Oral Contraceptives (OCs): In a Nutshell (Nursing)

00:00 Okay, so let's wrap this up. Now remember there are 2 types of oral contraceptives; combination or the minipill. The combination has progestin and estrogen. The minipill has progestin only.

00:16 Now, the adverse effects of combination oral contraceptives are an increased risk of developing clots. I'm going to stop right there because I want you to circle that and that's the most important takeaway point I want. Now, you know that you develop clots. If those travel around, they can be pulmonary embolism, MI, stroke, those are the issues. I want you to always keep in mind that if someone develops a clot, you don't have to memorize PE, MI, stroke. You just know that but make sure the biggest risk for combination OCs are developing clot. Now they can also have abnormal uterine bleeding and they'd want to contact their healthcare provider to work through that, but most important I don't want to move on until you have that point is the risk of developing clots. Now it also may increase the risk of stroke for women with migraines and remember if they have an aura, it's a no go. You shouldn't be taking oral contraceptives. The combination ones if you have an aura with a migraine. It also can cause a rare benign hepatic adenoma.

01:17 Now, we put that on here but it's not as critically important as the clots. So, other mild effects that you experience are uncomfortable, they come from the estrogen or progestin imbalance but they're not as significant as the risk from the clot. So patients won't like it, you'll need to work with them to help them find the best for their life but they're not as significant as the risk for clots. Okay, so we gave you the World Health Organization Category 4, absolute no. Category 3 only with caution. So take a minute and review those that we have there but what I want you to do is go back and look at the summary slides that we provided you with the big stop sign and make your own handwritten notes on the space here on your downloadable material. See, that's what it's going to take for you to remember those big issues. You taking the time, go back and look at that slide now, write in your own handwriting on this slide the ones that you want to remember. Remember, combination oral contraceptives suppress ovulation. Now, progestin- only oral contraceptives prevent contraception by altering the cervical secretion, makes them super thick and so it's like a barrier to sperm. Also, if one of the little ___ got through, the uterus is not really hospitable to implantation. Okay, so combination oral contraceptives are given on a 28-day cycle or a 91-day cycle which we considered just like a continuous cycle.

02:49 Progestin-only contraceptives are given on a continuous cycle. Specific guidelines exist for patients to follow up the doses missed for combination and progestin-only contraceptives. So that's a really important point for you to educate your patient and yourself so you know what to do in the case of a missed dose. Now, you used to teach that all antibiotics reduce the effectiveness of birth control but we know now that rifampin is the main one that will reduce the effectiveness of oral contraceptives. Warfarin and hypoglycemic drugs are less effective and they may require an increased dosage if your patient is taking an oral contraceptive with these medications. Now, theophylline and tricyclic antidepressants, diazepam and chlordiazepoxide are different because those levels will be increased if your patient is taking oral contraceptive with those medications. So we might need to decrease the dosage and do some additional monitoring.