Margaret is a 40-year-old white female in for her annual examination. She states she has been under increased stress in her life for the past few months. She and her husband are currently separated and considering divorce.

Pharm Week 8

The contraceptive options appropriate for Margaret include non-hormonal methods such as the Copper intrauterine device. She can also use mechanical barriers such as condoms or permanent contraception through tubal ligation (Britton et al., 2020). These methods do not contain hormones, which may affect the patient’s blood pressure and weight. The Copper intrauterine device would be the most appropriate since it is long-term and have high efficacy.

Contraceptive options contraindicated for Margaret include hormonal contraceptives due to associated side effects of weight gain, depressed mood, hypertension, and arterial and venous thrombosis (Curtis et al., 2016). The hormonal contraceptives include Progestin-only oral pills (POPs), combined oral contraceptives (COCs), Contraceptive vaginal ring, Combination patch contraceptive, and Injectable Depo-Provera.

Besides, hormone-releasing intrauterine devices such as Mirena are contraindicated for this patient. Contraindications for hormonal contraceptives containing estrogen include History of smoking more than g ≥15 cigarettes/day, multiple risk factors for cardiovascular disease, hypertension with systolic BP 140–159, or diastolic pressure 90–99 mmHg, and obesity (Curtis et al., 2016). The patient in the case has a high BP of 148/88, a high BMI of 28.6, an active smoker, and has multiple risk factors for cardiovascular diseases.

Patient education for Margaret should center on lifestyle modification on diet, physical activity, and smoking. She should be recommended to engage in regular physical exercises to promote weight loss and lower BP. Besides, she should be advised to have a low sodium and caloric diet to lower BP and promote weight loss. The patient should be advised to stop taking contraceptive pills and be educated on their side effects (Britton et al., 2020).

Furthermore, she should be advised to use a barrier method if she has multiple sexual partners to prevent STIs (Britton et al., 2020). The patient’s normal pelvic exam influences the decision to have the Copper intrauterine device since there are no signs of conditions that would rule out IUD insertion.

References

• Britton, L. E., Alspaugh, A., Greene, M. Z., & McLemore, M. R. (2020). CE An Evidence-Based Update on Contraception. The American journal of nursing, 120(2), 22–33. https //doi.org/10.1097/01.NAJ.0000654304.29632.a7
• Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., … & Whiteman, M. K. (2016). US Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR. Recommendations and reports Morbidity and mortality weekly report. Recommendations and reports, 65(3), 1-103.