Advanced Pharmacology Sample Paper 3


            For various reasons such as unwanted pregnancies and spaced births, people opt for different contraceptive methods. Colquitt and Martin (2017) classify the methods as hormonal, barrier, natural, surgical, and intrauterine or emergency contraception. Due to the diversity of individuals, the choice for contraceptive methods is influenced by various reasons including costs, side effects, availability, and the cultural and religion acceptance (Colquitt & Martin, 2017). This forms the basis of discussion in this paper by inferring to the case study provided.

Contraceptive Options

            The options, as aforementioned, are influenced by a variety of factors, side effects being among them. Being that Margaret is at risk for cardiovascular events; contraceptives that do not contain estrogen are recommended. For her case, progestogen-only contraception is feasible. This form of contraception can be in the form of pills or injectable for those who have difficulty with pills (Bansode, Sarao & Cooper, 2020). Further, the Depo-Provera, an injectable progestogen-only contraception confers a 12-13 weeks of birth control and further reduces the risks for premenstrual syndrome (Bansode et al., 2020). The third option for progestogen-only method is the sub-dermal patches (Implanon) that is highly effective and provides long term contraception.

Additionally, intrauterine devices (IUD) can be considered. These devices can either be copper or hormonal; however devoid of estrogen therefore making it safe for the patient. Even though she is separated from her spouse, she is sexually active; she can use cheaper and widely available barrier methods such as female or male condoms. Moreover being that she is approaching menopause, and has two children, an ideal number of children according to the majority (Petrowski, Cappa & Gross, 2017), she can opt for sterilization techniques such as bilateral tubal ligation.

Contraindicated Options

            From the health history, use of combined oral contraceptive pills is contraindicated. An absolute contraindication for COC includes circulatory diseases or risk factors for cardiovascular events (Gomez-Tabares, 2020). Margaret is hereditarily susceptible to cardiovascular diseases as both of her parents are hypertensive. Additionally, her paternal grandfather died of hypertension, type 2 diabetes and coronary artery disease making her genetically vulnerable. Further, she is overweight (BMI of 28.6) and has systolic hypertension, risk factors for cardiovascular diseases. Moreover, the patient is an active smoker, a habit attributed fully to her stressful life events. Women who smoke cigarettes and use COCs are at an increased risk for peripheral arterial diseases (Gomez-Tabares, 2020).

Patient Education

            It is for the best interest of the patient to quit smoking. Concomitant use of COCs alongside smoking is associated with adverse cardiovascular events as aforementioned. Besides the cardiovascular related risks, pulmonary diseases such as lung cancer can ensue. Further, being that she is overweight, education on the importance of weight management and physical activity is crucial. Additionally, the patient reports not to eat well; therefore, nutritional counseling is equally important. The patient leads a stressful life as evidenced by her failed marriage, need to work for extra time and her adolescent sons. She therefore needs counseling from a psychiatrist. Since she is sexually active, safe sex education is necessary should she opt to look for another partner. Finally, regular blood and glucose measurement and breast cancer screening is vital due to her inherent risk for hypertension and diabetes type 2, and the association of breast cancer with COCs.

Normal Pelvic Exam and the Influence on Decision Making

            Even though the pelvic examination reveals normal findings, there is a minimal whitish non odorous vaginal discharge. Use of COCs has been associated with cystitis, a condition that can present with a whitish vaginal discharge (Judge et al., 2018). Further test are therefore required to rule out the condition before contraception is chosen. Further, the whitish discharge can be a sign of a sexually transmitted disease which would contraindicate the use of an IUD (Matorras et al., 2018).In the presence of the STD; an IUD can cause a pelvic inflammatory infection. Treatment is therefore required before IUD insertion