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8/8/2019 Bai evra 1-2
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Gii thiu 1 phng php nga thai mi
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Thuc trnh thai cha HORMONEThuc trnh thai cha HORMONE
Thuc trnh thai kt hpThuc trnh thai kt hpestrogen+progestogenestrogen+progestogen
Vin ung
Tim hng thng
Vng t trong m o
Ming dn trnh thai
Thuc trnh thai ch cThuc trnh thai ch cProgestogenProgestogen
Vin ung Tim di da
Cy di da Dng c t trong t
cung
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EVRA RTHEVRA
EVRA (*)6mg Norelgestromin(NGMN) + 0.600 mg ethinylestradiol (EE)
Sn xut ti c .
c chun y ti 69 qucgia v M
Th nghim lm sng Vit Nam s dng EVRAsn xut ti c
ORTHO EVRA (*)6mg Norelgestromin(NGMN) + 0.750 mgethinyl estradiol (EE)
Sn xut tiPUERTO
RICO
Ch c chun y ti M
(*) The patches are manufactured at different companies, using a slightly different manufacturing process
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Ming dn Evra:20 cm2; 4,5 x 4,5 cm
Hm Lng:6 mg norelgestromin (NGMN)
0,6 mg ethinyl estradiol (EE)
Thnh phnThnh phn
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Cht tan trong m thm qua da d dng
Cht tan trong nc khng thm qua
da
Gia cc t bo lp
sng ca da c cckhe h nhiu chtm.
Cc cht tan ctrong m thm qua
cc khe ny d dng.
Evra thm qua daEvra thm qua da
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Tun1Tun1 Tun 2Tun 2 Tun 3Tun 3 Tun 4Tun 4
Ming 1
Chu k 28 ngy
Tun 5Tun 5
Bt u chu k miBt u chu k mi
Chu k 28 ngyChu k 28 ngy
Cch dng thun tinCch dng thun tin
Ming 2 Ming 3
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Bn v tr c th dn* Tc dng iu tr tng ng nhau* thay ming dn bt c lc no trong ngy
V tr thun tin nht:* t c xt,t m hi
V tr dn EvraV tr dn Evra
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Ngay
N
ongd
oEEtrungb
inh(pg/mL)
0.90.80.70.60.50.4
100
90
80
50
30
20
Nong
do
NGMNtru
ngb
in h
(ng/mL)
0.31 2 3 4 5 6 7 8 9 101112
NGMN Evra
70
60
40
10
1314151617181920
1.01.11.21.3
Dan miengdau tien
Ngay 8:Mieng thu 2
Ngay15:
ngay can dan miengthu 3
EE Evra
Quen thay miengdan 2 ngay
Liu thuc duy tr n ngy th 9
Abrams LS, Skee DM, Wong FA, Anderson NJ, Leese PT. Pharmacokinetics of norelgestromin and ethinylestradiol from two consecutive contraceptive patches.J Clin Pharmacol. 2001;41:1232-1237.
Ngay 18: danmieng 3
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May 2009
u hng ngy 200 mcg norelgestromin35 mcg ethinyl estradiol
Ch s Pearl ton b v s tht bi ca phng php Ci thin ra mu/ra huyt thm git Tc dng ph
EvraEvra
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c ch hiu qu s phng
non.c ch s pht trin nonnang (khi dng ng cch vc khi dng 9 ngy/1 mingdn)
Gim nhy c t cung, cntr s xm nhp ca tinhtrng.
Gim nhy ni mc tcung, lm ni mc t cung
khng thch hp cho s lmt ca hp t.
C ch tc dng ca EvraC ch tc dng ca Evra
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Pearl Index
So snh vi Mercilon:Evra Mercilonn= 844 656
S TH c thai : 4 2
Pearl index: 0.88 0.56Tun th: 94.4% 87.8%
Ra mu
gia k/thm git 14% 15%
Hedon B, Helmerhorst FM, Cronje HS, Shangold G, Fisher A, Creasy G, and the EVRA 003 Study Group.
Comparison of efficacy, cycle control, compliance, and safety in users of a contraceptive patch vs an oral contraceptive.Int J Gynecol Obstet. 2000;70 (suppl 1):78.
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Hiu qu trnh thaiHiu qu trnh thaixut sc 99%!xut sc 99%!(dng ng cch)(dng ng cch)
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Tun th dngTun th dngthuc cao!thuc cao!
Tun th hon hoTun th hon hotrn 88.2% s chu ktrn 88.2% s chu k
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T l thay ming dn
Cc nghincu Nghin cu atrung tm ti M Nghin cu sdng khi vn ngnhiu
Tng s ming dn sdng
70.552 4.877 87
Thay ming dn do bonghon ton
1.8% 1.7% 1.1%
Thay ming dn do bongmt phn
2.9% 2.6% 0%
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dnh cao! dnh cao!1,8% trng hp1,8% trng hp
ming dn bong raming dn bong rahon tonhon ton ( phi thay( phi thayming khc)ming khc)
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%% ngng dng do tcngng dng do tcdng ph:dng ph:
Bun nn:Bun nn: 1,7%1,7%
Nhc u:Nhc u: 1,1%1,1%
Cng ngc:Cng ngc: 1,9%1,9%
Phn ng ti ch dn:Phn ng ti ch dn:1,9%1,9%
Sibai BM, Odlind V, Meador ML, Shangold GA, Fisher AC, Creasy GW. A comparative and pooledanalysis of the safety and tolerability of the contraceptive patch (ORTHO EVRA/Evra).FertilSteril. 2002;77(suppl 2):19S-26S.
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Rat thch
Thch
Khong thch lam
Rat thch
Thch
Khong thch lam
12%12%
23%23%
3%
38%
23%
Phn hi ca ngi dngPhn hi ca ngi dng
>60% thch/rt thch!>60% thch/rt thch!
Rt thch
Thch
Khng thchlm
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Bt u dng EVRALn u dng thuc nga thai ni tit
Phng php bt uCn lm
Ngy thay mingdn Bin php trnh
thai h tr
Bt uNGY KINH
U TIN
Dn ming Evrau tin vo ngyu tin kinh nguyt
Dn ming dnEVRA u tin trongvng 24 gi u c
kinh
Cng mt ngyhng tun (trtun 4: khng
dn)
Khng cn
Bt uNGY CHNHT
Dn ming Evra vongy ch nht
Dn ming dnEVRA u tin vongy Ch nht utin sau khi c kinh
Ch nht hngtun (tr tun 4
khng dn)
Cn thit cho 7ngy u tin
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Bt u dng EvraChuyn t thuc ung nga thai ni tit
Phng php bt u
Cn lm Ngy thay mingdn
Bin Php ngathai h tr
Bt uNGY KINH
U TIN
Hon thnh chuk dng thucung
Dn ming dnEVRA u tin
trong vng 24 gi
u c kinhnguyt sau dng
thuc ung
Cng mtngy hng
tun (tr tun
4: khng dn)
Khng cn
Bt u
NGY CHNHT
Dn ming EVRA
u tin vo ngyCh Nht
Dn ming dn
EVRA u tinvo ngy ChNht u tin saukhi c kinh nguytsau dng thucung
Ch nht hng
tun (tr tun4: khng dn)
Cn thit cho 7
ngy u tin
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Qun thay ming dn EVRATNH HUNG CN LM NGY THAY MiNG
DNBiN PHP NGA THAI
PH TR
Qun dnming dn
Vo ngy u tinca chu k mi(ngy th 1)
Dn cng sm cng ttkhi nh ra
Ly mc l ngy dnming dn ln ny(khc vi trc)
Cn thit cho 7 ngy utin ca chu k mi ny
ming dntrn da hn 7ngy
Vo gia chu k
(ngy th 8 hocngy th 15)
Khng qu 2 ngy(48 gi)
G b ming dn c,dn ming mi ngay
Nh trc Khng cn thit
Qu 2 ngy (48 gi) G b ming dn c,
dn ming mi ngay.By gi ly mc ngyth 1 l ngy ny
Ly mc l ngy dn
ming dn ln ny(khc vi trc)
Cn thit cho 7 ngy u
tin ca chu k mi ny
Cui chu k (ngyth 22)
G b ming dn cngay khi nh ra
Nh trc Khng cn thit
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Ming dn Evra bong ra
TNH HUNG CN LM NGY THAY MINGDN
BIN PHP NGATHAI PH TR
Ming dnbong ra mtphn hoc rira
Ko di di 1ngy (24 gi)
Dn li phn b bong,hoc thay vo v tr
ming dn mi
Nh trc Khng cn thit
Ko di hn 1ngy (24 gi) hockhi khng chcchn thi gianbong/ri
G b ming dn c,dn ming mi ngay.
By gi ly mc ngy 1l ngy ny
Ly mc l ngy dnming dn ln ny(khc vi trc)
Cn thit cho 7ngy u tin ca
chu k mi ny
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So snh Evra v thuc ung nga thai
Thuc ung : mi ngy 1 vin k t ngy u thy kinh, lin tc trong 21 ngy. Ngh 7 ngy khngung thuc
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3
Cch ung
Evra: Dn 1 ming Evra vo ngy u kinh nguyt lin tctrong 7 ngy, thay cc ming k tip sau 7 ngy. Ngh 7ngy khng dn Evra.
Ngy u tin thy kinh7 ngy ngh khngdng thuc
7 ngy ngh khngdn Evra
Ung tip vmi
1 vin cho mi ngy: ung 21 ln/chu k dng thuc
Dn Evra mi1 ming dn cho 7 ngy, dn 3 ln/chu k dng thuc
S h E th th i
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So s nh Evra v thu c u ng ng a thai(Mercilon)
Thuc ung
Nu b tiu chy, i ma trong vng 4 gi sau khi dng thuc, vin thuc ny c th cha c hp thu hon ton vo c th.
Trng hp ny nn ung thuc tip tc nh t hng l ng thi phi dng bin php nga thai ph t r trong 7 ngy
Trng hp b tiu chy, i ma sau khi dng thuc
Evra:
Vic phng thch cc hormon trong
Evra khng b nh hng khi bnb tiu chy hay b bun nn
Khng cn bin php nga thai ph
tr.
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So snh Evra v thuc ung nga thai
Thuc ung
Di 12 gi: ung vin thuc qun, vin k tip ung theo gi thng l, khng cn bin php nga thai ph tr
Trn 12 gi: : ung ngay vin ca ngy hm trc, vin hm nay vn ung vo gi thng . Cn c 7 ngy ung thuc khng gin on v dng bin phpnga thai trong 7 ngy khi ung thuc.
Qun dng thuc
Gia chu kEvra:
Di 48h: Dn ming dn tip ngay khinh ra v KHNG CN dng binphp nga thai ph tr.
Trn 48 gi: Dn ming dn Evra tiptheo v xem ngy dn ny l ngythay ming dn v bt u mt chuk dng thuc mi ( dn lin tip 3ming trong 3 tun ) dng thm binphp nga thai ph tr trong 7 ngy.
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Thn trng
Ph n trn 35 tui c ht thuc
Cn nng trn 90 kg
C cc bnh suy gan,cao huyt pTrm cm nng
Tiu ngBnh nhn b ung th c quan sinhsn v v
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CHN THNH CM N