Claudia (G2P2) is a 36-year-old mother who recently delivered a child 9 months ago. She has been using condoms for birth control for the last 7 months. Today she is requesting a more convenient method of birth control. She is not sure of her current pregnancy plans, however, she does not wish to discuss sterilization or an IUD. She has no religious contraindications for treatment.
PMH: positive for mild hypertension with first pregnancy, seasonal allergies.
Surgeries: Left inguinal hernia and tonsillectomy.
Family history: Mother-HTN; Father-Colon CA (both deceased)
Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week.
Drug allergies-Sulfa causes a rash.
Current medications-MVI with Fe, Calcium chews, Allegra 10mg daily prn for allergies.
Vitals: Height 67 inches, weight 157 pounds, BP 110/75, P 70, R 16. PAP collected today, breast exam WNL, urine pregnancy negative.
Physical exam is normal.
What are your treatment goals for Claudia today?
What are two possible medications (in different classes) that you can recommend for Claudia? Please provide detailed rationale and mechanism of actions for each medication. Make sure that all recommendations are cited with guidelines or scholarly, peer-reviewed articles and always include medication, strength, dosage form, route, frequency and duration when making recommendations.
Pick of the medications from your response above and list five (5) patient-centered teaching points to communicate to the patient.
What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per day? Explain your answer.