Question

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.

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.

Answer 1

Patient has a symptoms of hot flushing,night sweat and genitourinary symptoms that she need immediate treatment.She is 46 years old and had a past history of hypertension.By monitor vitals her blood pressure seems to be 150/90mmHg. Her last menstrual period is 1 month back and patient has atypical squamous cells of underdetermined significance (ASCUS) in pap 5 years back, that not leads to any problem in the late period.Based on the above symptoms she is in perimenopausal period.She need immediately treatment to prevent complications.

Treatment:

• Hormonal therapy: Estrogen therapy is used to decrease symptoms and prevent the developing of cancer.Vaginal estrogen is to manage genitourinary symptoms.
• Selective serotonin reuptake inhibitors is used decrease the symptoms and stabilize the patient mental condition. Low dose should be preferred.
• Gabapentin is anticonvulsant drug is used to decrease night sweats and hot flushing.
• Clonidine belongs to alpha agonist used to control blood pressure.
• Vitamin D and calcium supplements is used to strengthen the bones.

Non pharmacological therapy:

• Advise patient to wear loose and comfortable clothes.
• Take plenty of fluids.
• Practice aerobic activity and weight bearing and stretching activity.
• Include calcium rich food in diet
• Increase fiber intake.
• Limit or avoid salt intake.
• Eat small quantity of meals compare to large meals.
• Avoid alcohol consumptions and caffeine intake that will worsen patient condition.
• Perform pelvic floor exercise
• Avoid saturated fats and high calorie diet.
• Include omega fatty acids to make heart healthy.
• Monitor regular screening that helps to avoid breast and cervical cancer.