NR 566 FINAL REVIEWS WITH
CORRECT ANSWERS
How to respond to missed doses or changing of contraceptive types from one to
another? - CORRECT ANSWER-For products that use a 28-day cycle, the following
recommendations from the Centers for Disease Control apply:
• If one or more pills are missed in the first week, take one pill as soon as possible and
then continue with the pack. Use an additional form of contraception for 7 days.
• If one or two pills are missed during the second or third week, take one pill as soon as
possible and then continue with the active pills in the pack but skip the placebo pills and
go straight to a new pack once all the active pills have been taken.
• If three or more pills are missed during the second or third week, follow the same
instructions given for missing one or two pills but use an additional form of contraception
for 7 days.
For combination OCs that use an extended or continuous cycle, up to 7 days can be
missed? - CORRECT ANSWER-with little or no increased risk for pregnancy provided
that the pills had been taken continuously for the prior 3 weeks.
If one or more doses is missed or taken greater than 3 hours after the scheduled dose,
the following guidelines apply: - CORRECT ANSWER--If one pill is missed, it should be
taken as soon as remembered and backup contraception should be used for at least 2
days. The pills should be resumed as scheduled on the next day.
-If two pills are missed, the regimen should be restarted and backup contraception
should be used for at least 2 days.
-If two or more pills are missed and no menstrual bleeding occurs, a pregnancy test
should be done.
Types of contraceptives and which would be best for specific patient scenarios -
CORRECT ANSWER-Combination OCs should be avoided by women with certain
cardiovascular disorders (see later) as well as by women older than 35 years who
smoke. For women in these categories, an alternative method (e.g., diaphragm,
progestin-only pill, or IUD) is preferable.
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, For women who engage in coitus frequently, OCs or a long-term method (e.g.,
Nexplanon, Depo-Provera, IUD) are reasonable choices.
when sexual activity is limited, and if individual has multiple partners use of a
spermicide, condom, or diaphragm may be more appropriate. Because barrier methods
combined with spermicides can offer some protection against STDs (as well as
providing contraception)
If adherence is a problem (as it can be with OCs, condoms, and diaphragms), usterm-
16e of a long-term method (e.g., vaginal contraceptive ring, IUD, Nexplanon, Depo-
Provera) can confer more reliable protection.
What effect does CYP450 inhibitors or inducers have on OCs? o Recall examples of
CYP450 inhibitors and inducers from NR565 (Chapter 4 in textbook) o How does this
impact prescribing of OCs? - CORRECT ANSWER-Inhibitors: Inducers:
Acyclovir Carbamazepine
Ciprofloxacin Phenobarbital
Ethinyl estradiol Phenytoin
Fluvoxamine Primidone
Isoniazid Rifampin
Norfloxacin Ritonavir
Oral contraceptives Tobacco
Zafirlukast St. John's wort
Zileuton
As a rule, high-estrogen OCs are reserved for women taking drugs that induce P450.
drugs that interact with oral contraceptives? - CORRECT ANSWER-Products that
induce hepatic cytochrome P3A4 can accelerate OC metabolism and thereby reduce
OC effects. indications are reduced OC blood levels, such as breakthrough bleeding or
spotting. If these signs appear, it may be necessary to either (1) increase the estrogen
dosage of the OC, (2) combine the OC with a second form of birth control (e.g.,
condom), or (3) switch to an alternative form of birth control.
can decrease the benefits of warfarin and hypoglycemic agents. May require increased
dosage
OCs can impair the hepatic metabolism of several agents, including theophylline,
tricyclic antidepressants, diazepam, and chlordiazepoxide. Can cause toxicity. if Toxicity
occurs dosage may have to be reduced.
Prevention of osteoporosis with hormone replacement therapy - CORRECT ANSWER-
prevention of osteoporosis requires lifelong HT, and hence the risk for harm is higher.
labeling of HT products currently must carry the following advice: When this product is
prescribed solely to prevent postmenopausal osteoporosis, approved nonestrogen
treatments should be carefully considered. Furthermore, HT should be considered only
for women with significant risk for osteoporosis, and only when that risk outweighs the
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CORRECT ANSWERS
How to respond to missed doses or changing of contraceptive types from one to
another? - CORRECT ANSWER-For products that use a 28-day cycle, the following
recommendations from the Centers for Disease Control apply:
• If one or more pills are missed in the first week, take one pill as soon as possible and
then continue with the pack. Use an additional form of contraception for 7 days.
• If one or two pills are missed during the second or third week, take one pill as soon as
possible and then continue with the active pills in the pack but skip the placebo pills and
go straight to a new pack once all the active pills have been taken.
• If three or more pills are missed during the second or third week, follow the same
instructions given for missing one or two pills but use an additional form of contraception
for 7 days.
For combination OCs that use an extended or continuous cycle, up to 7 days can be
missed? - CORRECT ANSWER-with little or no increased risk for pregnancy provided
that the pills had been taken continuously for the prior 3 weeks.
If one or more doses is missed or taken greater than 3 hours after the scheduled dose,
the following guidelines apply: - CORRECT ANSWER--If one pill is missed, it should be
taken as soon as remembered and backup contraception should be used for at least 2
days. The pills should be resumed as scheduled on the next day.
-If two pills are missed, the regimen should be restarted and backup contraception
should be used for at least 2 days.
-If two or more pills are missed and no menstrual bleeding occurs, a pregnancy test
should be done.
Types of contraceptives and which would be best for specific patient scenarios -
CORRECT ANSWER-Combination OCs should be avoided by women with certain
cardiovascular disorders (see later) as well as by women older than 35 years who
smoke. For women in these categories, an alternative method (e.g., diaphragm,
progestin-only pill, or IUD) is preferable.
amuri
, For women who engage in coitus frequently, OCs or a long-term method (e.g.,
Nexplanon, Depo-Provera, IUD) are reasonable choices.
when sexual activity is limited, and if individual has multiple partners use of a
spermicide, condom, or diaphragm may be more appropriate. Because barrier methods
combined with spermicides can offer some protection against STDs (as well as
providing contraception)
If adherence is a problem (as it can be with OCs, condoms, and diaphragms), usterm-
16e of a long-term method (e.g., vaginal contraceptive ring, IUD, Nexplanon, Depo-
Provera) can confer more reliable protection.
What effect does CYP450 inhibitors or inducers have on OCs? o Recall examples of
CYP450 inhibitors and inducers from NR565 (Chapter 4 in textbook) o How does this
impact prescribing of OCs? - CORRECT ANSWER-Inhibitors: Inducers:
Acyclovir Carbamazepine
Ciprofloxacin Phenobarbital
Ethinyl estradiol Phenytoin
Fluvoxamine Primidone
Isoniazid Rifampin
Norfloxacin Ritonavir
Oral contraceptives Tobacco
Zafirlukast St. John's wort
Zileuton
As a rule, high-estrogen OCs are reserved for women taking drugs that induce P450.
drugs that interact with oral contraceptives? - CORRECT ANSWER-Products that
induce hepatic cytochrome P3A4 can accelerate OC metabolism and thereby reduce
OC effects. indications are reduced OC blood levels, such as breakthrough bleeding or
spotting. If these signs appear, it may be necessary to either (1) increase the estrogen
dosage of the OC, (2) combine the OC with a second form of birth control (e.g.,
condom), or (3) switch to an alternative form of birth control.
can decrease the benefits of warfarin and hypoglycemic agents. May require increased
dosage
OCs can impair the hepatic metabolism of several agents, including theophylline,
tricyclic antidepressants, diazepam, and chlordiazepoxide. Can cause toxicity. if Toxicity
occurs dosage may have to be reduced.
Prevention of osteoporosis with hormone replacement therapy - CORRECT ANSWER-
prevention of osteoporosis requires lifelong HT, and hence the risk for harm is higher.
labeling of HT products currently must carry the following advice: When this product is
prescribed solely to prevent postmenopausal osteoporosis, approved nonestrogen
treatments should be carefully considered. Furthermore, HT should be considered only
for women with significant risk for osteoporosis, and only when that risk outweighs the
amuri
