From the Guidelines
To properly take Ortho's tactics, it is essential to follow the guidelines for combined oral contraceptives (COCs) as outlined in the most recent and highest quality study, which emphasizes the importance of taking the pills at the same time every day and using a backup method for at least 7 days after initiating COCs or missing a pill 1. When taking Ortho's tactics, also known as combined oral contraceptives (COCs), it is crucial to understand the proper way to take them to ensure effectiveness and minimize risks.
- The estrogen component in COCs, typically ethinyl estradiol, should be taken in amounts varying from 10 to 50 μg, with "low-dose" pills (35 μg or less) being first-line options for adolescents 1.
- Patients should be counseled to take the missed pill as soon as possible and use a backup method, such as condoms, for at least 7 consecutive days to ensure contraceptive efficacy 1.
- If two or more consecutive hormonal pills have been missed, patients should take the most recent missed pill as soon as possible, discard any other missed pills, and continue taking the remaining pills at the usual time, using backup contraception until hormonal pills have been taken for 7 consecutive days 1.
- Emergency contraception should be considered if hormonal pills were missed during the first week and unprotected sexual intercourse occurred in the previous 5 days 1. Key points to consider when taking Ortho's tactics include:
- Starting COCs on the same day as the visit ("quick start") or on the day following emergency contraception use in healthy, non-pregnant adolescents 1.
- Counseling patients on common transient adverse effects, such as irregular bleeding, headache, and nausea, and providing recommendations for managing these effects 1.
- Informing patients about the increased risk of blood clots associated with COC use and the importance of reporting any symptoms, such as leg pain or swelling, to their healthcare provider 1.
From the Research
Orthostatic Hypotension Management
The proper way to take orthostatic hypotension tactics involves a combination of nonpharmacological and pharmacological measures.
- Nonpharmacological measures are the key to success, including increasing fluid and salt intake, and venous compression methods 2.
- Pharmacologic options include volume expansion with fludrocortisone and sympathetic enhancement with midodrine, droxidopa, and norepinephrine reuptake inhibitors 3.
Midodrine Administration
Midodrine is a prodrug that undergoes enzymatic hydrolysis to the selective alpha 1-adrenoceptor agonist desglymidodrine after oral administration.
- Oral midodrine significantly increases 1-minute standing systolic blood pressure compared with placebo 4.
- The risk of supine hypertension, which is associated with midodrine therapy in up to 25% of patients, can be reduced by taking the final daily dose at least 4 hours before bedtime 4.
Fludrocortisone Administration
Fludrocortisone is a mineralocorticoid that increases blood volume and blood pressure.
- Fludrocortisone is considered the first- or second-line pharmacological therapy for orthostatic hypotension alongside mechanical and positional measures 2.
- However, fludrocortisone has been associated with adverse events including renal and cardiac failure and increased risk of all-cause hospitalization 3.
Patient Response to Treatment
The response to treatment with midodrine or fludrocortisone can vary depending on the patient's condition.
- Midodrine is effective in the treatment of orthostatic hypotension only in those patients with significant preservation of autonomic reflexes 5.
- Patients with peripheral sympathetic denervation respond better to norepinephrine agonists/precursors such as droxidopa, whereas patients with central autonomic dysfunction respond better to norepinephrine reuptake inhibitors 3.