NR 508 Week 1 Discussions 1 (Part Two)

NR 508 Week 1 Discussions 1 (Part Two)

NR 508 Week 1 Discussions 1 (Part Two)

discussion part two

you diagnose emily with polycystic ovarian syndrome (pcos) and decide to prescribe drospirenone-ethinyl-estradiol as a way to control both the pcos symptoms, as well as to act as an oral contraceptive. NR 508 Week 1 Discussions 1 (Part Two)

at what dose should this be prescribed?
what is the mechanism of drospirenone-ethinyl-estradiol, and why would, because of its mechanism, it be a good choice for her pcos symptoms (include the medication-altered physiology)?
how would you monitor for efficacy and toxicity? NR 508 Week 1 Discussions 1 (Part Two)
at what dose should this be prescribed?

discussion part three

emily subsequently returns to your clinic 5 months later, and decides to inform you that within the first 3 months after treatment, she struggled with a severe bout of depression. instead of returning to your clinic to be prescribed, yet another pharmaceutical, she consulted her herbalist who told her about the anti-depressant, over-the-counter, herbal formulation, st. john’s wort. she decided to begin taking st. john’s wort in conjunction with her prescribed oral contraceptive medication, and she has now reappeared at your clinic because she is pregnant, and is distraught about how this occurred since she took her oral contraceptive compliantly since its prescription. NR 508 Week 1 Discussions 1 (Part Two)

why then, is she pregnant?
please include detailed pharmacological mechanisms of how this occurred, and your subsequent steps in her management.

discussion part one 

cynthia is a 65-year-old african american female who presents to the clinic for a check-up. her last examination was ~5 years ago. she has no specific, significant, or urgent complaint. she explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. you decide to do a physical exam, as well as draw labs and receive the following results: NR 508 Week 1 Discussions 1 (Part Two)

 social history: no smoking or alcohol consumption.

physical examination:

gen: well nourished, slightly obese female

vs: bp 180/103 hr 73 rr 13 t 98.4 weight 90 kg, height 5’6”

heent: perrla

cor: rrr, nmrg

chest: cta

neuro: monofilament test shows decreased peripheral sensation

ext: normal

laboratory (fasting):

na 139 meq/l

k 3.8 meq/l

alt 34 u/l

ca 9.1 mg/dl

cl 102 mmol/l

hco3 22 meq/l NR 508 Week 1 Discussions 1 (Part Two)

ast 39 u/l

tp 6 g/dl

bun 33 mg/dl

scr 2.0 mg/dl

alb 4.1 g/dl

cholesterol 254 mg/dl

bg 300 mg/dl

tsh 0.12 mu/ml

ua: sg 1.013 mg/24h, ph 6.5, +++ protein

what are the major problems in this patient, and what diagnoses do these values indicate?

additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?  NR 508 Week 1 Discussions 1 (Part Two)

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