Shannon Hobson 242425
BIOP211 Pharmacology
Abbreviated Drug Monograph
By: Shannon Hobson
Student Number: 242425
Word count: 1100
Drug Monographs:
OCP, Warfarin, Paracetamol, and Beta-blockers
1
Shannon Hobson 242425
Abstract:
A drug monograph as a document that outlines the class, indications, limitations, efficacy,
mechanism of action, cautions, contradictions, interactions, safety, as well as, the health
effects of a pharmaceutical drug. This report outlines 4 drug monographs, focusing on oral
contraceptive pills (specifically Triphasic formulation), Warfarin, Paracetamol, and betablockers (specifically Carvedilol).
2
Shannon Hobson 242425
Table of Contents:
Introduction, p.4
Drug Monographs
Oral Contraceptive Pill: Triphasic formulation, pp. 5-7
Warfarin, pp. 8-10
Paracetamol, pp. 11-13
Beta-blocker: Carvedilol, pp. 14-15
Conclusion, p.16
References, pp. 17-20
3
Shannon Hobson 242425
Introduction:
The turnover for pharmaceutical companies here in Australia is estimated at a staggering
$23.4 billion (Australian Government 2014), and the one issue surrounding the heavy
reliance on pharmaceuticals is their risks versus rewards. This report outlines 4 drug
monographs; oral contraceptive pills (Triphasic formulation), Warfarin, Paracetamol, and
beta-blockers (Carvedilol). These monographs outline indications, mechanism of action,
efficacy and limitations, cautions/contradictions, as well as, adverse health effects that could
occur upon use. It’s important to note that there are alternatives to pharmaceutical drug use,
and that these drugs should not be considered a ‘cure-all’ solution.
4
Shannon Hobson 242425
Drug Monographs:
1) Oral Contraception Pill: Triphasic formulation
Class: Combined oral contraceptive pill (MIMS Australia 2015)
Table 1.1: Examples and Active ingredients of Triphasic Formulations
Example
Active Ingredients
Triphasil®
Levonorgestrel, Ethinyl Estradiol
Ortho Tri-Cyclen®
Norgestimate, Ethinyl Estradiol
Ortho Tri-Cyclen® Lo
Norgestimate, Ethinyl Estradiol
*table information from The American Society of Health-System Pharmacists (2015)
Indications: Oral contraceptive or birth control pills are used to prevent pregnancy
(triphasic’s), and some are used to treat acne and reduce symptoms of premenstrual
dysphoric disorders (The American Society of Health-System Pharmacists 2015). A
randomised control trial by Byamugisha et al. (2010, p.670) outlined that the active
ingredients Levonorgestrel and Ethinyl Estradiol are used for emergency
contraception (EC).
Mechanism of Action: Oestrogens and progestin’s inhibit the release of follicle
stimulating and luteinizing hormones, thus not enabling the follicle to grow (West
Virginia University 2013). Progestin’s also alter the uterine lining, making it
inhospitable for implantation, as well, they increase cervical mucus which reduces
sperm motility (West Virginia University 2013).
Efficacy and limitations: A review by Grimes et al. (2009, p.13) determined that
triphasic formulations of oral contraceptive pills did have a slightly better outcome in
reducing pregnancies, as well as, having less break-through bleeding then
monophasics pill formulations. Although, WHO (2015) determined that triphasic
formulations did not have a significant advantage over monophasic formulations.
Also, a systematic review by Mansour et al. (2010, p.9) points out that triphasic
failure rates depend greatly on compliance with dosing regime and fecundity.
Cautions/contradictions: Use caution when combining triphastic oral contraceptive
with hepatic enzyme inducers, protease inhibitors, St. John’s Wort, CYP3A4
5
Shannon Hobson 242425
inhibitors, beta-adrenergic antagonists, caffeine, competitive inhibitors of gastrointestinal sulfation, drugs that decrease gastro-intestinal transit time, antihypertensive’s, anti-convulsant’s, anti-coagulants, and hypoglycaemic’s (MIMS
Australia 2015). The American Society of Health-System Pharmacists (2015) also
state to exercise caution if overweight, have a family history of breast cancer, may be
pregnant, or having surgery.
Table 1.2: Adverse effects
Source
Adverse Health Effects
The American Society of Health-
Outline that the oral contraception pill can
System Pharmacists (2015)
cause nausea, breast tenderness, mood
changes, break-through bleeding,
headaches, skin changes, change in
libido, and potential weight gain. Also,
possible serious adverse effects include
thrombosis and potential increased risk of
developing breast cancer.
Battaglia et al. (2014, p.478)
This randomized control trial determined
that the active ingredient Ethinyl Estradiol
in birth control formulations caused a
reduction in female sexual libido,
specifically decreasing clitoral
vascularization and increasing vaginal
dryness, as well as, decreasing
testosterone levels.
Klipping et al. (2011, p.165)
This open-label, randomized, crossover
study determined that an intake of a
ethinylestradiol/levonorgestrel formulation
showed adverse effects like headache
and nasopharyngitis among some
participants. Also,
ethinylestradiol/levonorgestrel formulation
showed an increase in D-dimer levels
and a more pronounced increase in
6
Shannon Hobson 242425
levels of prothrombin and fibrinogen, thus
a slight increase to coagulation.
Ziller et al. (2014, p.417)
Determined that there is a higher risk of
deep vein thrombosis when using
combined oral contraceptive pills. Also,
the use of pills containing Norgestimate
over Levonorgestrel did slightly increase
this risk.
7
Shannon Hobson 242425
2) Warfarin:
Class: Anti-thrombotics, anticoagulants (MIMS Australia 2015)
Table 2.1: Examples and Active ingredients of Warfarin
Example
Active Ingredients
Coumadin
Warfarin sodium
Marevan
Warfarin sodium
*table information from MIMS Australia 2015
Indications: Warfarin is used as a prophylactic and treatment for deep vein
thrombosis and pulmonary thromboembolism, associated with myocardial infraction,
atrial fibrillation or person’s with prosthetic heart valves (Bryant & Knights 2015,
p.580).
Mechanism of Action: Warfarin inhibits the synthesis of clotting factors, as well as,
C1 subunit of vitamin K (epoxide reductase enzyme complex), and thus reduces the
regeneration of vitamin K1 epoxide (MIMS Australia 2015). Warfarin also decreases
the amount of active form vitamin K dependent clotting factors by 30-50%, which are
made in the liver (MIMS Australia 2015).
Efficacy and limitations: Yuh-Jer Shen et al. (2008, p.818) outlines Warfarin’s lack
of efficacy in relation to use for noncardioembolic stroke in differing ethnic
populations. Schulman (2014, p.2) outlines that warfarin needs to be taken for longer
(5 days) to see maximum effects, as well it has a longer half-life (36-48 hours) in
comparison to new anti-coagulants, thus it takes longer for warfarin to reach a steady
state in the body, this could lead to adverse health effects if dosing is not correct.
Cautions/contradictions: Warfarin is known to have many drug and food
interactions; table 2.2 outlines these. MIMS (2015) states that Marevan and
Coumadin should not be interchanged. The Mayo Foundation for Medical Education
and Research (2015) states that person’s on warfarin need to have regular blood
tests to determine viscosity of blood for proper dosing. The Mayo Foundation for
Medical Education and Research (2015) also states that using warfarin during
pregnancy and lactation is not recommended, also that there is an increased risk of
bleeding if injury should occur. Table 2.3 outlines more of Warfarin’s cautions and
contradictions.
8
Shannon Hobson 242425
Table 2.2: Drug and Food Interactions with Warfarin
Interactions with:

Antimicrobials, cardiovascular drugs, anti-inflammatories, immunodulators,
analgesic drugs, drugs for the gastrointestinal system, anti-neoplastic drugs
(Bryant & Knights 2015, p.580)

Food interactions:
-Increased anti-coagulating effect seen with dong quai, St. John’s Wort,
garlic and papaya
-Decreased anti-coagulating effect seen with ginseng
(Bryant & Knights 2015, p.580)

Leafy green vegetables reduce warfarin’s anti-coagulating effects, thus
increasing the chances of clotting if eaten in high doses (Palo Alto Medical
Foundation 2009)

Ingestion of large amounts of cranberry juice and mangoes increases
warfarin’s effects and thus increases chance of bleeding (Palo Alto Medical
Foundation 2009)

Alcohol consumption over moderate intakes (over 2 drinks/day) increases
the risk of bleeding when on warfarin (Palo Alto Medical Foundation 2009)
Table 2.3: Other cautions and contradictions when using Warfarin
Other cautions/contradictions:

Use with caution in people with a history of allergic reactions (severe) or
anaphylaxis, oedema, high cholesterol, hypothyroidism, the elderly,
alcoholics, person’s on psychotics or the mentally unstable, blood
disorders, pericarditis, visceral cancer, liver and kidney impairment, vitamin
C deficiency, vitamin K deficiency, or endocarditis (Bryant & Knights 2015,
p.580)
9
Shannon Hobson 242425
Table 2.4: Adverse effects
Source
Adverse Health Effects
Yuh-Jer Shen et al. (2008, p.819)
Outlines that warfarin is associated with a
greater bleeding risk then aspirin. As
well, this review determined that there
was a 2-fold increase to the risk of stroke
when on warfarin for people of colour.
Reddy et al. (2014, p.1991-1993)
Adverse effects seen in this randomized
clinical trial were major bleeding, serious
pericardial effluence, stroke, and
cardiovascular or unexplained death.
Guidoni, Obreli-Neto & Leira Pereira
This study found that there was a high
(2014, p.547)
incidence of excessive anticoagulation
and risk of bleeding in patients taking
warfarin.
Verret et al. (2012, p.876)
Adverse effects seen, in this randomized
control trial, were ocular hematoma from
taking the wrong dosage amount, some
major bleeding events, gastrointestinal
bleeding associated with chronic
ulcerative colitis, and haematuria in posturologic surgery.
10
Shannon Hobson 242425
3) Paracetamol:
Other name: Acetaminophen (The Mayo Foundation for Medical Education and
Research 2015)
Class: Analgesic and antipyretic (MIMS Australia 2015)
Dosage forms: Paracetamol dosage forms include capsules, oral powder, oral
liquid or suspension, soluble tablets and tablets (uncoated, film coated, effervescent
and gelatine coated) (Australian Government TGA 2014).
Indications: Paracetamol is used readily to relieve fevers, as well as, mild to
moderate pain, including use for headaches, period pain, otitis media (earache),
migraine, muscular pain/aches, postoperative pain and osteoarthritis (first-line
treatment) (Bryant & Knights 2015, p.67). Paracetamol can also be used for
toothache, sinus pain, back pain, arthritis, tennis elbow, colds, and flu (Australian
Government TGA 2014).
Mechanism of Action: Paracetamol’s mechanism of action is still not completely
understood (Marzuillo, Guarino & Barbi 2014, p.418). It is thought that paracetamol
has an inhibiting effect on prostaglandin synthesis in the brain, but it has been further
hypothesised that paracetamol activates the serotonergic inhibitory descending pain
pathway (central serotonergic mechanism). Also, it has been hypothesised that
paracetamol has an effect on cannabinoid receptors creating a paracetamol
metabolite fatty acid amide N-arachidonoylphenolamine, giving this drug the ability to
depolarize afferent neurons, causing the synthesis of nitric oxide within the spine and
having an inhibiting effect on nociceptive conduction (Marzuillo, Guarino & Barbi
2014, p.418).
Efficacy and limitations: A randomized comparative study by Vyas et al. (2014)
determined that paracetamol did have an antipyretic action, seen over a 4 hour
period, and having a 1.48% decrease in the temperature. Also, a randomized control
trial by Williams et al. (2014) showed that paracetamol did not show any
improvement to varying degrees of back pain versus the placebo treatment. As well,
a randomised noninferiority trail by Ghosh et al. (2013, p.440) determined that
differing dosages (1000mg/2 a day vs 500mg/4 times a day) of paracetamol did have
an analgesic and antipyretic effect.
Cautions/contradictions: Caution should be taken when giving paracetamol, as
person’s with renal or liver dysfunction could be adversely affected (Bryant & Knights
2015, p.67). The Mayo Foundation for Medical Education and Research (2015)
11
Shannon Hobson 242425
outlines that paracetamol should not be given to children under the age of 2, that
paracetamol is considered safe for use during pregnancy, and has minimal risk
during breastfeeding. Paracetamol should be taken as per instructions as over-dose
can occur (The Mayo Foundation for Medical Education and Research 2015).
Paracetamol does interact with other medicines and other, which is outlined in table
2.1.
Table 3.1: Paracetamol drug and other interactions
Drug and Other Interactions:
Drugs/medicines:

Imatinib

Isoniazid

Pixantrone

Pneumococcal 13-Valent Vaccine, Diphtheria Conjugate

Acenocoumarol

Carbamazepine

Fosphenytoin

Lixisenatide

Phenytoin

Warfarin

Zidovudine
Other:

Ethanol

Tobacco

Cabbage
*table information from The Mayo Foundation for Medical Education and Research
(2015)
Table 3.2: Adverse effects
Source
Adverse Health Effects
Marzuillo, Guarino & Barbi 2014,
This study outlines that paracetamol can
p.418
potentially cause a rash or allergic
reaction in some people, but this rash
12
Shannon Hobson 242425
can become serious and could be
accompanied by mucosal lesions and
fever. This study also states that
paracetamol can cause flushing,
hypotension, tachycardia, and is
potentially linked to the development of
childhood asthma if mother’s are
exposed during pregnancy. As well,
acute liver failure is considered a major
adverse effect with the use of
paracetamol, being seen in both adults
and children.
Vyas et al. (2014)
This randomized comparative study did
see vomiting and abdominal pain as
adverse effects of taking paracetamol,
although these reactions were not seen
in all patients.
The Mayo Foundation for Medical
Outlines that paracetamol can cause rare
Education and Research (2015)
side effects like blood in stools,
haematuria or cloudy urine, sharp lower
back pain, pinpoint red spots, rash, hives,
ulcers or sores, decrease in urine output,
tiredness, and yellow of the skin and
eyes. Also if dosing is not followed as
per instructions over-dose can occur.
13
Shannon Hobson 242425
4) Beta-blocker: Carvedilol
Class: Beta-adrenergic blocking agent, alpha1, nonselective beta-blocker (MIMS
Australia 2015)
Indications: Carvedilol is used for hypertension (MIMS Australia 2015) and
congestive heart failure (mild to severe) (Bryant & Knights 2015, p.247).
Mechanism of Action: Carvedilol has haemodynamic effects on β₁, β₂ and αadrenoceptors, and blocks their activation. A study by Jing Duan et al. (2010, p.996)
outlines that carvedilol is a β-adrenorector antagonist, but has other non-betablocking actions like causing vasodilation, antioxidant and neuroprotective actions
(Inhibition of potassium channels), reduction of mitochondrial damage, and protection
against apoptosis.
Efficacy and limitations: A randomised, controlled, double-blind study done by
Hori, Izumi & Matsuzak (2014, p.245) determined that carvedilol did have an effect
on lowering heart rate in patients with chronic heart failure, but did not have an effect
on systolic or diastolic blood pressure. A prospective, randomized, open, blindedend point, multi-centre study by Kim et al. (2014, p.53-57) saw that using carvedilol
reduced brachial blood pressure significantly (systolic and diastolic), decreased
central pulse pressure, saw no significant difference to cfPWV, and saw a significant
increase to triglyceride levels, while lowering HDL cholesterol levels.
Cautions/contradictions: MIMS (2015) outlines carvedilol can cause
decompensated heart failure, asthma, allergic reactions, sick sinus syndrome,
cardiogenic shock, worsening heart failure, withdrawal symptoms, and hepatic
dysfunction. Also, carvedilol should be taken with caution by patients taking CYP450
inducers and inhibitors (ex: grapefruit juice), and in people with worsening heart
failure, severe hypertension, diabetes, and hypersensitivities (MIMS 2015). Caution
should also be taken in children under age 18, pregnancy and lactation (MIMS 2015).
Table 4.1: Adverse effects
Source
Adverse Health Effects
Hori, Izumi & Matsuzak (2014, p.245)
This study outlined that a rare adverse
effect in patients with chronic heart failure
taking carvedilol were the development of
diabetes mellitus and gastrointestinal
bleeding.
14
Shannon Hobson 242425
Kim et al. (2014, p.54)
This study saw some adverse effects like
back pain due to acute transverse
myelitis, chronic sinusitis, and 1 case of
facial oedema, dizziness and nausea.
The Mayo Foundation for Medical
The Mayo Clinic outlines a large list of
Education and Research (2015)
adverse reactions that may occur when
using carvedilol. The more commonly
seen effects are allergic reaction, chest
discomfort or tightness, dizziness,
fainting, oedema of the feet/ankles/legs,
shortness of breath, slowed heartbeat,
weight gain, tingling sensations, and
diarrhoea.
(Acharya, Wilton & Shakir 2005, p.4)
A cohort study followed over 800 patients
to look specifically at the adverse
reactions when taking carvedilol. These
reactions included dyspepsia, lassitude,
depression, respiratory infections, deep
vein thrombosis, and wheezing, although
symptoms were varied and moderate.
15
Shannon Hobson 242425
Conclusion:
Currently the TGA is responsible for the research, licensing, safety, monitoring, and
surveillance of pharmaceutical and complementary products on the Australian market.
Although there is a regulating body, there are many over-the-counter drugs that offer
medicinal benefits, but run the risk of adverse health effects. As outlined throughout this
report, a relatively healthy individual should weigh-out the risk-benefits in relation to taking
some of these discussed pharmaceuticals. Unfortunately, some of the drugs like Warfarin
are necessary to ensure the continued health of some individuals. Education is key and
creates patient awareness, which is very important in a pharmaceutically driven society that
is seen today.
16
Shannon Hobson 242425
References:
Acharya, N, Wilton, L & Shakir, S 2005, 'Observational cohort study to monitor the use and
safety of carvedilol in the treatment of heart failure in clinical practice in England--1st interim
report', International Journal Of Clinical Pharmacology And Therapeutics, vol. 43, no. 1, pp.
1-6, viewed 11 May 2015, <http://www.ebscohost.com>.
Australian Government 2014, Australian Pharmaceuticals Industry Data Card 2014, viewed
14 May 2015,
<http://www.industry.gov.au/industry/IndustrySectors/PharmaceuticalsandHealthTechnologie
s/Pharmaceuticals/Pages/PharmaceuticalsIndustryDataCard.aspx>.
Australian Government TGA 2014, OTC medicine monograph: Paracetamol for oral use,
viewed 9 May 2015, < https://www.tga.gov.au/otc-medicine-monograph-paracetamol-oraluse#active>.
Battaglia, C, Morotti, E, Persico, N, Battaglia, B, Busacchi, P, Casadio, P, Paradisi, R &
Venturoli, S 2014, 'Clitoral vascularization and sexual behavior in young patients treated with
drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot
study', The Journal Of Sexual Medicine, vol. 11, no. 2, pp. 471-480, viewed 9 May 2015,
<http://www.ebscohost.com>.
Bryant & Knights 2015, Pharmacology for Health Professionals, Elsevier, Australia.
BYAMUGISHA, J, MIREMBE, F, FAXELID, E, TUMWESIGYE, N & GEMZELLDANIELSSON, K 2010, 'A randomized clinical trial of two emergency contraceptive pill
regimens in a Ugandan population', Acta Obstetricia Et Gynecologica Scandinavica, vol. 89,
no. 5, pp. 670-676, viewed 9 May 2015, <http://www.ebscohost.com>.
Denus, S 2012, 'Impact of a pharmacist-led warfarin self-management program on quality of
life and anticoagulation control: a randomized trial', Pharmacotherapy, vol. 32, no. 10, pp.
871-879, viewed 9 May 2015, <http://www.ebscohost.com>.
Duan, J, Wang, Q, Deng, C, Kuang, S, Chen, R & Tao, L 2010, 'Effects of carvedilol on
delayed rectifier and transient inactivating potassium currents in rat hippocampal CA1
neurons', Clinical & Experimental Pharmacology & Physiology, vol. 37, no. 10, pp. 996-1003,
viewed 11 May 2015, <http://www.ebscohost.com>.
Ghosh, S, Patel, J, Patel, H, Pandya, N, Naik, S & Patel, H 2013, 'Acute & Perioperative
Pain Section: A Novel Paracetamol 1,000 mg Sustained Release Formulation vs
Conventional Paracetamol 500 mg Formulation in Patients with Fever and Pain: A
17
Shannon Hobson 242425
Randomized Noninferiority Trial', Pain Medicine, vol. 14, pp. 436-441, viewed 10 May 2015,
<http://www.ebscohost.com>.
Grimes, DA, Lopez, LM, Schulz, KF, Van Vliet, HAAM & Helmerhorst, FM 2009, Triphasic
versus monophasic oral contraceptives for contraception (Review), Wiley Publishers, viewed
14 May 2015, <http://apps.who.int/rhl/reviews/CD003553.pdf>.
Guidoni, C, Obreli-Neto, P & Pereira, L 2014, 'Pharmacoepidemiologic study of warfarin
prescription in a Brazilian tertiary hospital', Journal Of Thrombosis And Thrombolysis, vol.
37, no. 4, pp. 542-548, viewed 9 May 2015, <http://www.ebscohost.com>.
Hori, M, Nagai, R, Izumi, T & Matsuzaki, M 2014, 'Efficacy and safety of bisoprolol fumarate
compared with carvedilol in Japanese patients with chronic heart failure: results of the
randomized, controlled, double-blind, Multistep Administration of bisoprolol IN Chronic Heart
Failure II (MAIN-CHF II) study', Heart And Vessels, vol. 29, no. 2, pp. 238-247, viewed 11
May 2015, <http://www.ebscohost.com>.
Kim, E, Song, W, Lee, J, Shin, M, Lee, S, Kim, B, Hong, K, Han, S, Park, C & Seo, H 2014,
'Efficacy of losartan and carvedilol on central hemodynamics in hypertensives: a
prospective, randomized, open, blinded end point, multicenter study', Hypertension
Research: Official Journal Of The Japanese Society Of Hypertension, vol. 37, no. 1, pp. 5056, viewed 11 May 2015, <http://www.ebscohost.com>.
Klipping, C, Duijkers, I, Parke, S, Mellinger, U, Serrani, M & Junge, W 2011, 'Hemostatic
effects of a novel estradiol-based oral contraceptive: an open-label, randomized, crossover
study of estradiol valerate/dienogest versus ethinylestradiol/levonorgestrel', Drugs In R&D,
vol. 11, no. 2, pp. 159-170, viewed 9 May 2015, <http://www.ebscohost.com>.
Mansour, D, Inki, P & Gemzell-Danielsson, K 2010, 'Efficacy of contraceptive methods: A
review of the literature', European Journal Of Contraception & Reproductive Health Care,
vol. 15, no. 1, pp. 4-16, viewed 9 May 2015, <http://www.ebscohost.com>.
Marzuillo, P, Guarino, S & Barbi, E 2014, 'Paracetamol: a focus for the general pediatrician',
European Journal Of Pediatrics, vol. 173, no. 4, pp. 415-425, viewed 10 May 2015,
<http://www.ebscohost.com>.
Mayo Foundation for Medical Education and Research 2015, Drugs and Supplements:
Warfarin (Oral Route), viewed 14 May 2015, <http://www.mayoclinic.org/drugssupplements/warfarin-oral-route/precautions/drg-20070945>.
MIMS Australia 2015, Abbreviated PI: Triphasil, viewed 14 May 2015, < https://wwwmimsonline-com18
Shannon Hobson 242425
au.ezproxy.endeavour.edu.au/Search/AbbrPI.aspx?ModuleName=Product%20Info&searchK
eyword=triphasil&PreviousPage=~/Search/QuickSearch.aspx&SearchType=&ID=58170001
_2>.
Palo Alto Medical Foundation 2009, Warfarin (Coumadin®) and Your Diet, viewed 14 May
2015, < http://www.pamf.org/anticoag/patients/handouts/Warfarin_and_Diet.pdf>.
Reddy, V, Sievert, H, Halperin, J, Doshi, S, Buchbinder, M, Neuzil, P, Huber, K, Whisenant,
B, Kar, S, Swarup, V, Gordon, N & Holmes, D 2014, 'Percutaneous left atrial appendage
closure vs warfarin for atrial fibrillation: a randomized clinical trial', Jama, vol. 312, no. 19,
pp. 1988-1998, viewed 9 May 2015, <http://www.ebscohost.com>.
Schulman, S 2014, 'Advantages and limitations of the new anticoagulants', Journal Of
Internal Medicine, vol. 275, no. 1, pp. 1-11, viewed 9 May 2015,
<http://www.ebscohost.com>.
Shen, A, Chen, W, Yao, J, Brar, S, Wang, X & Go, A 2008, 'Effect of race/ethnicity on the
efficacy of warfarin: potential implications for prevention of stroke in patients with atrial
fibrillation', CNS Drugs, vol. 22, no. 10, pp. 815-825, viewed 9 May 2015,
<http://www.ebscohost.com>.
The American Society of Health-System Pharmacists 2015, Estrogen and Progestin (Oral
Contraceptives), viewed 14 May 2015,
<http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601050.html>.
Vyas, FI, Rana, DA, Patel, PM, Patel, VJ & Bhavsar, RH 2014, ‘Randomized comparative
trial of efficacy of paracetamol, ibuprofen and paracetamol-ibuprofen combination for
treatment of febrile children’, Perspect Clin Res., vol. 5, no. 1, pp.25–31, viewed 10 May
2015, <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3915365/>.
West Virginia University 2013, Estrogens and Female Reproductive Drugs, viewed 14 May
2015,
<http://www.hsc.wvu.edu/som/physio/classes/pcol260/classroom/notes/estrogens.htm>.
WHO 2015, Monophasic versus multiphasic oral contraceptives, viewed 14 May 2015,
<http://apps.who.int/rhl/fertility/contraception/dscom/en/>.
Williams, C, Maher, C, Latimer, J, McLachlan, A, Hancock, M, Day, R & Lin, C 2014,
'Articles: Efficacy of paracetamol for acute low-back pain: a double-blind, randomised
controlled trial', The Lancet, vol. 384, pp. 1586-1596, viewed 10 May 2015,
<http://www.ebscohost.com>.
19
Shannon Hobson 242425
Ziller, M, Ziller, V, Haas, G, Rex, J, & Kostev, K 2014, 'Risk of venous thrombosis in users of
hormonal contraceptives in German gynaecological practices: a patient database analysis',
Archives Of Gynecology & Obstetrics, vol. 289, no. 2, p. 413, viewed 9 May 2015,
<http://www.ebscohost.com>.
20