Question

.L., a 27-year-old account executive, presents to the Family Medicine office for her annual checkup with her primary care provider. She has no significant past medical history. Her medications include calcium carbonate 500 mg orally twice a day and a multivitamin daily. She exercises regularly. Her family history is significant for cardiovascular disease (her father had an MI at age 54 and died of a further MI at age 63). She notes that she has been dating her current partner for approximately 5 months. She is interested in a reliable form of contraception. After discussing the various contraceptive options, she decides that an OC would best fit her needs.

1. Before prescribing an OCP regimen, what tests or examinations would you like to perform?
2. Identify three different OCP regiments that could be chosen for J.L. Note their differences and why you chose them.
3. Identify the potential side effects that need to be relayed to J.L. Note especially those effects for which J.L. should seek immediate medical care.
4. Write your prescription for this patient.

Answer 1

Oral Contraceptive pills (OCP)

Contraception is the use of a device or procedure to prevent conception as a result of sexual activity. Oral Contraceptive pills are the hormonal based tablets that used to prevent the occurrence of pregnancy.

1. Test and ex*mination to perform before initiating OCP:

Before starting an OCP regimen, a detailed history, especially on family medical history and hereditary diseases has to be collected, mainly to assess the history of Cardiovascular diseases.

Health professionals may also ask about the habit of smoking or history of any blood clots. Presence of smoking habits and history of blood clots and family history of Cardiovascular diseases can increase the risk of Cardiovascular diseases in JL.

* An accurate BP monitoring.

* Blood test or Urine test to find out the presence of any STDs ( Sexually Transmitted diseases).

Previously Physician used to conduct a pap test for Cervical cancer and a pelvic ex*m . But for teen and young women, these examination are not needed.

2. 3 different OCP regimen:

a. Balziva 28

It consist of norethindrone( 0.4mg) and ethinyl estradiol tablets ( 0.035mg). It contains two hormones oestrogen and progestine. The packet contains 21 active tablet and 7 inactive tablet. Tablet has to be taken once in a day.  

b. Estrostep Fe:

It consists of Norethindrone acetate and ethinyl estradiol tablets . The packet contains 21 white hormonal tablet and 7 ferrous fumarate ( iron). Dosage: One tablet per day

c. Desogestrel and Ethinyl esteem tablets ( Femilon): It contains two hormones, progestin and oestrogen. The packet contains 21 white tablet and 7 inactive tablets. One tablet per day , start from the first Sunday of cycle.

These all OCP tablets are having the ,

Mechanism of Action :

*thickens Cervical mucous so that prevents the sperm entry

* preventing the release of ovum.

* Alters the lining of uterus, so to prevent attachment of fertilized egg.

( MOA can apply to 3 regimen and can use as the purpose of choice of the regimen. )

3. Potential side effects:

Allergic reactions: If there is an allergic reaction to OCP, such as skin rashes, hives, eczema, anaphylaxis ( breathing difficulty, swelling of throat ), report to doctor immediately and stop the medications . It may be due to hypersensitivity towards progesterone.

Other side effects of OCP:

nausea, breast tenderness, intermenstrual spotting, weight gain, mood changes, headaches, decreased sexual interest, acne.

4. Femilon ( Desogestrel 0.15 mg, Ethinyl Estradiol (0.02mg): Once in a day

( start the first day of menstrual cycle, if it is on sunday, otherwise  start on immediate sunday).upto 21 days with active tablet, then 7 days, with the inactive tablet .