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Please review the complete instructions on attached document.    

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.

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

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 –

Top of Form

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. Climacteric19(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.

Bottom of Form

Bottom of Form

Discussion: Women’s and Men’s Health, Infectiou

s Disease, and

Hematologic Disorders

Instructions:

1.

Respond

to

2 of your

colleague

s

(Rep

ly 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 re

ply

cited within the body of the reply & at the end**

Reply # 1

EUGENIA

SAKYI

Discussion

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

activi

ties

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,

al

ternative

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

vaso

motor

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

me

nopausal

presentations

(Kizior

&

Hodgson,

2021).

I

would,

therefore,

discontinue

this

drug

and

prescribe

Lisinopril

20mg

OD.

The

patient

will

be

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 –

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

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