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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Describe the advantages and disadvantages of the various options for emergency contraception.

  • Discuss the possible side effects and contraindications of the various forms of emergency contraceptives, including both oral and nonoral options.

  • Provide patient education regarding the use of emergency contraception.

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PATIENT PRESENTATION

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Chief Complaint

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“I forgot to restart my birth control pill pack. I have gone 9 days without a ‘real’ pill. I’m not ready to be pregnant yet!”

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HPI

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Olivia Furtel is a 19-year-old woman who presents to the Family Medicine Clinic in a panic. She states that she typically throws out the last week of pills in her pack, “since they are not ‘real’ pills anyway,” and she forgot to start her new pill pack on time. She had intercourse with her husband 2 days ago and wants to know what she should do to avoid pregnancy.

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PMH

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Seasonal allergies

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FH

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Mother, age 47, with type 2 diabetes. Father, age 45, with hypertension. Maternal grandmother, age 69, with COPD.

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SH

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  • Denies smoking

  • Enjoys an occasional glass of wine

  • Married × 1 year—mutually monogamous relationship

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Meds

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  • Cetirizine 10 mg PO once daily × 5 years

  • Aviane (ethinyl estradiol 20 mcg/levonorgestrel 0.1 mg) 1 tablet PO once daily × 2 years

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All

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NKDA

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ROS

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Patient is a nulligravida woman whose menstrual periods are regular with the use of the combined oral contraceptive pill. She denies any breakthrough bleeding or spotting with routine use. She is tolerating the contraceptive pill well.

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Physical Examination

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Gen
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WDWN female appearing anxious

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VS
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BP 106/70 mm Hg, P 60 bpm, RR 13, T 37°C; Wt 53.5 kg, Ht 5′5″, BMI 19.6 kg/m2

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Skin
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Clear

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Exam
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Deferred; she had a complete examination 3 months ago that was normal

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Labs

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3 months ago
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Negative Pap smear

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1 year ago
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Tests negative for Chlamydia, gonorrhea, syphilis, and HIV

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Assessment

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Healthy, sexually active female who missed two doses of her combined oral contraceptive pill, extending her pill-free interval >7 days. Emergency contraceptive options to prevent pregnancy should be discussed.

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QUESTIONS

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Problem Identification

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1. Identify the patient’s drug therapy problem.

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