Prescribing Combined Oral Contraceptives.

The evidence-based practice (EBP) guidelines changed in 2012 to allow clinicians to prescribe birth control without performing a pap smear until a woman turns age 21. Explain briefly why this change was made. (Hint: related to HPV). In a minimum of 175-300 words, discuss combination oral contraceptives (COC) and how they are a common choice employed. Ensure you: Explain briefly the mechanism of action of COCs. Identify the best candidate for COC. Explain briefly 3 common side effects. Discuss cautions and absolute contraindications to prescribing COCs. Describe the significance of the acronym ACHES and how you as a clinician would communicate this very important information to your patients. Prescribing Combined Oral Contraceptives.

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

Presently the following are the contraceptive pills in the US; progesterone-only, continuous use and combined pill. The most prescribed is the combined estrogen and progesterone pill. According to Cooper & Mahdy (2020), more than 20% of women of reproductive age use the combined pill as their contraception. In this paper, the author discusses the mode of action of Combined Oral contraceptives (COCs), the candidates for COCs, common side effects, and contraindications. This knowledge is important as it informs the prescribing practices of Nurse Practitioners (NPs) in routine care. Prescribing Combined Oral Contraceptives.

Mechanism of action of COCs

COCs act by preventing ovulation. They suppress the release of luteinizing hormone (LH) and follicular development. The negative feedback of progestogen works in the hypothalamus to reduce the frequency pulse of the gonadotropin-releasing hormone (Cooper & Mahdy, 2020). This subsequently reduces the secretion of follicle-stimulating hormone (FSH) and LH. When follicular development is inhibited, the levels of estradiol decrease stopping the mid surge of the LH cycle which prevents ovulation. Prescribing Combined Oral Contraceptives.

Candidates for COCs

According to Stewart & Black (2015), COCs can be prescribed to all non-pregnant women with no history of uncontrolled hypertension and diabetes. They can also be prescribed to women with no; breastfeeding infants, breast cancer, history of a stroke or a blood clot, persistent migraines, smoking history, or liver diseases. Prescribing Combined Oral Contraceptives.

Common Side Effects

When prescribing COCs, clients must be instructed to take them daily at approximately the same time every day. During initiation, clients must know that they are not safeguarded from conception in the initial 7 days and it is in this period that they can use an alternate birth control method. If the client misses a tablet, it must be taken immediately she recalls. However, if she misses 2 tablets, the client must take two tablets on the day she recalls, and another two the following day before resuming one tablet per day. Cooper & Mahdy (2020) emphasize that clients must be educated on the most common side effects that can occur with COCs which can range from mild to severe and include breakthrough bleeding, headaches, and breast tenderness as a result of the body adjusting to hormonal changes.Prescribing Combined Oral Contraceptives.

Contraindications of COCs

Nurse practitioners must not prescribe COCs to pregnant women, women with uncontrolled hypertension and diabetes since they increase the risk of hyperglycemia, women with a history of ischemic heart disease, endometrial or breast cancer, and migraines (Stewart & Black, 2015). COCs are also contraindicated in women who are active smokers aged 35 years or older as it increases the risk of cardiovascular events such as deep vein thromboembolism.Prescribing Combined Oral Contraceptives.

Significance of the Acronym ACHES

The word ACHES (abdominal pain, chest pain, headaches, eye problems, sudden leg pain) is an acronym that is used by NPs to help patients remember the adverse effects that they may have undergone while using COCs. Prescribing Combined Oral Contraceptives.Using this acronym during assessments, NPs can assess clients for a possible tubal pregnancy or cyst that can cause abdominal pain, chest pain, sudden shortness of breath(SOB), heart attack, or a persistent blood-stained cough that indicates a possible blood clot in the lungs, sudden severe headaches or dizziness as a sign of a stroke, vision changes that may be caused by an ocular blood clot and sudden pain in the calf muscles, the leg, swelling, heat, and redness that may indicate a possible blood clot. Clinicians can use this information to inform decision making on whether a patient can stop or continue using COCs. Prescribing Combined Oral Contraceptives.