PHARM W8 RESPONSE 5 PHARM W8 RESPONSE Pharm w8 Response Name of the University Author Name
Added on 2021-04-24
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Running head: PHARM W8 RESPONSEPharm w8 responseName of the StudentName of the UniversityAuthor note
1PHARM W8 RESPONSEAnswer oneContraceptives are likely to fail in obese patients and they need to be counselled aboutthe appropriate birth control options. Combination oral contraceptives (COCs) put obese womenat risk for venous and arterial thromboembolic disease (Lopez et al., 2013). Similarly, in thegiven case study, Margaret is obese and at a high risk of unintended pregnancy as compared tonon-obese counterparts. The overall effectiveness of contraceptives in reduced in obese women.Moreover, she is hypertensive and estrogen induced contraceptives cannot be used as it sharplyincreases the risk of hypertension. Margaret should not receive estrogen-containing oral pills ashypertension can be heightened by risk factors like obesity. Obesity is also considered a riskfactor for her arterial thromboembolic events in COC users. She is obese and increases the riskof acute myocardial infarction (AMI) (Brynhildsen, 2014). Considering these factors,Progesterone-only methods are the only options that comprises of progesterone-only pills(POPs), newer subcutaneous DMPA, depot medroxypro-gesterone acetate (DMPA) and depo-subQ Provera 104. From a safety standpoint, this birth control method is the most viablealternative for Margaret with contraindications to estrogen. There is increased risk for vascularcomplications as she is obese and have a high risk for COC and hypertension, the preferredoption for her may be progesterone-only method (Suchon et al., 2016). POPs comprises of long-acting reversible contraceptives (intrauterine devices [IUDs,implants], pills and injections. Levonorgestrel (LNG)-releasing intrauterine systems, (LNG-IUS)are highly effective and prevent pregnancy for more than three years. This hormone delivers thehormone directly to endometrium that causes endometrial thinning, decidualization and as aresult, ovulation is suppressed in half cycles. These implants deliver the hormone progestincontinuously to show its contraceptive effect via ovulation suppression and have mediated
2PHARM W8 RESPONSEeffects on endometrium and cervical mucus (Heikinheimo & Gemzell‐Danielsson Kristina,2012). POP is minipill that causes thickening of cervical mucus and endometrial lining thinningthat makes the uterus non-receptive to the ovum implantation. According to a study byTzankova, Petrov & Danchev (2010) there is an increased risk for deep vein thrombosis due tolethal combination of smoking and contraceptives. Margeret also smokes around 15 cigarettes aday and therefore, she needs to be counselled to quit smoking to enhance the efficacy of birthcontrol pills that she is intended to take. It is also important for her to lose weight and maintain aproper BMI as to increase the efficacy of birth control measures. Vaginal contraceptive ring isalso a reasonable birth control option for Margaret. Vaginal ring are more efficacious ascompared to oral contraceptives with precise and stable serum levels. The ring is hypothesized tooffer high hormone levels for overweight women as hormones are absorbed directly in themucosa of vagina and do not go through liver metabolism. Therefore, POPs and vaginal ring arethe safest birth control options for Margaret (Lopez et al., 2013). Answer two POPs and vaginal rings mentioned in the discussion by Crystal Richardson are the safestbirth control options for Margaret. This pill is helpful for individuals with high blood pressure asit reduces the risk for vascular complications. POPs are moderately efficacious and combinationhormonal contraceptives (CHCs) mentioned in the discussion cannot be used as it increases therisk of thromboembolism and cardiovascular diseases (CVDs). Estrogen is present in CHCs thatstimulates fibrinolytic and coagulation pathways. This would increase the risk of CVDs evenhigher for her (Horton, Simmons & Curtis, 2016). The copper IUD mentioned is an emergencycontraception option that may be good for obese women like Margaret if there is high failure rateof oral contraception. Education counseling recommended by Crystal is a good option for
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