Ethics question regarding P-450

[Phloston]

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Here's a question from Kaplan QBank. 66% of people got this correct, so obviously I'm just a ****.

Perhaps I'm crazy, but FA doesn't list the penicillins as inducers of P-450. Therefore, I would have thought that the doctor's choice of drug was correct and that the patient shouldn't worry.

If the drug prescribed were an inducer listed in FA, then I would understand otherwise.

I realize that there are technically hundreds of drugs that could impact P-450, but amoxicillin isn't one of the notable ones, is that not correct?

The answer explanation even says to admit a mistake. How in the world is amoxicillin a mistake?

Does anyone have any input here?

 

[Myxedema]

Why do you think it's about p450? There are other mechanisms of interactions as well.

 

[da Vincis World]

Why do you think it's about p450? There are other mechanisms of interactions as well.

I agree. This has nothing to do with P450 interactions. Even if it did, you do not need that info to answer the question. I think you are thinking a bit too much into this question.

 

[Phloston]

Why do you think it's about p450? There are other mechanisms of interactions as well.

I've never heard of amoxicillin interacting with OCPs. The concern I have with this question is about this drug interaction and has nothing to do with ethics.

 

[Myxedema]

I've never heard of amoxicillin interacting with OCPs. The concern I have with this question is about this drug interaction and has nothing to do with ethics.

Apparently, it does interact with OCPs: http://tinyurl.com/8dtxc38

 

[da Vincis World]

I've never heard of amoxicillin interacting with OCPs. The concern I have with this question is about this drug interaction and has nothing to do with ethics.

I believe it has something to do with broad spectrum antibiotics killing gut flora and estrogen absorption.

 

[Phloston]

Thanks so much for posting that!

Still, I wonder what the mechanism is. I'm not too familiar with how OCPs are metabolized.

 

[Belleza156]

I think its more like a general rule of thumb that when women take antibiotics (any kind) they are always told to not count on birth control being an effective method of BC that month, and to stay away from alcohol. I know I was always told that BC wasn't going to work properly. And that the antibiotics regimen would fail if I drank alcohol. Never gave it much thought until now.

Sent from my PC36100 using SDN Mobile

 

[glykon]

Hi,

I found a table of drug interactions with OCPs- I know these are very high-yield for Step 1:
http://books.google.ro/books?id=TFQ...epage&q=amoxicillin interactions ocps&f=false
(on page 127)
And to answer ur question about the mechanism of this interaction:
http://www.livestrong.com/article/108288-antibiotics-weaken-birth-control/
More extensive data on OCPs:
http://www.straighthealthcare.com/oral-contraceptives.html#di

Anyway, since they test an obscure interaction, but ur question stem says the pharmacist said they interact, u should assume he is right about the pharmacology of the medication. I think in Behavioural Science, u should never say a bad thing about ur colleague/ play smart in front of the patient ( choice F).
Ur patient is angry and when u have an angry patient, the rule in BS is that u should always appologize (answer A)+/- take the blame+/- try to figure out a solution.
Hope this helps.

 

[Belleza156]

Hi,

I found a table of drug interactions with OCPs- I know these are very high-yield for Step 1:
http://books.google.ro/books?id=TFQ...epage&q=amoxicillin interactions ocps&f=false
(on page 127)
And to answer ur question about the mechanism of this interaction:
http://www.livestrong.com/article/108288-antibiotics-weaken-birth-control/

The OCP/Brith control precaution isn't based on evidence based medicine. It's really more of a general assumption. Besides Rifampin there isn't any antibiotic that has proven to affect OCP. The livestrong article is from from 2002, we are in 2012....that's too outdated of a reference. Look up current articles and you won't find any because it's not really ethical to test if a woman on OCP can get pregnant from taking antibiotics.

 

[glykon]

No, actually, that article is dated and reviewed on 2010, look at the date before 'assuming' it (seriously, what's your problem?).
Anyway, that's the table I found (and was used by that Qbank), if you find anything better than 'the rule of the thumb', feel free to post it. Aside from wrongfully criticising, you don't seem very helpful on this matter.

 

[Belleza156]

No, actually, that article is dated and reviewed on 2010, look at the date before 'assuming' it (seriously, what's your problem?).
Anyway, that's the table I found (and was used by that Qbank), if you find anything better than 'the rule of the thumb', feel free to post it. Aside from wrongfully criticising, you don't seem very helpful on this matter.

Here you go: http://reference.medscape.com/medline/abstract/21477683

The article you posted was reviewed on 2010, but they were using an article from 2002 as their basis. There's no proof that antibiotics interact with oral contraceptives but its better to be safe than sorry.

 

[glykon]

Here you go: http://reference.medscape.com/medline/abstract/21477683

The article you posted was reviewed on 2010, but they were using an article from 2002 as their basis. There's no proof that antibiotics interact with oral contraceptives but its better to be safe than sorry.

Now you're talking 🙂
Although there are some limitations to this study as well and the topic remains controversial, I agree with you about safety. As for Step 1, I want to know well the possible interactions, just in case I have tricky qs on OCPs.

 

[alternatego]

The real issue is that the doctor in the stem did a poor job during history taking, and didn't ask the patient if she was taking any other drug.

 

[Belleza156]

Now you're talking 🙂
Although there are some limitations to this study as well and the topic remains controversial, I agree with you about safety. As for Step 1, I want to know well the possible interactions, just in case I have tricky qs on OCPs.

You may get a question on OCPs for Step 2, but for Step 1 it's highly unlikely. Beyond our scope at this point. Besides knowing the abortifactants, I don't think you need more beyond that. I say this and I got heavily tested on repro on my step exam, very heavy on the pregnancy related questions. But nothing on OCP specifically. Wait till step 2 to learn about those. Focus on antibiotics, now those are heavily tested.

Sent from my PC36100 using SDN Mobile

 

[Phloston]

Hi,

I found a table of drug interactions with OCPs- I know these are very high-yield for Step 1:
http://books.google.ro/books?id=TFQ...epage&q=amoxicillin interactions ocps&f=false
(on page 127)
And to answer ur question about the mechanism of this interaction:
http://www.livestrong.com/article/108288-antibiotics-weaken-birth-control/
More extensive data on OCPs:
http://www.straighthealthcare.com/oral-contraceptives.html#di

Anyway, since they test an obscure interaction, but ur question stem says the pharmacist said they interact, u should assume he is right about the pharmacology of the medication. I think in Behavioural Science, u should never say a bad thing about ur colleague/ play smart in front of the patient ( choice F).
Ur patient is angry and when u have an angry patient, the rule in BS is that u should always appologize (answer A)+/- take the blame+/- try to figure out a solution.
Hope this helps.

Thanks for posting those links. Good point about not "stepping in to down a colleague," even though in real life, most physicians / health care practitioners have no idea what they're doing.

And also, thanks for your input belleza/alternatego.

 

[glykon]

You may get a question on OCPs for Step 2, but for Step 1 it's highly unlikely. Beyond our scope at this point. Besides knowing the abortifactants, I don't think you need more beyond that. I say this and I got heavily tested on repro on my step exam, very heavy on the pregnancy related questions. But nothing on OCP specifically. Wait till step 2 to learn about those. Focus on antibiotics, now those are heavily tested.

Sent from my PC36100 using SDN Mobile

Good to know, thanks for sharing that.

Good luck!

 

[glykon]

Thanks for posting those links. Good point about not "stepping in to down a colleague," even though in real life, most physicians / health care practitioners have no idea what they're doing.

And also, thanks for your input belleza/alternatego.

You're welcome🙂
A very interesting article I found in NY Times about the bullying culture of medical schools (to be read for leisure):
http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/?ref=health

 

[Phloston]

You're welcome🙂
A very interesting article I found in NY Times about the bullying culture of medical schools (to be read for leisure):
http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/?ref=health

Just read the article, and it definitely seems to hold some truth. I recall having asked a doctor for a chart last year, and he threw it at me in such a way that I was like, "who does this guy think he is...."

I remember thinking, "as knowledgeable as I may be some day, I will never be a pr*ck like that."

 

[glykon]

I remember thinking, "as knowledgeable as I may be some day, I will never be a pr*ck like that."

Yeah, I had some bullying teachers as well. I'll try my best not to be like that with students/other doctors (or at least I won't be the one to start it)😀