Pharm
Read
a selection of your colleagues’ responses from Week 9 and respond to at least two of who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. APA style 3 citations references each response
Post 1
Based on the patient’s symptoms and age, I would say she is entering the pre-menopausal stages. While the patient has yet to enter initial phase of menopause as that consists of menstrual cycles becoming irregular. This is determined by the patient’s history as she voiced that her cycles have remained regular and occur monthly. The symptoms the patient has mentioned are considered vasomotor symptoms which include the hot flashes and night sweats she has been experiencing. Genitourinary symptoms are an occurrence during menopause which happens because like the vagina, the urethra has some of the highest concentration of estrogen receptors. “When estrogen levels decline during menopause, these structures undergo degenerative change.” (Rosenthal & Burchum pg. 427) Common urinary symptoms include urge incontinence and urinary frequency.
For this patient I would utilize estrogen/progestin therapy (EPT) as the progestin “counterbalances estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer.” (Rosenthal & Burchum pg. 431) Considering the patients history of a positive ASCUS during a routine pap smear, it would be pertinent to keep risk factors for cancer low. Typically, hormone therapy is short-term to reduce the risk of patients experiencing harmful side effects.
Teaching would include for patient to understand that this oral therapy will need to be taken daily. These replacement hormones will help with vasomotor symptoms exhibited by the patient along with genitourinary symptoms. It can also assist in the prevention of osteoporosis due to the decrease in natural estrogen which occurs in menopause. Education over potential for increased risk of DVT with addition of hormone therapy and which symptoms to monitor for such as swelling to one leg, redness to calf area, tenderness, and warmth. Potential side effects include vaginal spotting, headaches, and bloating. Another point to cover is informing the patient there are other options that can be attempted but may not assist in the genitourinary symptoms they have experienced. For examples, some antidepressants can be utilized to help relieve hot flashes and selective estrogen modulators “to relieve hot flashes or pain during intercourse.” (ACOG, 2021)
References:
Hormone therapy for Menopause. ACOG. (2021, October). Retrieved January 26, 2022, from https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
Mone, A. (2018, January 9). Abnormal pap test results. Kimmel Cancer Center. Retrieved January 26, 2022, from https://www.hopkinsmedicine.org/kimmel_cancer_center/cancers_we_treat/cervical_dysplasia/diagnosis_and_treatment/abnormal_pap_test.html
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Post 2
My patient was a 43-year-old white male who complained of pain in the clinic with crutches. Patient-reported pain started seven years ago when he fell from work and injured his right hip. He also reports that he experiences severe cramping of the extremity. His fiancé also left him. His leg is turning purple from the knee down, and his foot is clearly in a visible cramp as the toes are curled inward, and his foot looks like it is folding in on itself. He reports that he has been using the hydrocodone that the family doctor prescribed for him sparingly because he does not like the side effects of feeling “sleepy” and constipation. He also reports that the medication makes him “loopy” and doesn’t do anything for the pain. The patient is alert and oriented x 4. The patient appeared appropriately in speech and dressing made good eye contact—no other concern.
According to Mundluru & Saraghi (2020). Complex regional pain syndrome (CRPS) is a potentially debilitating form of neuropathic pain that may manifest following a traumatic injury or surgery. CRPS is also known as algodystrophy, causalgia, or reflex sympathetic dystrophy (RSD). It is a form of chronic pain that affects an arm or a leg. The pain is always out of control to the severity of the initial injury. My main goal is to relieve my patient’s pain to a tolerable one, to get him back to his daily activity.
Medication such as Savella is a good choice. This medication is made initially to treat pain caused by a condition called fibromyalgia, Keks et al. (2018). The medication has the same pain condition with (CRPS) this medication is a serotonin-norepinephrine reuptake inhibitor (SNRI). It helps to restore the balance of neurotransmitters. This can also work for depression, Marlow et at. (2018). I will start from low doses until I reach the therapeutic amount with a minimum side effect.
The patient has a complex neuropathic pain syndrome that may never respond to pain medication. I Rosenthal & Burchum (2021). will educate the patient about this condition that there will always be a level of pain daily, and this condition needs to be managed to not get in the way of daily activities. I recommend physical therapy, chiropractic care, heat, and massage therapy.
References:
Marlow, N. M., Simpson, K. N., Vaughn, I. A., Jo, A., Zoller, J. S., & Short, E. B. (2018). Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin Initiators. Pain Practice, 18(2), 154–169. https://doi.org/10.1111/papr.12585
Mundluru, T., & Saraghi, M. (2020). Anesthetic Management of a Complex Regional Pain Syndrome (CRPS) Patient With Ketamine. Anesthesia Progress, 67(4), 219–225. https://doi.org/10.2344
Keks, N. A., Hope, J., Keogh, S., & Copolov, D. L. (2018). Milnacipran: serotonin-noradrenaline reuptake inhibitor approved for fibromyalgia may be a useful antidepressant. Australasian Psychiatry, 26(5), 537–540. https://doi.org/10.1177/1039856218794874
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
