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  • Title: Managing drug interactions with oral contraceptives.
    Author: Stoehr GP, White J.
    Journal: JOGN Nurs; 1983; 12(5):327-31. PubMed ID: 6355611.
    Abstract:
    An increasing concern to nurses is the possibility of drug interactions involving oral contraceptives. Information regarding the mechanisms, significance, and management of drug interactions with oral contraceptives is provided. Approaches to counseling patients also are discussed. Drus interactions involving oral contraceptives (OCs) are of increasing concern. Antitubercular drugs, anticonvulsants, and antibiotics are among the drugs believed to alter the efficacy of OCs. Rifampin, for example, appears to induce an increase in the rate of metabolism of OCs, resulting in unacceptable rates of breakthrough bleeding and pregnancy. Phenobarbital stimulates the liver's drug metabolizing enzymes and may alter the disposition of some progestogens by increasing their binding affinity to plasma proteins. In addition, OCs may affect the activity of certain drugs and vitamins, including anticoagulants, vitamin B6, and folic acid. Conscientious family planning nurse practitioners can play an important role in the management of these drug interactions. OC users who require antibiotic therapy should be monitored for signs of diminished estrogen effect. Women receiving anticoagulants should be monitored when OCs are either begun or discontinued, and weekly or twice weekly determinations of prothrombin time may be required. Significant drug interactions may indicate the need for another means of contraception. Effective contraceptive counseling in such cases requires a sympathetic approach and a review of alternate contraceptive methods. Techniques of insertion, known side effects, and noncontraceptive benefits should be discussed. Patients who are switched to another OC preparation should be instructed to report breakthrough bleeding. Family planning nurse practitioners, especially those working with very young or low income women, should stress the need for adequate nutrition. In some cases, nutritional supplements may be indicated. In addition, patients should be instructed to question other health care providers about possible interactions with OCs whenever drug therapy is prescribed.
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