Replies for Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Instructions:

1. Respond to 2 of your colleagues (Reply 1 and Reply 2) and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples.

**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**

Reply # 1

EUGENIA SAKYI 

Discussion -

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The current health needs of the patient include uncontrolled hypertension and menopause symptoms. The patient presents with both genitourinary and vasomotor symptoms associated with menopause. Menopausal symptoms interfere with an individual’s daily activities and most individuals resort to hormonal replacement therapy (HRT) to relieve these symptoms. Nonetheless, estrogen replacement therapy is contraindicated in individuals with a history of some conditions such as heart disease and breast cancer (Lumsden, 2016). The above patient has a breast cancer history in the family. The patient has also had ASCUS in the past although the recent Pap smear tests have all come back normal. Based on this, the patient is in the high risk category of HRT and therefore, alternative methods should be explored in the management of the presenting symptoms. In such high risk patients, antidepressants such as SSRIs can be prescribed to relieve the experienced vasomotor symptoms. Escitalopram can be prescribed to relieve the vasomotor symptoms and topical estrogen can also be prescribed to relieve the experienced genitourinary presentations (Rosenthal & Burchum, 2018).

The patient is currently on Norvasc, a drug that results in side effects such as hot flashes and intensifies menopausal presentations (Kizior & Hodgson, 2021). I would, therefore, discontinue this drug and prescribe Lisinopril 20mg OD. The patient will be advised to keep a log of her blood pressure (BP), twice daily for about two weeks to determine the effectiveness of the new prescription. If Lisinopril alone can manage the patient’s BP, the HCTZ will be discontinued. The patient’s education would comprise home BP monitoring, signs and symptoms of hypotension, and the side effects of Lisinopril and escitalopram that would require attention (Lumsden, 2016). The patient will also be educated on weight management approaches to promote cardiovascular health and follow-up appointments scheduled to ensure proper dosage against the required weight loss. Lastly, the patient will be educated on topical estrogen application. Patient education is important to facilitate medication adherence and proper self-care.

References

Kizior, R. J., & Hodgson, K. (2021). Saunders Nursing Drug Handbook 2022 E-Book. Elsevier Health Sciences.

Lumsden, M. A. (2016). The NICE Guideline–Menopause: diagnosis and management. Climacteric, 19(5), 426-429. https://doi.org/10.1080/13697137.2016.1222483

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s Pharmacotherapeutics for Advanced Practice Providers. St. Louis, MO: Elsevier.

Reply # 2

JASON WILCOX 

The patient in my scenario is a 46yo female who presents with a history of hypertension, hot flashes, night sweats, and genitourinary symptoms. One must consider this patient’s age, gender, and presenting symptoms when assessing the patient for a diagnosis. Menopause occurs when a woman hasn’t menstruated in 12 consecutive months and can no longer become pregnant naturally. It usually begins between 45 and 55 but can develop before or after this age range. (Person, 2020) Women may experience symptoms such as my patient, hot flashes, migraine headaches, a decline in libido, stress incontinence, dysuria, and a change in mood, irritability, depression, etc. These can all be classified as vasomotor, urogenital, psychogenic symptoms of menopause. (Peacock, 2021)

To relieve this patient’s symptoms, there are several ways to address her symptoms. Some women let the symptoms subside naturally, while others look at treatments, like hormone therapy and topical therapy. Estrogen Therapy and Estrogen Progesterone/Progestin Hormone Therapy are the primary types of hormone therapy women seek. There are risks associated with HT: increased risk for endometrial cancer, blood clots/strokes, and dependent upon age the risk for dementia is also increased. The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit dedicated explicitly to this conversation. (Clevland Clinic Staff Editors, 2021)

With my patient’s past medical history and familial links to breast cancer, I believe it would be in her best interest to choose therapy other than HT to start. The treatment is for the symptoms experienced from menopause, not menopause itself, because it does not require treatment.  Antidepressants are used to treat more than just depression, and they also work well to treat vasomotor symptoms such as hot flashes, night sweats, and skin flushing. These are also some of the most common menopause symptoms. Almost  80 percent  of menopausal women experience these symptoms. (Iftikhar, 2018) SNRIs may be adequate to help reduce menopause-related hot flashes. (Athanasiadis & Goulis, 2019) I would start this patient on Effexor to help with the hot flashes.  An estrogen cream would be my first choice of treatment; these prove to be less risky than oral estrogen. 

My education for this patient would be formed around the side effects and correct use of Effexor. Take with food at the same time each day. Swallow the extended-release capsule or tablet whole and do not crush, chew, break, or open it. If you cannot swallow a capsule whole, open it and mix the medicine with applesauce. Swallow the mixture right away without chewing. (RxList, 2020)

References:

Athanasiadis, L., & Goulis, D. G. (2019, October 14). Starting and stopping menopausal hormone therapy and antidepressants for hot flushes: A case-based approach. Case reports in women's health—retrieved October 27, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829163/.

Clevland Clinic Staff Editors. (2021, June 28). Hormone therapy for menopause: Types, benefits & risks. Cleveland Clinic. Retrieved October 27, 2021, from https://my.clevelandclinic.org/health/treatments/15245-hormone-therapy-for-menopause-symptoms.

Iftikhar, N. (2018, June 19). Antidepressants for menopause: Benefits, types, side effects, and more. Healthline. Retrieved October 27, 2021, from https://www.healthline.com/health/antidepressants-for-menopause#types.

Peacock, K. (2021, June 29). Menopause. StatPearls [Internet]. Retrieved October 26, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK507826/.

Person. (2020, January 13). What you need to know about menopause. Healthline. Retrieved October 26, 2021, from https://www.healthline.com/health/menopause.

RxList. (2020, January 22). Side effects of Effexor (venlafaxine hydrochloride), warnings, use. RxList. Retrieved October 27, 2021, from https://www.rxlist.com/effexor-side-effects-drug-center.htm.

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