Answer Post.. ..
Provide recommendations for alternative drug treatments to address the patients pathophysiology. Be specific and provide examples.
The patient that I have is a 46-year-old female who is 230 pounds and has a history of breast cancer. Patient is up to date on her yearly mammograms and has a history of hypertension. Patient complains of night sweats, hot flashes, and genitourinary symptoms. Patient also has a history of ASCUS about 5 years ago on pap smear, but all other pap smears have been normal. Patient has regular menstrual cycles, states that last one was 1 month ago. Patient currently takes Amlodipine (Norvasc) 10mg PO daily and Hydrochlorothiazide (Microzide) 25mg PO daily. Patients blood pressure today is 150/90. In this case study, I feel like this patient is experiencing symptoms of perimenopause. The patients healthcare needs include hypertension management, yearly pap smears because of her history of ASCUS, yearly mammograms due to family history of breast cancer, and weight management. To better manage the patients blood pressure, I would discontinue the Amlodipine (Norvasc) 10mg PO daily and start Lisinopril 20mg PO daily for hypertension. With discontinuing the Amlodipine (Norvasc) 10mg PO daily this might would help stop the hot flushing. With taking Amlodipine (Norvasc), researchers observed edema, dizziness, flushing, and palpitations in controlled clinical trials in a dose-dependent manner (Bulsara & Cassagnol, 2022). With starting patient on Lisinopril 20mg PO daily, I would have the patient record her blood pressure in the morning and at bedtime for 2 weeks and then follow up with her to see how her blood pressure is running. If the patients blood pressure was controlled, I would discontinue the Hydrochlorothiazide (Microzide) 25mg PO daily and see how the patient done for 2 more weeks with just the Lisinopril 20mg PO daily. If the patients blood pressure was controlled with just the Lisinopril 20mg PO daily and I could discontinue the Hydrochlorothiazide (Microzide) this would help alleviate some of the genitourinary problems that the patient is having. I would consider a Hormone Replacement Therapy due to patient being perimenopause. Hormone replacement therapy (HRT) can help balance estrogen and progesterone levels during or near menopause (Hormone replacement therapy: Uses, types, and alternatives). HRT can help relieve hot flushing and night sweats. Before prescribing any Hormone Replacement Therapy I would order some blood work to check the patients levels before initiating HRT. I would educate the patient on the importance of getting yearly mammograms due to her family history of breast cancer and HRT could increase the risk of breast cancer as well. I would also educate the patient on the importance of getting yearly pap smears due to a history of ASCUS. Patient education would include education on the side effects of lisinopril include feeling tired, feeling dizzy or lightheaded, cloudy urine, decrease in urine output, confusion, blurred vision, and sweating (Lisinopril (oral route) side effects). Also, I would educate the patient on the importance of knowing how to recognize signs and symptoms of hypotension. I would educate the patient on weight management techniques and would also recommend some exercise regimens due to the patient being overweight. During the patients weight loss, her blood pressure will need to be monitored closely so hypotension can be avoided.
Bulsara, K., & Cassagnol, M. (2022). Amlodipine – StatPearls – NCBI Bookshelf. Retrieved July 26, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519508/
Hormone replacement therapy: Uses, types, and alternatives. (n.d.). Medical News Today. Retrieved July 26, 2022, from https://www.medicalnewstoday.com/articles/181726
Lisinopril (oral route) side effects. (2022). Mayo Clinic. Retrieved July 26, 2022, from https://www.mayoclinic.org/drugs-supplements/lisinopril-oral-route/side-effects/drg-20069129