Case Studies: September 2021

Case 1

MP is a 22-year-old woman who is sexually active and accidentally missed
her daily birth control dose both yesterday and the day before, as she left her pills at home while traveling for work. She takes a monophasic combination oral contraception pill containing ethinyl estradiol 20 mcg and norethindrone acetate 1 mg per tablet. MP notes that her placebo pills start next week, and she takes a 28-day pill pack. She asks whether she should take the missed pills today. How should the pharmacist respond?

What is the explanation?

A: MP should take a pill as soon as possible and continue her remaining active pills as scheduled. Because her 2 consecutive pills were missed during the last week of hormonal pills, she should omit the hormone-free interval (placebo tablets) by finishing the hormone pills and start a new pack the next day. If MP does not have her new pack yet, she should avoid sexual intercourse or use a back-up contraception method, such as condoms or a diaphragm, until hormonal pills from a new pack have been taken for 7 consecutive days.

Case 2

JF is a 55-year-old man who recently became homeless after losing his job, because of economic hardship. He has type 2 diabetes and has been on insulin glargine for the past 5 years. Now that JF does not have constant access to refrigeration, he is worried that his insulin will not be effective and his diabetes will worsen. He is terrified, because his grandfather had his leg amputated as a result of diabetes. What advice should the pharmacist give to JF?

A: Reassure JF that most insulin products, opened or unopened, may be left unrefrigerated at a temperature between 59 °F and 86 °F for up to 28 days and continue to work. Insulin loses some effectiveness when exposed to extreme temperatures, so JF should keep the insulin out of direct sunlight. JF can inquire with his town for information on local shelters, or visit the Red Cross for more information at https://www.redcross.org/get-help/disaster-relief-and-recovery-services/find-an-open- shelter.html. Because this is a very stressful time for JF, also provide education on hyperglycemia or hypoglycemia and when he should seek emergency care for his diabetes.

REFERENCES

1. Frieden TR, Jaffe HW, Stephens JW, Cardo DM, Zaza S. U.S. selected practice recommendations for contraceptive use, 2013. MMWR[KM1] . 2013;62(5).
2. Information regarding insulin storage and switching between products in an emergency. FDA. Updated September 19, 2017. Accessed May 22, 2021. https://www.fda.gov/drugs/emergency-preparedness-drugs/information-regarding-insulin-storage-and-switching-between-products-emergency