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Old 12-02-2011
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Drug Contraindication to OCPs

A 31-year-old woman comes to your office seeking advice about birth control. She had her third child 3 months ago and does not wish to get pregnant in the near future. Her medical history is significant for HIV infection with a CD4 count of 500 cells/mm3 and a viral load of 2000 copies/mL. She also has migraine headaches with an aura that she has had since the age of 14 years. She has never had surgery. She takes no medications and has no known drug allergies. She has a family history significant for breast, endometrial, and ovarian cancers. Her physical examination, including breast and pelvic examination, is normal. Which of the following conditions represents a contraindication to the combined oral contraceptive pill for this patient?

A. Family history of breast cancer
B. Family history of endometrial cancer
C. Family history of ovarian cancer
D. Human immunodeficiency virus infection
E. Migraine with aura
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Old 12-02-2011
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A. Family history of breast cancer
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Old 12-02-2011
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A. Family history of breast cancer
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Old 12-03-2011
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A. Family history of breast cancer
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Old 12-03-2011
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family history of breast cancer..
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Old 12-03-2011
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I'll go woth E. Migraine with aura....as long as I know there are several contraindications to OCP: Hx of blood cloths, age over 35, smoking, migranes, CAD(There might be other contraindications but I don't remember all)....

For sure OCP have a protective effect against ovarian cancer....as long as OCP are combined pills(estrogen and progesterone), they should have a minimal if not quite none effect on endometrial cancer(if OCP are only estrogen or high estrogen OCP, there is a very strong pro endometrial cancer effect). Regarding breast cancer and OCP: as long as I know, this is a very debatable issue(some say there is a minimal risk, some say there is not)....I do not know anything about HIV; Besides this, I don't think the family history of cancer could be a contraindication for OCP but I might be wrong; from what I know for sure, migranes are a true contraindication for OCP and this patient has it....so my answer is E. Migraine with aura.
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Old 12-03-2011
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yes i totally agree it has to be E.migraine with aura
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Old 12-03-2011
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Quote:
Originally Posted by sonu.agarwall View Post
yes i totally agree it has to be E.migraine with aura

I don't wanna look smart or put you in a bad light but about 10 hours ago you post a different answer
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Old 12-03-2011
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i know man thats why i posted a reply to what you said and thanked your post.it was exactly because i got the question wrong and after reading your post i got it right.
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Old 12-04-2011
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The correct answer is E. There is much confusion regarding the use of the combined oral contraceptive pill (i.e., the oral contraceptive pill containing estrogen and a progestin) in women with a history of headache. There is an association between headache history, oral contraceptive use, and stroke, but this association is for patients with migraine headaches. Women who suffer from muscular or tension headache are able to take the combined oral contraceptive pill. The concern that exists regarding migraine sufferers who take the oral contraceptive pill is an increased risk for stroke. Several studies have demonstrated that combined oral contraceptive users with a history of migraine have a two- to fourfold increased risk for stroke over and above that seen in women with a history of migraine who do not use the oral contraceptive pill. This risk seems to be greatest in women who suffer from migraine with an aura or focal neurologic symptoms. The World Health Organization in their year 2000 policy statement on medical eligibility criteria for contraceptive use considers migraine with focal neurologic symptoms to be a condition that represents an unacceptable health risk to the use of the combined oral contraceptive.
A family history of breast cancer (choice A) does not represent a contraindication to the use of the combined oral contraceptive pill. Various studies have been published over the past several years, some of which have shown an association between oral contraceptive use and breast cancer and others that have not. An association has not been proven.
A family history of endometrial cancer (choice B) or a family history of ovarian cancer (choice C) does not represent contraindication to the use of the oral contraceptive pill. It has now been well established that users of the combined oral contraceptive pill have lower risks for endometrial and ovarian cancer.
Human immunodeficiency virus infection (choice D) does not represent a contraindication to the use of the combined oral contraceptive pill. Theoretic concerns exist that combined oral contraceptive use may allow for disease progression by affecting the virus itself or the patientís immune system. There is also some evidence that use of the combined oral contraceptive pill may increase shedding of HIV-1 infected cells, which may affect transmission. These are theoretic concerns and preliminary results, however, and HIV infection at this time is not considered a contraindication to the use of the combined oral contraceptive pill.
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