Instructions: Read a selection of your colleagues’ posts from Week 9 and respond to at least two of your colleagues 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. Two references for each response (4 references total). Each response needs to be at least 1 paragraph long.
STUDENT 1 POST:
\”The case study that I have chosen for this discussion is case study #2, of a 46-year old woman complaining of night sweats, flushing and genitourinary symptoms. Her GYN history includes a PAP that showed ASCUS 5 years ago with negative PAPs since, regular monthly cycles with a LMP one month prior, and a family hx of breast cancer. Due to age and symptom progression, it would be my suspicion that the patient was nearing perimenopause. I would draw labs for estrogen, progesterone, FSH, LH to confirm, as well as have the patient provide a urine sample to rule out any urinary tract infection, rule out pregnancy, and GYN swabs to test for yeast, BV, and other STIs.
When other causes have been ruled out and patient shows that she is entering into perimenopause hormone therapy could be introduced as an effective way of reducing her night sweats and flushing, it is considered relatively safe and this patient is more likely to have more severe symptoms as they have begun before the cessation of her menstrual cycle (Roberts, & Hickey, 2016). As the flushing symptoms are related to the withdrawal of estrogen, estrogen therapy is an effective treatment. There are many possible routes of administration for this therapy such as orally, transdermal patch, sprays/emulsions, and vaginal creams and inserts (Rosenthal & Burchum, 2021). I would likely recommend a transdermal option such as a patch as less hormone levels are required with higher blood concentrations of estrogen due to formulation in comparison with oral options (Rosenthal & Burchum, 2021). However, Fait (2019) recommends intravaginal preparations of estrogen to relieve these symptoms and to prevent vaginal atrophy into menopause (Fait, 2019)\”
STUDENT 2 POST:
\” I choose to discuss case study 1. HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet currently with complaints of nausea and vomiting.
The patient needs to continue taking his antibiotics as his WBC has improved over the course of 3 days but remains elevated. Azithromycin should continue to be given to decrease his WBC. It is a standard treatment for Gram-positive cocci (Skidmore-Roth, 2017). His vital signs have also come down to normal limits except for his temperature. I would recommend IV Tylenol to be considered as it will lower his fever and help with any potential pain. I would also recommend this patient take IV Ondansetron for nausea and vomiting that he is experiencing. This drug is used to prevent nausea and vomiting. It is very effective by itself and has a quick onset (Rosenthal & Burchum, 2021).
One discussion I would certainly have with this patient would be patient education regarding his various medications. Considering his extensive past medical history, it could become difficult for him to continue taking his old medication in addition to any new ones that he will be prescribed upon discharge. Research over the past several years has indicated that personal beliefs about the illness and treatment are important regarding medication adherence, so that what may seem puzzling behavior from the perspective of the health professional is a rational response within the context of the person’s life, reflecting their perceptions, experiences, and priorities (While, 2020). Hopefully discussing the importance of medication adherence while also better educating the patient on his disease will yield positive results.\”
Discussion responses
Student’s Name
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Discussion responses
Response to Student 1 Post.
The discussion post by student 1 is about case study 2, explaining a 46-year woman suffering from perimenopause symptoms. I agree with the assessment methods suggested in the discussion post to investigate a patient’s diagnosis. The patient’s diagnosis should include GYN swabs to test for yeast, BV, and other STIs. Issues related to progesterone, FSH, and LH would also be investigated (Wu et al., 2020). Another possible treatment apart from hormone therapy is the use of antidepressants and in particular, selective serotonin reuptake inhibitors (SSRIs) might be helpful. These medications may help reduce menopausal hot flashes (Karanth et al., 2019). These antidepressants can be an alternative treatment for women who cannot take hormone therapy for medical reasons.
Response to Student 2 Post
The discussion post by student 2 is about case study 2, explaining a 68-year-old Male patient who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. I agree that the patient needs to be educated regarding various medications that he currently takes. Educating the patient about medication adherence will help enhance his recovery. The suggested treatment is good for the patient to improve the symptoms and cure the disease. An alternative treatment for this patient would include Clindamycin 300-450 mg PO q6-8hr with primaquine for 21 days (Mayo Clinic, 2021). Clindamycin is widely used to treat community-acquired pneumonia. It is FDA-approved to treat septicemia, intra-abdominal infections, lower respiratory infections, gynecological infections, bone, and joint infections, and skin and skin structure infections (Murphy et al., 2021). Clindamycin is also used to treat streptococcal pharyngitis, acne vulgaris, bacterial vaginosis, and severe pelvic inflammatory disease.
Reference
Karanth, L., Chuni, N., & Nair, N. S. (2019). Antidepressants for menopausal symptoms. The Cochrane Database of Systematic Reviews, 2019(9). https://doi.org/10.1002/14651858.CD013417
Murphy, P. B., Bistas, K. G., & Le, J. K. (2021). Clindamycin. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519574/
Mayo Clinic. (2021). Clindamycin (Oral Route). https://www.mayoclinic.org/drugs-supplements/clindamycin-oral-route/proper-use/drg-20110243
Wu, C. K., Tseng, P. T., Wu, M. K., Li, D. J., Chen, T. Y., Kuo, F. C., … & Sun, C. K. (2020). Antidepressants during and after menopausal transition: a systematic review and meta-analysis. Scientific reports, 10(1), 1-10. https://doi.org/10.1038/s41598-020-64910-8