NURS 131 Plan B and Mifeprex

jasmine's version from 2016-04-18 06:07

Section 1

Question Answer
Plan B, Plan B One-Step, Next Choice (levonorgestrel emergency contraceptive) Contains the medicine levonorgestrel, a female hormone that prevents ovulation; It also causes changes in cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus; Used to prevent pregnancy after unprotected sex or failure of other forms of birth control
Plan B actions Emergency contraceptive pills are not effective if a woman is already pregnant. Plan B One-Step is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun.
Metabolism and excretion of Plan B Ethinyl estradiol and norethindrone undergo extensive first-pass hepatic metabolism. Mestranol is rapidly converted to ethinyl estradiol. Desogestrel is rapidly metabolized to 3-keto-desogestgrel, the active metabolite. Most agents are metabolized by the liver. Appoximately 45 percent of levonorgestrel and its metabolites are excreted in the urine and approximately 32 percent are excreted in feces, mostly as glucuronide conjugates
Contraindications of Plan B Hypersensitivity; pregnancy; history of thromboembolic disease (e.g., DVT PE, MI, stroke); Valvular heart disease; major surgery with extended periods of immobility; diabetes with vascular involvement; uncontrolled hypertension; history of breast, endometrial, or estrogen-dependent cancer; abnormal genital bleeding; liver disease, renal impairment, or adrenal insufficiency (risk of hyperkalemia; intrauterine anomaly, postpartum endometriosis, immunosuppression, history of ectopic pregnancy; lactation avoid use
Adverse/Side effects of Plan B Thromboembolism (risk is greatest during first 6 months of therapy or after restarting the same or different therapy); Drosperinone-containing products; pancreatitis; intrauterine levonorgestrel uterine imbedment/uterine rupture; injectable medroxyprogesterone bone loss
Drug-drug interactions of Plan B Oral contraceptive efficacy may be decreased by penicillins, chloramphenicol, barbiturates, chronic alcohol use, carbamazepine, oxcarbazepine, bosentan, felbamate, systemic corticosteroids, phenytoin, topiramate, primidone, modafinil, rifampin, rifabutin, some protease inhibitors (including ritonavir), non-nucleoside reverse transcriptase inhibitors, or tetracyclines. May increase effects/risk of toxicity of some benzodiazepines, beta blockers, corticosteroids, cyclosporine, and theophylline. Increase risk of hepatic toxicity with dantrolene (estrogen only). No formal drug-drug interaction studies were conducted with Plan B One-Step, according to FDA website (
Drug food and natural product interactions of Plan B Grapefruit juice may increase effects/risk of toxicity; concomitant use with St. John’s wort may decrease contraceptive efficacy and cause breakthrough bleeding and irregular menses
Nursing assessment of Plan B Assess BP before and periodically during therapy; Exclude the possibility of pregnancy on the basis or history and/or physical exam or a pregnancy test before administering emergency contraceptives; Acne: assess skin lesion before and periodically during therapy; Menopausal symptoms: assess vasomotor symptoms or symptoms of vulvar and vaginal atrophy due to menopause prior to and periodically during therapy; Lab test considerations: monitor hepatic function periodically during therapy
Patient/Family teaching of Plan B Instruct patient to take emergency contraceptive as directed; Inform patient emergency contraceptives are not to be used as a routine form of contraception or to be used repeatedly within the same menstrual cycle; Advise patient to read Patient Guide before starting and with each Rx refill in case of changes; Advise patient to eat solid food if nausea; Advise patient to report signs and symptoms of fluid retention (swelling of ankles and feet, weight gain) thromboembolic disorders (pain, swelling, tenderness in extremities, headache, chest pain, blurred vision), mental depression, hepatic dysfunction (yellowed skin or eyes, pruritus, dark urine, light colored stools), or abnormal vaginal bleeding, Women with a strong family history of breast cancer, fibrocystic breast disease, abnormal mammograms, or cervical dysplasia should be monitored for breast cancer at least yearly; Advise patient to stop taking medication is pregnancy is suspected; Caution patient hormonal contraceptives do not protect against HIV or other sexually transmitted diseases; Emphasize the importance of routine follow up
Evaluation/Desired outcomes of Plan B Prevention of pregnancy; regulation of the menstrual cycle; decrease in menstrual blood loss; decrease in acne; decrease in symptoms of premenstrual dysphoric disorder; decrease in vasomotor symptoms or symptoms of vulvar and vaginal atrophy due to menopause
Potential nursing diagnoses of Plan B Non-compliance (patient/family teaching)

Section 2

Question Answer
Mifeprex (Mifepristone) Also known as RU-486 and is a synthetic steriod; Abortifacients and anti-diabetics; Typically used with misoprostol to end pregnancy in women who have been pregnant for 7 weeks or less.
Mifepristone actions Blocks progesterone necessary for pregnancy to continue; Blocks endometrial and myometrial effects of progesterone; Sensitizes the myometrium to contraction-inducing activity of prostaglandins; Blocks the glucocorticoid receptor
Mifepristone therapeutic effects Termination of pregnancy; Improved control of blood glucose
Contraindications of Mifepristone Hypersensitivity; Confirmed or suspected ectopic pregnancy; Undiagnosed adnexal mass; chronic adrenal failure; concurrent long-term corticosteroid therapy; bleeding disorders or concurrent anti-coagulant therapy; inherited porphyrias; severe hepatic impairment; endometrial hyperplasia with atypia or endometrial carcinoma
Adverse/Side effects of Mifepristone Headache, dizziness, abdominal pain, nausea, vomiting, uterine bleeding, uterine cramping
Drug-drug interactions of Mifepristone Increase blood levels and risk of toxicity from dihydroerotamine, ergotamine, lovastatin, simvastatin, cyclosporine, fentanyl, pimozide, quinidine, dirolimus, or tacrolimus; concurrent use with korlym is contraindicated
Food and natural product interactions of Mifepristone Blood levels and effects may be increased by grapefruit juice, and decreased by St. John’s wort
Nursing assessment of Mifepristone Determine duration of pregnancy (first day of last menstrual); assess amount of bleeding and cramping during treatment, and determine if termination is complete on day 14; monitor for signs and symptoms of adrenal insufficiency (weakness, nausea, increased fatigue, hypotension, hypoglycemia); lab test considerations as decrease hemoglobin, hematocrit and RBCs may occur; monitor Hemoglobin A1C periodically during therapy
Nursing implementation of Mifepristone Should be administered only by health care professionals who are able to provide surgical intervention in cases of incomplete abortion or severe bleeding; any IUD should be removed prior to administration
Patient/family teaching of Mifepristone Advise patient of the treatment and its effects-patient must understand the necessity of completing the treatment schedule of three office visits (day 1, day 3, and day 14); Inform that prolonged or heavy vaginal bleeding is not proof of complete expulsion, and that bleeding or spotting occurs for an average of 9-16 days yet may continue for more than 30 days; Caution patient to notify health care professional immediately if develops weakness, nausea, vomiting, diarrhea, with or without abdominal pain or fever more than 24 hr after taking as it may indicate life-threatening sepsis; avoid driving or other activities requiring alertness until response to medication is known; Caution that pregnancy can occur following termination of pregnancy and before resumption of normal menses, and contraception is safe to use; Advise patient to notify health care professional if smokes at least 10 cigarettes a day
Potential nursing diagnoses of Mifepristone Acute pain (side effects); Deficient knowledge, related to medication regimen (patient/family teaching)
Evaluation/Desired outcomes of Mifepristone Termination of an intrauterine pregnancy of less than 7 weeks duration