RN Nursing · Adverse Effects, Interactions, and Contraindications · Practice question
A nurse is performing a medication reconciliation for an adolescent. The adolescent has a new prescription for an estrogen-based oral contraceptive. Which of the following medications should the nurse report to the provider?
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Promethazine
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Buspirone
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Ciclesonide
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✓
Phenytoin
Answer & explanation
Correct: Phenytoin
Phenytoin is a hepatic enzyme inducer (CYP450 inducer) that increases the metabolism of estrogen-based oral contraceptives, significantly reducing their effectiveness and increasing the risk of unintended pregnancy. This is a clinically significant drug-drug interaction that must be reported to the provider. Promethazine, buspirone, and ciclesonide do not have significant interactions with estrogen-based oral contraceptives. Nurses must identify medications that induce hepatic enzymes when clients are prescribed hormonal contraceptives. (Karch, Focus on Nursing Pharmacology, 8th ed.)
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