A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
-Post a brief description of your patientâ€™s health needs from the patient case study you assigned. Be specific.
-Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response.
-Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.
You will respond to your colleaguesâ€™ posts in Week 10.
In this case study, a 46-year-old woman presents with hot flushing, night sweats, and genitourinary symptoms. Given her age and sex, and the fact that 95 percent of women enter menopause between 45 and 55 years old, her symptoms appear to be menopausal (Rosenthal & Burchum, 2018). The hot flashes and night sweats symptoms appear to be vasomotor symptoms of menopause. Vasomotor symptoms are typical during the transition into menopause and affects nearly 80 percent of women. The patient also presents with genitourinary symptoms which are typically vaginal dryness and urinary symptoms (Roberts & Hickey, 2016). As estrogen levels decrease, the urethra and vaginal epithelium undergo degenerative changes causing urge incontinence, urinary frequency, dryness, urinary tract infections, and vaginal infections (Rosenthal & Burchum, 2018).
The patient would like relief from these symptoms. These symptoms interfere with oneâ€™s daily life activities and women commonly seek hormone therapy (HT) once these symptoms arise (Rosenthal & Burchum, 2018). Women who take HT often report an improved quality of life with relief of their vasomotor and genitourinary symptoms, as well as other benefits. There are also risks associated with taking hormone replacement therapy. Estrogen replacement therapy is contraindicated in persons with a history of breast cancer, heart disease, DVT, PE or MI, and also in persons with a history of vaginal bleeding with no known cause (Rosenthal & Burchum, 2018). The patient has a family history of breast cancer (although no personal history of breast cancer), a history of ASCUS (although recent pap smears have been normal, currently has hypertension and possible CHD.
Given that the patient is considered high risk for HT, I would consider alternative options. In high risk patients, certain antidepressants such as SSRIs or SNRIs have been shown to relieve vasomotor symptoms of menopause, although not as effectively (Rosenthal & Burchum, 2018). I would treat the patient with escitalopram for vasomotor symptoms, along with a topical estrogen to treat genitourinary symptoms. The SSRI escitalopram is a good first choice drug for vasomotor symptoms as it is well tolerated and provides about 50-60 percent reduction in vasomotor symptoms (Roberts & Hickey, 2016). I chose to use a topical estrogen because it is safer for use with high risk patients than oral, systemic estrogen replacement therapy, as blood estrogen levels remain low (Rosenthal & Burchum, 2018).
I would develop an education strategy that includes side effects of using escitalopram, such as diarrhea, drowsiness, headache, insomnia, and nausea (Quiring, Sanoski, & Vallerand, 2019). I would also include instructions on the use of topical estrogen, as well as lifestyle improvements to promote cardiovascular health.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Escitalopram. In Davis’s Drug Guide.
Available from https://www.drugguide.com/ddo/view/Davis-Drug-Guide/51276/all/escitalopram
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 53â€“58.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehneâ€™s pharmacotherapeutics for advanced practice
providers. St. Louis, MO: Elsevier.