WBR0789

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pharmacology
Sub Category	SubCategory::Reproductive
Prompt	[[Prompt::A 37 year old woman is seeking her gynecologist’s advice for contraception. She already has 3 children and does not wish to have any more. She explains that her husband doesn’t always agree to wear a condom and she was considering either tubal ligation or oral contraception as possible alternatives. Which of the following characteristics would make oral contraception contraindicated in this patient?]]
Answer A	AnswerA::Family history of heart disease
Answer A Explanation	AnswerAExp::Family history is never a contraindication to OCP prescription.
Answer B	AnswerB::Family history of breast cancer
Answer B Explanation	AnswerBExp::Family history is never a contraindication to OCP prescription.
Answer C	AnswerC::Current smoker
Answer C Explanation	[[AnswerCExp::Female smokers >35 years of age should not be prescribed OCPs due to the increased risk of cardiovascular events.]]
Answer D	AnswerD::Varicose veins
Answer D Explanation	AnswerDExp::Varicose veins are not a contraindication to OCP prescription.
Answer E	AnswerE::History of pelvic inflammatory disease
Answer E Explanation	AnswerEExp::History of pelvic inflammatory disease is not a contraindication to OCP prescription.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Oral contraception is a common and relatively safe means of contraception that usally combines both estrogen and progestin in different doses. OCPs work by inhibiting the positive estrogen feedback loop that leads to the LH surge and eventual ovulation. OCPs have been shown to be safe and not associated with an increased risk of cancer or thromboembolism in the general population. OCPs are usually contraindicated in cetain sub-populations at higher risk including patients with the following characteristics: - Smoker >35 years of age - Previous personal history of DVT, PE, or stroke - Previous personal history of estrogen dependent breast cancer Learning objective: OCPs are contraindicated in female smokers >35 years of age due to the increased risk of cardiovascular events. References: Marchbanks PA, Mcdonald JA, Wilson HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med. 2002;346(26):2025-32. Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol. 2008;83(2):97-102. Shapiro S, Rosenberg L, Slone D, Kaufman D, Stolley P, Miettinen O. ORAL-CONTRACEPTIVE USE IN RELATION TO MYOCARDIAL INFARCTION. The Lancet. 1979;313(8119):743-747. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::OCPs, WBRKeyword::contraception, WBRKeyword::contraindications
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::