Hormonal contraceptives

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

Hormonal contraceptives (brand name Depo-Provera) — Contraceptive; Estrogen-progestin combinations and progestin-only products.

Identification

• Therapeutic class: Contraceptive.
• Pharmacologic class: Estrogen-progestin combinations and progestin-only products.

Pharmacology

• Mechanism of action: Suppress ovulation, thicken cervical mucus, and thin the endometrium.
• Onset / peak / duration: Daily (pills), weekly (patch), monthly (ring), every 3 months (injection), or multi-year (implant, IUD).
• Half-life / therapeutic level: Variable; no routine level.

Clinical use

• Indications: Contraception, menstrual regulation, acne, emergency contraception (levonorgestrel).
• Usual dose, route, frequency: By product and route.
• Maximum dose / adjustments: Progestin-only preferred when estrogen is contraindicated (smokers over 35, clot risk, breastfeeding).

Safety

• Contraindications: History of clots, stroke, estrogen-dependent cancer, smokers over 35, uncontrolled hypertension, migraine with aura (estrogen products).
• Black box warning: Medroxyprogesterone injection carries a boxed warning for loss of bone mineral density with prolonged use.
• Interactions: Enzyme-inducing drugs (rifampin, some antiepileptics, St. John's wort) reduce effectiveness, requiring backup; some antiretrovirals.
• Pregnancy / lactation: Not for use in pregnancy; progestin-only preferred while breastfeeding.
• High-alert: No.

Adverse effects

• Common side effects: Nausea, breast tenderness, spotting, mood changes, headache.
• Serious effects to report: Signs of clot (the ACHES mnemonic: abdominal pain, chest pain, headache, eye or vision changes, severe leg pain).
• Antidote / reversal: Discontinue.

Nursing process

• Assessment before administration: Clot and cardiovascular risk, blood pressure, smoking, pregnancy status.
• Interventions during therapy: Teach consistent timing and backup methods with interacting drugs.
• Monitor: Blood pressure, clot symptoms.
• Evaluation / expected outcome: Effective contraception.

Patient teaching

• Patient teaching: Take pills at the same time daily; use backup with antibiotics like rifampin or with enzyme-inducing drugs; report ACHES symptoms; do not smoke.
• Notify provider if: Chest or leg pain, severe headache, vision changes, abdominal pain.
• Administration tips: Consistent timing; backup methods when indicated.