NAPLEX Question of the Week: Choices, Choices, Choices?

In many states, pharmacists are integrally involved in choosing contraception options for patients. Are you up to the challenge?
NAPLEX Question of the Week: Choices, Choices, Choices?
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KC is a 20-year-old female who presents to your pharmacy counter to discuss potential contraception options. She has never been on any form of birth control before and is open to discussing both oral and non-oral contraceptives. Her past medical history is significant for GERD and migraine headaches with aura. She takes sumatriptan, a women’s daily multivitamin and TUMS OTC prn.  Which of the following would be acceptable birth control choices for KC? (Select all that apply) 

A. Yaz tablets 

B. Errin tablets 

C. Copper T IUD 

D. Levonorgestrel-IUD 

E. NuvaRing

F. Nexplanon arm implant  

G. Depot medroxyprogesterone acetate injection 

H. Xulane patch  

 

Answers with rationale: 

Answers: B, C, D, F, G 

Explanation: This patient cannot receive products containing estrogen because she has a history of migraines with aura. Migraines with aura can increase the risk of stroke and are a contraindication for estrogen use. This means that she cannot receive any method of contraception that contains combined hormones. This rules out combined contraceptive pills (Yaz (ethinyl estradiol + drospirenone)), the ring (NuvaRing (ethinyl estradiol & etonogestrel)), and the patch (Xulane patch (ethinyl estradiol & norelgestromin)). Other contraindications to estrogen containing products would be current or past DVT/PE, uncontrolled hypertension, patients >35 years of age who smoke, severe cirrhosis, women who are <21 days postpartum, or current or past diagnosis of breast cancer. She can take any progestin only products such as the progestin only pills (Errin (norethindrone)), the levonorgestrel- IUD, the Nexplanon (etonogestrel) arm implant, the depot injection, or the non-hormonal option of the copper IUD. Contraindications for progestin therapy would include active breast cancer, and contraindications for IUD use would be anatomical uterine abnormalities or current cervical cancer.  

NAPLEX Exam Competencies Covered: Area 3 (Develop or manage treatment plans), Section 3.6 (drug contraindications, allergies or precautions)  

 

Source for more info: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a3.htm

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