This document summarizes various hormonal contraceptive methods. It discusses oral contraceptive pills including combination and progestin-only pills. It describes injectable and implantable contraceptives such as DMPA and Norplant. Emergency contraception methods like Plan B are mentioned. The mechanisms of action, effectiveness, side effects, and contraindications are summarized for each method. Non-contraceptive health benefits are also noted such as reduced cancer risk. Research into male hormonal contraception is described though challenges in reversibly inhibiting spermatogenesis without affecting libido or hormones are acknowledged.
Hormonal contraception (Combined Hormonal Contraceptives)Naji Majid Ahmed
Combined Hormonal Contraceptives :
includes:
Combined Oral Contraceptives (Pills)
Contraceptive vaginal ring
Transdermal patch
2. Progestogen Only Contraceptions(POC):
includes:
Progestogen-only pill(POP)
Implant
Progestogen-only injectable
Progestogen-releasing intrauterine system(LNG–IUS)
Missed pills:
If one pill is missed, anywhere in the pack (ie more than 24 and up to 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
The rest of the pack should be taken as usual.
No additional contraception is needed.
The seven-day break is taken as normal.
Emergency contraception is not needed if just one pill has been missed. However, it should be considered if other pills have been missed recently, either earlier in the current packet, or at the end of the previous packet.
Missed pills:
If two or more pills are missed (ie more than 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
Any earlier missed pills should be left.
The rest of the pack should be taken as usual and additional precautions (eg, condoms or abstinence) should be taken for the next seven days.
The next step then depends on where in the packet the pills are missed:
The next step then depends on where in the packet the pills are missed:
If the pills are missed in the first week of a pack (pills 1-7): emergency contraception should be considered if the patient had unprotected sex in the pill-free interval or the first week of the pill packet. She should finish the packet and have the usual pill-free interval.
If the pills are missed in the second week of a pack (pills 8-14): there is no need for emergency contraception as long as the pills in the preceding seven days have been taken correctly. The packet should be finished and the usual pill-free interval taken.
If the pills are missed in the third week of a pack (pills 15-21): the next pack of pills should be started without a break - ie the pill-free interval is omitted. If taking a packet with dummy/placebo pills, these should be discarded, and the new packet started. Emergency contraception is not required.
If more than seven pills are missed, the woman should start again as if starting for the first time. (Exclude pregnancy, and start a new pack on the first day of the next menstrual period.)
the presentation includes a definition of oral contraceptives, type of oral contraceptives, detail description of both types with its mode of action and potential beneficial and unwanted effects also include pharmacokinetics of oral contraceptives and knowledge of emergency contraceptives
Hormonal contraception (Combined Hormonal Contraceptives)Naji Majid Ahmed
Combined Hormonal Contraceptives :
includes:
Combined Oral Contraceptives (Pills)
Contraceptive vaginal ring
Transdermal patch
2. Progestogen Only Contraceptions(POC):
includes:
Progestogen-only pill(POP)
Implant
Progestogen-only injectable
Progestogen-releasing intrauterine system(LNG–IUS)
Missed pills:
If one pill is missed, anywhere in the pack (ie more than 24 and up to 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
The rest of the pack should be taken as usual.
No additional contraception is needed.
The seven-day break is taken as normal.
Emergency contraception is not needed if just one pill has been missed. However, it should be considered if other pills have been missed recently, either earlier in the current packet, or at the end of the previous packet.
Missed pills:
If two or more pills are missed (ie more than 48 hours late):
The last pill missed should be taken now, even if it means taking two pills in one day.
Any earlier missed pills should be left.
The rest of the pack should be taken as usual and additional precautions (eg, condoms or abstinence) should be taken for the next seven days.
The next step then depends on where in the packet the pills are missed:
The next step then depends on where in the packet the pills are missed:
If the pills are missed in the first week of a pack (pills 1-7): emergency contraception should be considered if the patient had unprotected sex in the pill-free interval or the first week of the pill packet. She should finish the packet and have the usual pill-free interval.
If the pills are missed in the second week of a pack (pills 8-14): there is no need for emergency contraception as long as the pills in the preceding seven days have been taken correctly. The packet should be finished and the usual pill-free interval taken.
If the pills are missed in the third week of a pack (pills 15-21): the next pack of pills should be started without a break - ie the pill-free interval is omitted. If taking a packet with dummy/placebo pills, these should be discarded, and the new packet started. Emergency contraception is not required.
If more than seven pills are missed, the woman should start again as if starting for the first time. (Exclude pregnancy, and start a new pack on the first day of the next menstrual period.)
the presentation includes a definition of oral contraceptives, type of oral contraceptives, detail description of both types with its mode of action and potential beneficial and unwanted effects also include pharmacokinetics of oral contraceptives and knowledge of emergency contraceptives
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
To overcome from unplanned pregnancy issues Buy Mifepristone pills are available online at pharmacy stores. Mifepristone is the FDA approved pill used by the women to terminate the pregnancy without any side effect.
For more visit : http://www.mtpabortionpill.com/mifepristone.html
short presentation an all the oral as well as injectable hormonal contraceptives, inclusive of their mechanism of actions , adverse effects and advantages.
Birth control pills (oral contraceptives) are prescription medications that prevent pregnancy.
Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).
Combined pill ,phased pill, post cotal pilla and mini pill.
Advantages and disadvantages with a note on adverse effects and contraindications of oral contraceptives with a note synthetic agents.
To overcome from unplanned pregnancy issues Buy Mifepristone pills are available online at pharmacy stores. Mifepristone is the FDA approved pill used by the women to terminate the pregnancy without any side effect.
For more visit : http://www.mtpabortionpill.com/mifepristone.html
short presentation an all the oral as well as injectable hormonal contraceptives, inclusive of their mechanism of actions , adverse effects and advantages.
Birth control pills (oral contraceptives) are prescription medications that prevent pregnancy.
Birth control (contraceptive) medications contain hormones (estrogen and progesterone, or progesterone alone).
Depo Provera Contraceptive Injection (Medroxyprogesterone Acetate) is used to prevent pregnancy. This medicine works by preventing the growth and release of an egg (ovulation) during the menstrual cycle.
Gossypol is a polyphenolic aldehyde that is produced in the cotton plant. Since long it has been reported
to possess antiproliferative activity against a variety of cancer cell lines as well as tumor regression in
animal models. However, the toxicity of gossypol does not permit it to be an effective antitumor agent.
One of the derivatives of gossypol to show promising results is apogossypolone. For example, it has been
shown to specifically target tumor growth in hepatocellular carcinoma xenograft in nude mice without
causing any damage to normal tissue.
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This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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4. Contraceptives in current use
• Combination oral contraceptive pills: containing a
combination of estrogen+progestins in varying
amounts or in phased regimens (monophasic,
biphasic, triphasic)
• Minipills (progestin only pills)
Containing progesterone preparation alone
• Postcoital (morning after)pills or emergency
contraceptive pills.
• Centchroman: nonhormonal estrogen receptor
antagonist.
6. Oral contraceptives
• Most popular and effective method with 99-
99.5 % success rate.
Estrogen Progestin Name
Ethinyl estradiol(30 µg) Norgestrel(300 µg) MALA D
Ethinyl estradiol(30 µg) Levonorgestrel(150 µg) OVRAL L
Ethinyl estradiol(30 µg) Desogestrel(150 µg) Desogen®
7. Monophasic combination pills
• No phasic increase or decrease in the
estrogen/progestin content during 21 days of pill
administration.
• The first pill is taken on the 5th day after the start
of menses.
• Thereafter, one pill is to be taken each day
consecutively for 21 days.
• Then , next 7 days are pill free period and the
next course starts again after the 5th day of
menses.
8. Biphasic pills
• Fixed dose of estrogen for 21 days but with
increasing doses of progesterone during two
successive phases, i.e., from the day 1-10 and
11-21.
Estrogen Progesterone
Ethinyl estradiol (35 µg) Norethindrone (500 µg) From day 1-10
Ethinyl estradiol (35 µg) Norethindrone (1000 µg) From day 11-21.
9. Triphasic pills
• Higher dose of estrogen near midcycle but
increasing doses of progesterone for three
successive phases i.e., for days 1-6, 7-11, 12-
21 days.
Ethinyl estradiol (30 µg) Norgestrel (50 µg) From day 1-6
Ethinyl estradiol (40 µg) Norgestrel (70 µg) From day 7-11
Ethinyl estradiol (30 µg) Norgestrel (125µg) From day 12-21
10. OC pills
• Most branded preparations provide packet of
21 tablets only.
• Others provide a packet of 21+7 extra pills,
which contain either lactose or some iron
preparation.
11. • If the woman misses one pill some day, she
should take 2 pills next day and continue one
pill a day as usual.
• If the pills have been missed for 2-3 days, then
the course should be stopped, mechanical
barriers like condoms, diaphragm or jelly
should be used and the next course should
start from 5th day of menses as usual.
12. Mechanism of action of OC pills
• Suppression of ovulation by inhibiting the
release of FSH and LH (mainly estrogenic
effect)
• Disruption of proliferative and secretory
phases of endometrium, reducing the chances
of implantation of ovum.
• Progestogenic effects increase the viscocity of
cervical mucus.
13. Side effects of OC pills
• Mild (no need to withdraw OC)
Estrogenic effects Progestogenic effects
Nausea Increase in apetite
Migraine Weight gain
Breast tenderness Acne
Mild oedema Hirsutism (mild)
Withdrawal bleeding which
at times fail to occur
Decrease in libido
Increase in body
temperature
14. Side effects of OC pills
• Moderate (may warrant discontinuation of
OC)
Estrogenic Progestogenic
Vertigo Breakthrough
bleeding(spotting)
Leg cramps Monilial vaginitis(urethral
dilatation and bacteriuria)
Uterine cramps Amenorrhoea (even after
stopping OC)
Precipitation of diabetes
15. Side effects of OC pills
• Severe(needs stoppage of OC)
Estrogenic Progestogenic
Thromboembolism Myocardial infarction
Cholestatic jaundice Cerebrothrombosis
Gall stones
Hepatic adenoma
16. Contraindications of OC pills(absolute)
• Thromboembolic, coronary and cerebrovascular
disease or a history of it.
• Moderate to severe hypertension;
hyperlipidemia.
• Active liver disease, hepatoma or h/o jaundice
during past pregnancy.
• Suspected/overt malignancy of genitals/breast.
• Porphyria
• Impending major surgery- to avoid postoperative
thromboembolism.
17. Contraindications of OC pills(relative)
• Diabetes
• Obesity
• Smoking
• Undiagnosed vaginal bleeding
• Age above 35 years
• Migraine
• Gall bladder disease
18. Side effects
• Estrogens- risk of endometrial ca.
• Progesterone- LDL cholesterol
• Progesterone - bone mineral density.
20. If pregnancy occurs during the use of
OC pills
• It should be terminated by suction-
evacuation,because there is risk of
• Malformations,
• Genital carcinoma of female offspring
• Undescended testes in male offspring
21. Minipills (progestin only pills)
• Given to those cases where estrogens are
contraindicated.
• Success rate is lower as compared to
combination pills (98.3%).
• Pills are prescribed soon after delivery and
continued without interruption.
22. Mechanism of action of progestin only
pills
• Progestins place the endometrium
prematurely to the secretory phase.
• Increase the viscosity of cervical mucus.
23. Side effects of progestin only pills
• Acne
• Hirsutism
• Amenorrhoea
24. Post coital contraception
• High dose estrogen and/or high dose
progestin.
• Two tablets of progestin levonorgestrel (750
µg each)[NORLEVO]. The first tablet must be
taken as soon as possible (within 48 hrs of the
coitus) and the second tablet taken after 12
hrs.
25. Post coital contraception
• Ethinyl estradiol (50 µg each tablet) +
Levonorgestrel (250 µg each tablet)[OVRAL].
Two such tablets are to be taken within 72 hrs
of unprotected coitus and next 2 tablets after
12 hrs.
26. Post coital contraception
• Mifepristone (antiprogestine) 600 mg single
dose taken within 72 hrs of unprotected
intercourse.
28. Centchroman (ormeloxifene)
• Nonsteroidal estrogen antagonist
• Developed at CDRI India.
• Oral contraceptive under the brand name
SAHELI.
• Dose 30 mg
• Taken twice in a week for first 3 months and
then once a week subsequently.
29. Centchromin
• Suppressed proliferative stage of
endometrium.
• If the menstrual cycle is prolonged for more
than 15 days, pregnancy should be ruled out.
30. Injectable contraceptives
• Depot medroxyprogesterone acetate (DMPA; Depo
Provera)
• Mode of action: same as minipills
• Longer acting progesterone derivative
• Injected i.m.
• Dose 150 mg every 3 months
• Useful in those
• where compliance is a problem,
• patients having heavy menstrual
bleeding
• in those for whom estrogens are
contraindicated
31. Injectable contraceptives
• Side effects: irregular bleeding ending up in
amenorrhoea and anovulation.
• Osteoporosis may occur on prolonged use as
Gn suppression may cause low estrogen
levels.
• Wight gain
• Increased risk of breast cancer.
• If pregnancy occurs it should be terminated to
avoid risk of congenital deformities.
33. Norplants
• A set of 6 capsules each filled with 36 mg of
levonorgestrol (total 216 mg)for subcutaneous
implantationon the inside of upper arm.
• If kept implanted, 1 set of 6 tubes remain
effective for 5 years.
• The contraceptive effects are readily reversible
with removal of implants.
• Mechanism of action: same as minipills.
34. Intrauterine inserts
• Levonorgestrol
• Released at the rate of 20µg/day.
• For a period of 5 years.
• It acts locally hence systemic side effects are
less.
• Return of fertility is immediate after removal
of these progestaserts.
35. Contraceptive failure
• Enzyme inducers- phenytoin, phenobarbitone.
• Suppression of intestinal microflora-
tetracycline, ampicillin, etc.,- no deconjugation
of estrogens excreted in bile- enterohepatic
circulation does not occur- blood levels fall.
36. Non contraceptive health benefits of
oral contraceptives
• The estrogen-progesterone pill is associated
with reduced risk of functional ovarian cysts,
ovarian cancer, endometrial cancer, fibrocystic
breast disease, bleeding uterine fibroids.
• The menses become more regular, with
reduced blood loss, less premenstrual tension
and dysmennorhoea.
37. Non contraceptive health benefits of
oral contraceptives
• Lower incidence of ectopic pregnancy,
endometriosis, and pelvic inflammatory
disease.
• Combined pills with newer progestins
e.g.,desogestrel are more safe for women who
suffer from weight gain, acne, hirsutism or
raised LDL-c because desogestrel lacks
androgenic side effects.
38. Non contraceptive health benefits of
oral contraceptives
• A combination pill of estrogen with an anti
androgen (cyproterone acetate) is useful for
treating acne and hirsutism.
39. Hormonal contraception for Men
• Major issues
• Spermatogenesis takes 64 days. The drugs which
even completely inhibits spermatogenesis will
take a long latent period to produce infertility.
Similarly, return of fertility will be slow.
• Gonadotropin suppression inhibits testesterone
secretion as well, resulting in loss of libido and
impotence (which is unacceptable).
40. Drugs tried for male contraception
• Antiandrogens
• Estrogens and progestins
• Androgens
• Superactive Gn RH analogues
• Cytotoxic drugs
• gossypol
41. Hormonal contraception for Men
• Gossypol
• Nonsteroidal drug obtained from cotton seed.
• 20 mg/day for initial 2-3 months followed by
50-60 mg/week as a maintainance dose.
• It should not be used for more than 2 years
otherwise return of fertility may be difficult.