth rate dropped 64%, saving the U.S. $4.4 billion. If all women of reproductive age had access to effective methods of contraception to avoid unplanned pregnancy and childbearing, the U.S. could save an estimated additional $1.9 billion per year.1

Pharmacists are access points to contraceptives. Outlined in Table 1, seven states and the District of Columbia allow pharmacists to prescribe self-administered contraceptives. This number is growing; Utah passed legislation in March 2018 to allow pharmacists to prescribe birth control and Maryland will follow suit when its law goes into effect in 2019. All of these states allow pharmacists to prescribe, but vary in other details (age requirement, length of supply, etc.). For example, in Oregon and Colorado, individuals under 18 years old must obtain their first prescription from a physician before a pharmacist can authorize refills.3

With this growing trend, pharmacists should be prepared to prescribe hormonal contraceptives where state law allows. They should be familiar with hormonal effects on the menstrual cycle, side effects of those drugs, and possible interactions with other medications or conditions. Pharmacists and pharmacy technicians should also be familiar with contraceptive options available overthe-counter, and long-term options that require referral to another healthcare provider.

References

Full List of References

1. Power to Decide. Access to Birth Control. Available at: https://powertodecide.org/what-we-do/access/access-birthcontrol. Accessed June 10, 2018.

2. Centers for Disease Control and Prevention. Contraception: How effective are birth control methods? Available at: https://www.cdc.gov/reproductivehealth/contraception/index. htm. Accessed June 10, 2018.

3. Kaiser Family Foundation. Oral Contraceptive Pills. Available at: https://www.kff.org/womens-health-policy/fact-sheet/oralcontraceptive-pills/. Accessed June 8, 2018.

4. DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. New York: McGraw-Hill Medical, 2008.

5. Knudtson J, McLaughlin JE. Merck Manual: Menstrual Cycle. Available at: https://www.merckmanuals.com/home/women-shealth-issues/biology-of-the-female-reproductivesystem/menstrual-cycle. Accessed June 30, 2018.

6. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep 2016;65(No. 4).

7. [No author] Choice of Contraceptives. Med Lett Drugs Ther. 2018 Oct 8;60(1557):161-168.

8. Lawrie TA, Helmerhorst FM, Maitra NK, et al. Types of progestogens in combined oral contraception: effectiveness and side-effects. Cochrane Database Syst Rev 2011;5:CD004861.

9. Sitruk-Ware R. New progestagens for contraceptive use. Hum Reprod Update 2006;12:169-78.

10. Ortho Evra (norelgestromin/ethinyl estradiol transdermal system) package insert. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 2001.

11. Nuva Ring (etonogestrel/ethinyl estradiol vaginal ring) package insert. Whitehouse Station, NJ: Merck & Co., Inc; 2001.

12. Depo-Provera Contraceptive Injection (medroxyprogesterone acetate injectable suspension) package insert. Kalamazoo, MI: Pharmada & Upjohn Company; 2002.

13. Cameron ST, Glasier A, Johnstone A. Pilot study of home self-administration of subcutaneous depo-medroxyprogesterone acetate for contraception. Contraception 2012;85:458-64.

14. Shartzer A, Courtot B, McMorrow S, Benatar S, Kenney G. Knowledge Gaps and Misinformation about Birth Control Methods Persist in 2016. Urban Insitute. Available at: https://www.urban.org/research/publication/knowledge-gapsand-misinformation-about-birth-control-methods-persist-2016. Accessed June 6, 2018.

15. [No author]. The American College of Obstetricians and Gynecologists. Long Acting Reversible Contraception: Intrauterine Device and Implant. Available at: https://www.acog.org/Patients/FAQs/Long-Acting-ReversibleContraception-Intrauterine-Device-andImplant?IsMobileSet=false. Accessed November 17, 2018.

16. Hardeman J, Weiss BD. Intrauterine Devices: an update. Am Fam Physician. 2014 Mar 15;89(6):445-50.

17. World Health Organization. Nonoxynol-9 ineffective in preventing HIV infection. Available at: http://www.who.int/mediacentre/news/notes/release55/en/. Accessed November 30, 2018.

18. [No author]. Cleveland Clinic. Toxic Shock Syndrome. Available at: https://my.clevelandclinic.org/health/diseases/15437- toxic-shock-syndrome. Accessed November 11, 2018.

19. Brand versus generic oral contraceptives. ACOG Committee Opinion No. 375. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;110:447–8. Available at: https://www.acog.org/Clinical-Guidance-andPublications/Committee-Opinions/Committee-on-GynecologicPractice/Brand-Versus-Generic-Oral-Contraceptives. Accessed November 17, 2018.

20. Nelson A, Cohen S, Galitsky A, et al. Women’s perceptions and treatment patterns related to contraception: results of a survey of US women. Contraception. 2018;97: 256-263.

21. Ortho Micronor (norethindrone) package insert. Raritan, NJ: Ortho-McNeil Pharmaceutical, Inc; 1998.

22. Fok WK, Blumenthal PD. Update on emergency contraception. Curr Opin Obstet Gynecol. 2016 Dec;28(6):522-529.

23. Plan B One-Step (levonorgestrel) package insert. Pomona, NY: Duramed Pharmaceuticals, Inc.; 1982.

24. [No author]. Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use. Available at: https://www.cdc.gov/reproductivehealth/unintendedpregnanc y/pdf/legal_summary-chart_english_final_tag508.pdf. Accessed June 30, 2018.