For week 6 discussion, select ONE of the two cases below. After you have read it thoroughly, respond to the questions. Responses should be substantive and meet the requirements of the weekly discussion board. Let me remind you that we are doing advanced pharmacological management of diseases through this course. Example, if you are asked to discuss pharmacological management of community acquired pneumonia and you are discussing Azithromycin & Alternate drugs such as levofloxacin or Doxycycline you need to discuss:
1. Mechanism of action of drugs at molecular level (Dynamics).
2. Therapeutic Outcome (Dynamics).
3. Adverse effects of drugs. (Dynamics).
4. How the drug is given (Kinetics).
5. How the drug is metabolized and eliminated (Kinetics).
6. Scholarly References & Any guidelines followed.
Remember, just mentioning the drug names and dosage is basic dispensing information, not advanced pharmacology.
Case 1
Your patient weighs 150 pounds at age 60. Her last menstrual cycle occurred at age 51. She has been taking Premarin for hot flash control since the start of menopause. She is unsure if she should stop taking this medication because she is now more than 5 years into menopause. She is concerned about her bone health if she stops. She is also concerned about the risk of cancer if she stays on it. She has noticed an uptrend of her lipid levels over the past 2 years. She is not certain the cardiovascular (CV) protection of the estrogen is still working.
What is the evidence about bone health during menopause after 5 years of hormone replacement therapy (HRT)?
What about the continuation of HRT after 5 years of use?
What plan for care would you design for her that also includes her concerns about her lipid levels?
Case 2
A 26-year-old female presents at clinic with symptoms of dysuria, frequency, and urgency. Further history yields 2 days of these symptoms but no fever, chills, or flank pain. She describes a burning discomfort during and immediately following urination and feeling the need to void every half hour. There is no vaginal discharge, itching, or odor. She uses a diaphragm and spermicide for birth control. She requests a urine culture and some sulfa pills. When asked to explain, she says that she has had many bladder infections over the past 3 years and sulfa pills usually work. She was evaluated approximately 5 years ago with an IV pyelography and cystogram, and nothing was wrong. Assessment A midstream urine specimen is collected for urinalysis and culture. A urine dipstick reveals 21 pyuria, 11 hematuria, and trace nitrates. Her pregnancy test is negative. She exhibits no costovertebral angle or abdominal tenderness. Her vital signs are within normal limits. Janice looks essentially well. There are no symptoms suggestive of pyelonephritis or vaginal disorders.
What would be the initial management plan for an adult woman with a simple uncomplicated urinary tract infection (UTI)?
What education is needed when treating a patient with a UTI?
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