NAPLEX Question of the Week: Patient Counseling

This week's question involves counseling of hormonal contraception.
NAPLEX Question of the Week: Patient Counseling

DJ is a 20-year-old female who comes to your clinic wishing to start hormonal birth control. Which of the following are key counseling points you should discuss with the patient? Select all that apply.

 A. Hormonal birth control comes in several forms (pill, patch, ring, injection, etc.) and are equally effective at preventing pregnancy if used correctly nearly 100% of the time.

B. When initiating combined hormonal contraception (CHC), a backup birth control method should be used for the first 3 days.

C. CHC carries BBW for increased cardiovascular events with smoking, cardiovascular disease, and increased risk of estrogen and progestin sensitive cancers

D. Junel should be avoided with anastrozole.

E. If a dose is missed using the progestin-only pill (POP), backup protection is not needed if the pill is taken within 6 hours of your scheduled dose.


Answers with rationale: 

Answers A, C & D are correct. 


While unintended pregnancy rates amongst the different types of hormonal contraception vary, these outcomes are understood to be due to incorrect administration of the medications. This is most often due to forgetting to take the oral pill or replace the patch or ring on time; backup recommendations vary depending on the type of hormonal contraception but may be needed for up to 7 days. Answer B is incorrect because backup methods should be used for 7 days when initiating CHC. If a patient misses a POP dose for longer than 3 hours of the scheduled dose, a backup method should be used for 48 hours, making answer E incorrect.  In addition to the BBW listed in answer C, the patch has an additional warning for increased risk of VTE in obese patients and is contraindicated in patients with a BMI ≥ 30 kg/m2. CHC have several drug-drug interactions with varying antiretrovirals, anticonvulsants and more. Estrogen products such as ethinyl estradiol found in Junel can counteract the estrogen suppressive effects of anastrozole, an aromatase inhibitor, which makes choice D the correct answer.

NAPLEX Competencies Covered: 

2.3 Boxed warnings or REMS

3.8 Drug interactions

5.5 Instructions or techniques for drug administration