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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 30, Contraception.
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KEY CONCEPTS
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Unintended pregnancy is a public health issue. A majority of unintended pregnancies that occur are due to inconsistent use or nonuse of contraceptives.
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Contraception implies the prevention of pregnancy.
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The following must be considered when selecting a contraceptive method: the effectiveness of the method, the noncontraceptive benefits and side effects of the method, attitude of the patient and of the sexual partner toward a contraceptive method, the ability to use the method correctly (which may alter the effectiveness of the method), and the ability to pay for the method.
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Patient-specific factors (eg, frequency of intercourse, age, smoking status, desire for return to fertility, concomitant diseases, medications, and drug–drug interactions) must be evaluated when selecting a contraceptive method.
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A variety of contraceptive methods are available. Nonhormonal methods include fertility awareness, barriers, spermicides, and the copper intrauterine device. Hormonal methods include estrogen/progestin products or progestin-only methods.
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Adverse effects or difficulties in using the selected method should be monitored carefully and managed in consideration of patient-specific factors.
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Some medications may alter the effects of hormonal contraceptives or vice versa; therefore, a patient’s concomitant medications should be assessed for drug–drug interactions with hormonal contraceptives.
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Accurate and timely counseling on the management of missed doses is critical for contraceptive effectiveness.
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Counseling on the optimal use of the contraceptive method and providing strategies for minimizing sexually transmitted infections/diseases (STIs/STDs) must be provided to all patients being initiated on contraceptives and for those also using contraception on an ongoing basis.
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Emergency contraception (EC) may prevent pregnancy after unprotected intercourse or when regular contraceptive methods have failed.
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Mifepristone, misoprostol, and methotrexate may be used in regimens for medical abortion.
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Patient Care Process for Contraception

Collect
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Patient characteristics (eg, age, sex, date of last menstrual period, pregnant, recently postpartum, breastfeeding, desire for pregnancy/return to fertility)
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Patient medical history (personal and family)
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Medication allergies
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Social history (eg, tobacco/ethanol use, relationships, sexual history)
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Current medications including over-the-counter (OTC), herbal products, dietary supplements
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Previous or current use of contraceptives
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Objective data: blood pressure (BP), height, weight
Assess
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Pregnancy status
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Effectiveness of previous contraceptive methods used (Tables 18-1 and 18-2)
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Blood pressure
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Weight and optimal method for use
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Precautions and contraindications to various types of contraceptives utilizing the CDC Medical Eligibility for Contraceptive Use, 2016 (see Table 18-6)
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Venous thromboembolism (VTE) risk factors (eg, recent surgery, plaster casting of lower extremity, cancer, prolonged immobility, recent hospitalization, recently postpartum)
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Drug interactions with various forms of contraception (see Table 18-6 for a select listing of drug interactions)
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Patient ability/willingness to use, adhere, or pay for various forms of contraception (Tables 18-1 and 18-2)
Plan*