Read a selection of your colleagues’ responses from Week 9 and respond to …

Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days 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.
Please see colleague Post:
In this case study, a 46-year-old is presenting with hot flushing, night sweats, and genitourinary symptoms. The most likely cause of these symptoms given the age is menopause. According to Rosenthal & Burchum, 95 percent of women enter menopause between the age of 45-55 (Rosenthal & Burchum, 2021). The hot flushing and night sweats are vasomotor symptoms associated with menopause (Nardone, 2014). More than 85% of women experience vasomotor symptoms as well as vaginal dryness (Nardone, 2014). Vulvovaginal atrophy, often called vaginal dryness is related to decreased estrogen associated with menopause, and it is the most common cause of dyspareunia in menopausal women and post-menopausal women (Nardone, 2014). Hence, this 46-year-old women is experiencing genitourinary symptoms as well as vasomotor symptoms of menopause such as hot flushing and night sweats.

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In terms of treatment regimen, I would recommend hormone therapy for this patient. Given that the patient is presenting with vasomotor symptoms, the patient would benefit from systemic estrogen hormone therapy. Systemic estrogen hormone therapy (HT), with or without progestin is the most effective therapy for menopause-related vasomotor symptoms as per evidence from multiple studies supporting the effectiveness (Croke, 2014). In addition, I would also recommend oral or transdermal (patches, gels, or sprays) estrogen, alone or in combination with progestin as it can help alleviate vasomotor symptoms (Croke, 2014). If these options do not work, then I would recommend treatment with SSRIs or SNRIs which can reduce the severity of hot flashes and night sweats in menopausal women. Studies demonstrated that paroxetine (Paxil), citalopram (Celexa) and escitalopram (Lexapro) were the most effective SSRIs, and venlafaxine (Effexor) was the most effective first line SNRI, with desvenlafaxine as a second option (Stubbs et al., 2017). Furthermore, in terms of the patient’s elevated blood pressure, I would increase the dosage of the blood pressure medication the patient is already on. I would not completely change the antihypertensive medications.

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Moreover, I would recommend for this patient to get another pap smear done just to confirm there are not new changes from the previous pap smear. I would also recommend for the patient to get basic blood work done, bone density testing, hormone imbalance testing, and an endometrial biopsy. Furthermore, I would educate the patient on better dietary habits such as avoiding alcohol, decreasing caffeine intake, and avoid spicy foods. I would educate the patient on focusing on regular physical activity such as exercise and focus on stress reduction.

References:

Croke, L. M. (2014, September 1). ACOG releases clinical guidelines on management of Menopausal Symptoms. American Family Physician. https://www.aafp.org/afp/2014/0901/p338.html.

Nardone, A. G. (2020, November 13). Managing menopause, Part 1: VASOMOTOR SYMPTOMS. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/managing-menopause-part-1-vasomotor-symptoms.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

SAMPLE SOLUTION

Response to Week 9 Discussion Post
You did an excellent post. From the discussion, the 46 years old presents symptoms such as genitourinary symptoms, night sweats, and hot flushing. Indeed, the most likely factor or cause for these symptoms | PLACE YOUR ORDER NOW AT writtask.com | refers to the transient sensations of heat, anxiety, flushing, sweating, and chills that last for about one to five minutes. These are the most common symptoms of menopause among women who seek treatment. Studies show that more…