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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Assess patient needs for hormonal contraceptives

  • Manage and minimize side effects associated with hormonal contraceptives on the basis of patient needs

  • Identify drug interactions and contraindications associated with hormonal contraceptives

  • Recommend an appropriate contraceptive method on the basis of patient characteristics and needs

  • Properly educate a patient using a recommended contraceptive method

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PATIENT PRESENTATION

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Chief Complaint

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"I'm getting married soon, and I need to start birth control."

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History of Present Illness

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Carrie Anderson is a 36-year-old woman who presents to her primary care physician (PCP) for a routine follow-up appointment and excitedly states that she is getting married in 4 months and "needs to start birth control." She has been seeing her PCP regularly for the management of HTN and depression. She and her fiancé; are currently using condoms for pregnancy prevention, but states that she wants "something easier." She would like to have children "in a year or so." She was treated for depression 1 year ago with sertraline 50 mg PO daily for 6 months and her BP is controlled with HCTZ 25 mg PO daily and recent addition of ramipril 5 mg PO 6 weeks ago. Overall, she is feeling well and very happy. She admits to a nagging cough that started about 2 weeks ago, but otherwise, she is seeking to start on a hormonal contraceptive.

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Past Medical History

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HTN diagnosed 2 years ago

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Depression treated successfully 1 year ago (6-month treatment course)

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Family History

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Father is alive at age 67 with HTN. Mother is alive at age 65 with osteoporosis and HTN. She has one brother and one sister who are healthy.

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Social History

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Single, planning to get married for the first time in 4 months, no children, but plans to have children in 1 year. Caucasian, English speaking, United States born

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Tobacco/Alcohol/Substance Use

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Social drinker; admits to smoking ½ ppd, but would like to quit

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications (Current)

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HCTZ 25 mg PO daily

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Ramipril 5 mg PO daily

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Ibuprofen 200 mg PO PRN menstrual cramps

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Dextromethorphan/guaifenesin 5 mL PO q 6 h PRN cough

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Review of Systems

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Noticed dry cough, attributes it to possibly new allergies; (−) fever, chills, sore throat; otherwise feeling well

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Physical Examination

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General
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Obese, well-appearing, Caucasian woman in no acute distress

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Vital Signs
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BP 137/82 mm Hg, P 84, RR 12, T 36.2°C

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Weight ...

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