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Old 12-02-2011
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Drug Relative contraindication to OCPs

A 42-year-old woman with hypertension and a past history of an ectopic pregnancy 18 years earlier comes to your office and reports one episode of unprotected sexual intercourse 6 days ago. Her last menstrual period was normal and occurred 2 weeks earlier. She is concerned about unintended pregnancy and asks you about the “Morning After” pill. She reports no other complaints, has been healthy recently, and her hypertension has been well controlled. She has smoked one pack of cigarettes per day for the past 20 years. Which of the following factors in this patient would be a relative contraindication to prescribing hormonal emergency contraception?

A. Age
B. Greater than 5 days since unprotected intercourse
C. History of ectopic pregnancy
D. History of hypertension
E. Smoking status
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Old 12-02-2011
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B. Greater than 5 days since unprotected intercourse
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Old 12-02-2011
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B. Greater than 5 days since unprotected intercourse
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Old 12-03-2011
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greater than 5 days
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Old 12-03-2011
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greater than 5 days
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Old 12-04-2011
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The correct answer is B. Emergency contraception consists of a course of high-dose hormone therapy, either a combination of estrogen and progestin or a progestin alone. Two sets of pills are taken 12 hours apart as soon as possible after unprotected intercourse. Although the exact mechanism of action is unknown, hormonal emergency contraception interferes with implantation of the zygote and is highly effective (75-89% effective) at preventing pregnancy, especially when taken early after intercourse. Implantation usually occurs 6-7 days after intercourse, although substantial variation can occur between patients. Because emergency contraception acts by interfering with implantation, it should be given within 120 hours (and preferably within 72 hours) of unprotected intercourse to be effective. If it is given after implantation, however, it is extremely unlikely to cause harm to the developing embryo. Because the regimen is very short in duration, there are almost no medical contraindications to emergency contraception. Adverse events tend to be mild and short-lived, including breast tenderness, spotting, nausea, and uterine cramping. In this patientís case, the time lapse of 6 days indicates that implantation may have occurred already. If she does not desire to be pregnant, she should instead consider a therapeutic abortion and should be counseled appropriately.
Although they are cause for caution in prescribing daily oral contraceptives, no serious adverse events have been associated with increased age, smoking status, or hypertension (choices A, D, and E).
There have been no associations between ectopic pregnancy and emergency contraception (choice C), so a history of ectopic pregnancy should not preclude one from prescribing this regimen.
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