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ORAL CONTRACEPTIVES
Chapter 6,7,8: Contraindications, Precautions, Drug Interactions
6. CONTRAINDICATIONS [23,25,32]
Preamble
COCs Progestinonly Pill Emergency Pill
Chapter 1
Introduction a. Venous thrombosis (deep venous a. Known, suspected or a past a. Acute porphyria
thrombosis, pulmonary history of breast, genital or
Chapter 2
embolism, myocardial infarction) hormone dependent cancer
Physiology of female
reproductive hormones
b. Arterial thrombosis (myocardial b. Acute or severe chronic
infarction or prodomi of a diseases including
Chapter 3 thrombosis (eg transient past or present liver tumours,
Indications of OCs ischemic attack, angina pectoris) DubinJohnson or Rotor
Chapter 4
c. Presence of a severe or multiple syndrome
Types of OCs risk factors (diabetes mellitus c. Active liver disease
with vascular symptoms, severe d. History during pregnancy of
Chapter 5 hypertension, severe idiopathic jaundice or severe
Side Effects
dyslipoproteinaemia) pruritus
Chapter 6,7,8 d. Hereditary/acquired e. Disorders of lipid metabolism
Contraindications, thrombophlebitis f. Undiagnosed abnormal vaginal
Precautions, Drug e. Pancreatitis associated with bleeding
Interactions severe hypertriglyceridaemia g. Known or suspected pregnancy
f. Migraine with focal neurological h. Hypersensitivity to any
Chapter 9
Patient Counselling
symptoms component
g. Severe renal insufficiency or
Chapter 10 acute renal failure
Effectiveness of the h. Severe hepatic disease, benign or
various methods
malignant liver tumours
Chapter 11 i. Sex steroidinfluenced
Common Q & A malignancies of genitals or breast
(from customers) j. Undiagnosed vaginal bleeding
k. Pregnancy
Chapter 12
Case Studies
Chapter 13 7. PRECAUTIONS [21,23,32]
Flowchart
COCs Progestinonly Pill Emergency Pill
Chapter 14,15
Sources & References a. Age (Over 50 year of age) a. Age (Reassess after age of 35 a. Asthma
b. Smoking, year of age) b. Heart failure
Quiz
c. Obesity b. Smoking c. Hypertension
d. Hypertension c. Obesity d. Migraine
Feedback
e. Hyperlipidemia d. Hypertension e. Epilepsy
f. Diabetes Mellitus e. Hyperlipidemia f. Renal impairment
g. Surgery or trauma w/ increased f. Diabetes mellitus g. Diabetes mellitus
risk of thrombosis g. History of hepatic dysfunction h. Hyperlipidaemia
h. Prolonged immobilization, h. Prolong immobilization i. Depression
i. Recent delivery or 2ndtrimester i. Epilepsy j. Existing or former
abortion j. Fluid retention thrombophlebitis,
j. Ocular lesions k. Depression thromboembolic diseases or
k. Migraine l. Migraine stroke
l. Angioedema m. History of ectopic pregnancy k. History of ectopic pregnancy
m. Depression
n. Lactation.
8. DRUG INTERACTIONS [25,3032,37]
a) Drugs that decrease effects a) Drugs that may decrease a) Drugs that may decrease
(causing spotting, breakthrough effects effects
bleeding and pregnancy)
i) via induce i) via induce
i) via reduce enzymatic metabolism enzymatic metabolism
enterohepatic Rifampicin Rifampicin
circulation Antibiotics: Carbamazepine Carbamazepine
Ampicilin Phenytoin Phenytoin
Cephalosporin Modafinil Modafinil
Chlaramphenicol Topiramate Topiramate
Erythromaycin Griseofulvin Griseofulvin
Isoniazid Barbiturates Barbiturates
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8/13/2015 MPS LMS Chapter 6,7,8: Contraindications, Precautions, Drug Interactions
Sulfonamides Phenobarbital Phenobarbital
Tetracyclines Ritonavir Ritonavir
Trimethoprin St John’s Wort St John’s Wort
sulfamethoxazole
b) Increased effects of other
Rifampicin
drugs
Rifabutin
Corticorsteroids
ii) via induce
enzymatic metabolism
Carbamazepine
Phenytoin
Modafinil
Topiramate
Barbiturates
Phenobarbital
Griseofulvin
Rifampicin
Ritonavir
Herbal remedies St
John’s Wort
b) Drugs that increase effects:
(May cause Toxicity)
Atorvastatin
Inhibitors of liver
enzymatic metabolism (for
example, indinavir)
Competitive inhibitors for
sulphation in the
gastrointestinal wall
(ascorbic acid and
paracetamol)
c) Increased effects of other drugs
Cyclosporin
Corticosteroids
Theophylline
Oral contraceptives may diminish glucose tolerance and increase the need for insulin or other antidiabetic drugs. In addition,
proton pump inhibitors, antacids and H2receptor antagonists may increase gastric pH and also induced enzyme, leading to
reduced OC levels [37].
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