Venous thromboembolism risk with non-oral hormonal contraceptives

By Suhair Shawar, PharmD, PGY2 EM Pharmacy Resident // Edited by Liz Rozycki, PharmD, Specialty Practice Pharmacist, EM

A 32 year-old female patient presented to the emergency department (ED) with shortness of breath and chest pain. Patient’s work up included ruling out pulmonary embolism (PE).  Otherwise healthy, the patient is currently on etonogestrel implant (Nexplanon®) for contraception. The clinical pharmacist in the ED was asked to help with literature search regarding thromboembolic risk associated with etonogestrel implant and other non-oral, hormonal contraceptive therapies

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Medications for Lactating Mothers in the Emergency Department

By Liz Rozycki, PharmD, Specialty Practice Pharmacist, Emergency Medicine, OSU

There is no shortage of information regarding the benefits of breast milk for infants and mothers, likewise, there is no shortage of challenges that face a mother who is trying to breastfeed her baby through the recommended one to two years of age. Medication use during lactation, for acute or chronic conditions, poses a challenge to mothers and clinicians.  Is this medication safe for my baby? Is there an alternative? Do I have to “pump and dump”?  Especially for mothers who are presenting to the emergency department, if a medication is required, there is likely some reason they came in and treatment is warranted.

The easy, conservative and often unwarranted approach to medication use in lactating mothers is instructing them to pump and dump during medication use. Depending on the duration of medication therapy, this recommendation may result in a mother deferring her medical care in lieu of her child or may be the end of the breastfeeding journey. Although some mothers may have a stash of milk accumulated and may be able to pump and dump for a short period of time, this may not always be the case.  The goal of this blog post is to make sure all other options have been evaluated before you discharge a patient with the recommendation to “pump and dump”. 

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