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Old 12-01-2011
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Drug Side Effects of Combined OCPs

A 33-year-old woman comes to your office for a blood pressure check. She has had chronic hypertension for the past 4 years, for which she takes hydrochlorothiazide. Her blood pressure has been reasonably well controlled with this medication. She also uses the combined oral contraceptive pill (i.e., the pill containing an estrogen and a progestin). She has no other medical problems and has never had surgery. She is allergic to penicillin. Her physical examination is normal. This patient should be counseled that patients with chronic hypertension who are also using the combined oral contraceptive pill might be at increased risk of which of the following?

A. Elevated blood pressure and smoking
B. Endometrial cancer and ovarian cancer
C. Endometrial cancer and stroke
D. Myocardial infarction and ovarian cancer
E. Myocardial infarction and strok
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Old 12-01-2011
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Old 12-01-2011
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E. Myocardial infarction and stroke ?
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Old 12-02-2011
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E. Myocardial infarction and strok
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Old 12-02-2011
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Old 12-02-2011
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E. Myocardial infarction and strok
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Old 12-02-2011
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E. Myocardial infarction and stroke
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Old 12-02-2011
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The correct answer is E. The combined oral contraceptive pill (OCP) appears, on the basis of a few clinical studies, to increase blood pressure. It appears to increase blood pressure in both normotensive and hypertensive women. Several studies have investigated the association between chronic hypertension, OCP use, and vascular events such as myocardial infarction (MI) and stroke. The results from these trials show that patients with chronic hypertension who use the OCP may have increased rates of MI and stroke. However, the results are not definitive. This patient has chronic hypertension but it is well controlled. Women who don’t smoke, who have well-controlled hypertension, who are less than 35 years old, and who have no other health problems and no evidence of end-organ vascular disease may use the OCP—but they should be aware of the potential increased risks of MI and stroke. They should also be aware of the symptoms of MI and stroke and the need to seek medical attention immediately if these symptoms develop.
Women with chronic hypertension who use the combined OCP are at increased risk of elevated blood pressure, but not smoking (choice A). Having hypertension and using the OCP doesn’t make a person more likely to smoke. But, if such a person does smoke, then he/she is at greater risk of a vascular event such as MI or stroke.
Women who use the OCP are at decreased risk of endometrial cancer and ovarian cancer (choice B).
Women who have chronic hypertension and use the OCP are at decreased risk of endometrial cancer but may be at increased risk of stroke (choice C).
Women with chronic hypertension who use the OCP have a decreased risk of ovarian cancer but may have an increased risk of MI (choice D).
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