NURS 6521 Advanced pharmacology

Patient’s Health Needs

The advanced practitioner will come across patients with signs and symptoms that could point to a number of illnesses; in order to effectively manage the patient, the practitioner must identify the root cause of the symptoms. The patient may be in the early stages of the menopausal transition, which would explain her symptoms and warning signs, according to the facts given in the scenario. The patient’s weight needs to be managed, and her uncontrolled hypertension needs to be treated. The patient receives comprehensive care from the advanced practitioner; their well-being should be improved by pharmacotherapeutics and therapies.

Herbal and homeopathic treatments should be used to treat the patient’s premenopausal symptoms. With a 46-year-old age, the patient is entering the period when menopause will start to set in as estrogen levels start to decline. Hot flashes, nocturnal sweats, vaginal dryness, and urine symptoms (genitourinary symptoms), which are associated with menopause, begin between the ages of 45 and 55. The steadily declining estrogen levels are to blame for these issues. The consumption of herbal and homeopathic medicines might be used to treat them because they aim to restore hormone levels to normal.

Treatment Regimen

My patient should begin with a modest dose and then reevaluate in 4-6 weeks. She needs to continue getting yearly PAP smear tests because of her history of an ASCUS. A colposcopy should be performed whenever this turns negative. Currently taking the maximum Norvasc dosage prescribed, my patient’s blood pressure is 150/90. At the moment, she is taking a 25mg daily starting dose of HTCZ. She could have a dose increase to 50 mg, taking 25 mg BID, to better manage her blood pressure. As she goes through menopause, I want to advise that her cholesterol be evaluated frequently to determine her CVD risk.

Hormone therapy is the first option for treating menopause symptoms that are severe. Patients who have had breast cancer in the past should not receive hormone therapy. A possibility exists that adding hormones could cause breast cancer to flare up again. Randomized clinical trials support the use of specific SSRIs and SNRIs for vasomotor symptoms. (Roberts & Hickey, 2016) Clonidine, SSRI, SRNI, and gabapentin were more effective than placebos and exhibited a reduction in symptoms in 50–60% of patients. Antidepressants such venlafaxine, sertraline, and paroxetine, which are taken in low doses, can aid with hot flashes (Stubbs et al., 2017). Because symptoms associated with menopause change over time, patients who have been prescribed one of these drugs should be checked again in a few months for assessment and then once a year. Women are at risk for bone loss and a changed lipid metabolism after menopause, in addition to vasomotor symptoms. LDL levels have risen and HDL levels have fallen according to studies on lipid metabolism. According to Chai et al. (2002), there is concern that this could raise a patient’s risk of cardiovascular disease. Following a study that showed a connection between thromboembolic events and an increase in breast cancer incidence in the early 2000s, the usage of hormone therapy was decreased.

Patient Education Strategy

Having a balanced, low-sodium diet and the value of exercise are two things I wish to teach my patient. As additional treatments for menopause symptoms, the authors advise yoga, acupuncture, behavior therapy, and relaxation.  Before beginning prescription treatment, I would suggest looking into over-the-counter (OTC) drugs that can help with genitourinary symptoms. Continue checking my patient’s blood pressure, scheduling routine mammograms, and performing PAP smear tests.

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