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
"I'm getting married soon, and I need to start birth control."
History of Present Illness
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.
HTN diagnosed 2 years ago
Depression treated successfully 1 year ago (6-month treatment course)
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.
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
Social drinker; admits to smoking ½ ppd, but would like to quit
Allergies/Intolerances/Adverse Drug Events
Ibuprofen 200 mg PO PRN menstrual cramps
Dextromethorphan/guaifenesin 5 mL PO q 6 h PRN cough
Noticed dry cough, attributes it to possibly new allergies; (−) fever, chills, sore throat; otherwise feeling well
Obese, well-appearing, Caucasian woman in no acute distress
BP 137/82 mm Hg, P 84, RR 12, T 36.2°C