How to respond to missed doses or changing of contraceptive types from one to another? - 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 possibl...
how to respond to missed doses or changing of cont
if one or more pills are missed in the first we
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How to respond to missed doses or changing of contraceptive types from one to another? - 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? -
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: - 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 - 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.
drugs that interact with oral contraceptives? - 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 - 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 risks of HT. Of course, all women (not to
mention men) should practice primary prevention of bone loss by ensuring adequate intake of
calcium and vitamin D, performing regular weight-bearing exercise, and avoiding smoking and
excessive alcohol use.
- When and when not to use progestin for hormone replacement therapy and why - ANSWER Use:
-Treatment of moderate to severe vasomotor symptoms associated with menopause
• Treatment of genitourinary syndrome of menopause
• Prevention of postmenopausal osteoporosis
Not use:
heart disease
dementia
alzeheimers disease
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