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Micronor, Nor-Q.D., Orvette
Class: Hormone/contraceptive

 Action Alters cervical mucus, interferes with implantation and may suppress ovulation.

 Indications Prevention of pregnancy.

 Contraindications Thrombophlebitis; thromboembolic disorders; history of deep vein thrombophlebitis; cerebral vascular disease; MI; coronary artery disease; known or suspected breast carcinoma; impaired liver function or disease; undiagnosed abnormal genital bleeding; known or suspected pregnancy; as diagnostic test for pregnancy.

 Route/Dosage

ADULTS: PO 1 tablet daily, starting on first day of menstruation.

 Interactions

Rifampin: Reduced plasma levels and pharmacologic effects of norethindrone.

 Lab Test Interferences Results of liver function tests, coagulation tests (increased prothrombin, factors VII, VIII, IX and X), thyroid function tests, metyrapone test and endocrine function tests may be altered. Pregnanediol determination may be altered.

 Adverse Reactions

CV: Thrombophlebitis; cerebrovascular disorders. CNS: Depression; tiredness; fatigue. DERM: Rash with and without pruritus; acne; melasma or chloasma; photosensitivity. EENT: Retinal thrombosis. GU: Breakthrough bleeding; spotting; hypomenorrhea; amenorrhea; changes in cervical erosion and cervical secretions. HEPA: Cholestatic jaundice. RESP: Pulmonary embolism. OTHER: Breast changes; masculinization of female fetus; edema; weight change.

 Precautions

Pregnancy: Category X. Lactation: Excreted in breast milk. Depression: Use drug with caution in patients with history of depression. Fluid retention: Use with caution in patients with hypertension, convulsive disorders, migraines, asthma, cardiac, hepatic or renal dysfunction. Lipid disorders: Progestins may elevate LDL levels. Tartrazine sensitivity: Some products may contain tartrazine, which may cause allergic-type reaction in susceptible individuals.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer at same time each day.
  • Start on first day of menstruation.
  • If GI upset occurs, administer with food.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Perform baseline physical examination before beginning therapy.
  • If spotting or breakthrough bleeding continues past second month, notify physician.
  • Do not administer oral contraceptives to induce withdrawal bleeding as test for pregnancy.
OVERDOSAGE: SIGNS & SYMPTOMS
  Nausea

 Patient/Family Education

  • Advise patient to use additional method of birth control until after first wk of administration in initial cycle.
  • Teach patient what to do if dose is missed. If 1 tablet is missed, take as soon as remembered and then take next tablet at regular time. If 2 consecutive tablets are missed; do not take missed tablets; discard and take next tablet at regular time. Use additional form of contraception until pregnancy is ruled out or menses occurs. If 3 consecutive tablets are missed, discontinue drug immediately. Use additional form of contraception until pregnancy is ruled out or menses occurs.
  • Encourage patient who smokes to stop. Cardiovascular dysfunction and thromboembolic disease have been associated with use of oral contraceptives in patients who smoke.
  • Advise patient that oral contraceptives may change fit of rigid contact lenses.
  • Caution patient to avoid prolonged exposure to sunlight, and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise patient to wait ³ 3 mo after discontinuing oral contraceptives before trying to become pregnant.
  • Instruct patient to report symptoms of blood clots (eg, pain, numbness, shortness of breath, visual disturbances).

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