Case 1: STI Prevention
Q: FK is a 19-year-old male college student who came to the pharmacy looking for different methods of contraception. His main concern is finding a product that provides protection against both pregnancy and sexually transmitted infections (STIs). What contraceptive products should the pharmacist recommend, and what counseling points should be provided for their use?
A: The pharmacist should recommend that FK consider condoms for protection against both pregnancy and STIs. When used correctly, condoms are 87% to 98% effective at preventing pregnancy and STIs.1 For optimal protection, FK should be counseled to use condoms for the entire duration each time he engages in sexual activity, apply them according to package instructions to minimize skin-to-skin contact, and avoid oil-based lubricants, which may damage latex condoms and induce breakdown. Additionally, FK should be counseled to always assess expiration dates on condom packages, and store them in a cool, dry place away from direct sunlight and sharp objects to optimize their efficacy and limit breakdown.
Case 2: Pregnancy Tests
About the Authors
Deanna Fox, PharmD, is a PGY-2 pharmacy resident at Atlantic Health System in Morristown, New Jersey.
Kylie Helfenbein, PharmD, is a PGY-2 pharmacy resident at Atlantic Health System in Morristown, New Jersey.
Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.
Q: SG is a 28-year-old woman who is trying to start a family with her husband. She is searching for a reliable pregnancy test to keep on hand at home. SG requests counseling from the pharmacist on the use of pregnancy tests and their reliability. What counseling points should the pharmacist provide about OTC pregnancy tests?
A: The pharmacist should reassure SG that OTC urine pregnancy tests are 99% to 100% accurate due to their sensitive detection of human chorionic gonadotropin, a hormone only produced during pregnancy.2 SG should be counseled that OTC pregnancy tests should be used as soon as possible after a missed period or 3 weeks after unprotected sex for the most accurate results.2 There are many different OTC pregnancy tests, which carry unique instructions for their correct use and varied displays for positive results. To optimize results, pregnancy tests should be used according to product-specific instructions prior to the expiration date on the package.2
Case 3: OTC Contraception
Q: LR is a 24-year-old woman who inquires about a new OTC contraception product called Opill, which she saw on social media. LR wants to know if the contraception product is safe and how effective it is at preventing pregnancy. How should the pharmacist respond to LR regarding the safety and efficacy of this OTC product?
A: Opill, also known as norgestrel, is a recently FDA-approved OTC daily progestin-only contraceptive that works by thickening the cervical mucus to prevent sperm motility.3,4 Opill was approved by the FDA to help decrease barriers to accessing reliable contraceptives.5 Opill must be taken at the same time each day to be an effective contraception method. If the tablet is not taken within 27 hours of the last dose, then a backup nonhormonal contraception method should be used for at least 48 hours. A benefit of Opill is that it does not contain estrogen, which is often associated with an increased risk of thromboembolic and cardiovascular events. However, vaginal bleeding is the most common adverse effect seen with Opill. Opill must be avoided by patients who have had or have breast cancer. Additionally, Opill has multiple drug interactions, so the pharmacist should ask LR about any other medications or herbal supplements she is taking.4,5
Case 4: Emergency Contraception
Q: JS is a 17-year-old high school student who visits the pharmacy looking for an emergency contraceptive. She explains to the pharmacist that she had unprotected sex 2 days ago and is concerned about a potential pregnancy. She is also worried she will not be able to purchase anything since she is not yet 18. What emergency contraception should the pharmacist recommend?
A: The pharmacist should recommend OTC levonorgestrel 1.5 mg, which is a progestin-only emergency contraceptive that works by delaying follicular development. The American College of Obstetricians and Gynecologists recommends the use of levonorgestrel instead of prescription combined hormonal products because it is more effective and associated with less nausea and vomiting. The pharmacist should counsel JS on the time frame in which levonorgestrel can be taken, which is within 72 hours of unprotected sex but preferably as soon as possible. The pharmacist should inform JS that levonorgestrel does not have any OTC age restrictions. Adverse effects that JS should be made aware of include irregular menstrual bleeding, which typically occurs within 1 week of the expected time after using levonorgestrel. However, spotting can occur in the meantime. Additionally, the pharmacist should educate JS that if her menstrual cycle is more than 1 week late, she should take a pregnancy test.6
References
6. Practice bulletin no.152: emergency contraception. Obstet Gynecol. 2015;126(3):e1-e11. doi:10.1097/AOG.0000000000001047
