Prescribing Safety Assessment (PSA) Practice Exam

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In which situation is the combined oral contraceptive pill (COCP) contraindicated?

In smokers over 35
Patients with migraines with aura
Patients with hypertension
Before surgical procedures

The correct answer is: Patients with migraines with aura

The combined oral contraceptive pill (COCP) is contraindicated in patients with migraines that are accompanied by aura due to the increased risk of stroke. Migraines with aura are considered a significant risk factor for thromboembolic events when taking estrogen-containing contraceptives. The presence of aura indicates a higher risk of vascular complications, making it essential to avoid COCP in such scenarios. In contrast, other situations listed, while they may require careful evaluation and consideration, are not absolute contraindications. For instance, smoking in individuals over 35 can increase the risk of cardiovascular issues, but not all smokers in this age group will be advised against using COCP—it's a matter of assessing specific risk factors. Patients with hypertension may also be prescribed COCP, but only if blood pressure is well controlled and there are no other additional risk factors. Regarding surgical procedures, the COCP may need to be reconsidered depending on the type of surgery and risk of thrombosis, but it is not universally contraindicated.