Mrs. Johanson’s physician has prescribed tetracycline 500 mg PO q6h. While assessing Mrs. Johanson’s nursing history for allergies, the nurse notes that Mrs. Johanson is also taking oral contraceptives. What is the most appropriate initial nursing intervention?
A. Administer the dose of tetracycline.
B. Notify the physician that Mrs. Johanson is taking oral contraceptives.
C. Tell Mrs. Johanson, she should stop taking oral contraceptives since they are inactivated by tetracycline.
D. Tell Mrs. Johanson, to use another form of birth control for at least two months.
Correct Answer: B. Notify the physician that Mrs. Johanson is taking oral contraceptives.
The nurse should be aware that tetracyclines decrease the effectiveness of oral contraceptives. The physician should be notified. Note on the client’s chart that the physician was notified. The two groups of antibiotics most commonly involved in contraceptive failures are tetracyclines and penicillins, namely ampicillin. Both ampicillin and tetracycline have been shown to affect plasma and urinary concentrations of estrogen in both pregnant and nonpregnant women, while progesterone levels remain constant.
Option A: Tetracycline decreases the effectiveness of oral contraceptives. There may be an equally effective antibiotic available that can be prescribed. Broad spectrum antibiotics can lead to lower levels of circulating oral contraceptive hormone levels and have, thus, been implicated in causing failures in women taking oral contraceptives. Failure of oral contraceptive steroids can lead to several outcomes, including breakthrough bleeding, pregnancy and menstrual abnormalities such as amenorrhea and spotting
Option C: The nurse should not tell the client to stop taking oral contraceptives unless the physician orders this. Oral contraceptives (birth control pills) containing estrogen may not work properly if taken while the woman is taking tetracyclines. Unplanned pregnancies may occur.
Option D: If the physician chooses to keep the client on tetracycline, the client should be encouraged to use another form of birth control. Antibiotics are suspected to diminish oral contraceptive efficacy by two main mechanisms: induction of the cytochrome P450 group of hepatic microsomal enzymes and interference with enterohepatic cycling of ethinylestradiol.