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Type 1 diabetes sick-day management — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)Type 1 diabetes sick-day managementUSMLE Step 3

A 31-year-old taking a combined oral contraceptive is starting tirzepatide for chronic weight management, with planned stepwise dose escalation. She wants to avoid pregnancy and has no contraindication to her current contraceptive. Which counseling is appropriate?

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Correct answer: E — Add a barrier method or switch to non-oral contraception for 4 weeks after initiation and each dose escalation

The best answer is “Add a barrier method or switch to non-oral contraception for 4 weeks after initiation and each dose escalation”. Tirzepatide delays gastric emptying and can reduce the efficacy of oral hormonal contraceptives, with the effect greatest after the first dose and during dose escalation. The FDA label advises switching to a non-oral method or adding a barrier method for 4 weeks after starting tirzepatide and for 4 weeks after every dose escalation. A short timing separation or backup confined to injection day does not address this pharmacokinetic effect.

Reference: FDA Prescribing Information: Zepbound (tirzepatide): https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806s037lbl.pdf