Write a reply/ respond to your classmate discussion board Alyssa Pacheco using the original post.
The patient assigned to me in this discussion is a 46-year-old female that weighs 230 pounds and has a family history of breast cancer. The patient has complaints of hot flushing, night sweats, and genitourinary symptoms. She us current on yearly mammograms and visited her gynecologist one month ago when she was feeling well to discuss her symptoms and have her annual gyn examination. She has a history of ASCUS that showed up on a Pap smear about five years ago but other than that her Pap smears have been normal. She has a history of hypertension and currently takes Amlodipine 10mg qd and HCTZ 25mg qd. Her blood pressure today was 150/90. The patient states she has regular monthly menstrual cycles, and her last menstrual period was one month ago.
Based on the symptoms the patient is experiencing along with her age it can be presumed the patient is experiencing early signs of menopause. Menopause can occur in women ages 40-50 with symptoms of hot flashes, night sweat, vaginal dryness, and weight gain (Mayo Clinic, 2020). These symptoms can occur for months or years leading up to menopause and while this patient is still having regular menstrual cycles, she may be in the beginning of going through menopause.
Based on this patient’s history and current symptoms I would first evaluate her medicine regimen. This patient’s hypertension is being treated with combination drug therapy of Amlodipine 10mg and Hydrochlorothiazide 25mg. Some side effects associated with Amlodipine are flushing, upset stomach and nausea (Medline Plus, 2021). This patient is not currently experiencing more side effects associated with amlodipine so I would leave her current dose of antihypertensives as is. The patient may be experiencing low levels of estrogen associated with menopause which can be treated with medication. The addition of hormone therapy would benefit this patient and decrease her symptoms. When prescribing hormone therapy, a thorough health history is necessary. Estrogen replacement therapy has been contraindicated in patients’ history of MI, DVT, breast cancer, and vaginal bleeding (Rosenthal & Burchum, 2021).
While oral route is more convenient, I would choose the transdermal route with this patient. Some advantages to transdermal administration are lower dose, less nausea and vomiting, decrease fluctuation of estrogen levels, and decreased risk of DVT, stroke, and PE (Rosenthal & Burchum, 2021). With this patient being overweight with a history og hypertension minimizing potentially dangerous side effects is important.
Estrogen and progesterone are prescribed together to decrease adverse effects of estrogen. Other methods can be used to treat menopause such as the use of SSRIs and SNRIs. However, they typically can exacerbate the hot flashes which is a primary complaint for this patient. I would prescribe Estradiol 14mcg once weekly transdermal once weekly and follow up with the patient in 6-8 weeks to see how she is feeling. If the patient is having adverse symptoms from Estradiol, I would consider adding progesterone to help with her symptoms. If the patient is not having adverse effects but still has complaints of hot flashes and vaginal changes increasing her dose could be done at this point with a follow up in another 6-8weeks.
Mayo Clinic. (2020, October 14). Menopause. Mayo Clinic. Retrieved October 26, 2021, from https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397.
MedLine Plus. (2021, February 15). Amlodipine: Medlineplus drug information. MedlinePlus. Retrieved October 28, 2021, from https://medlineplus.gov/druginfo/meds/a692044.html.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
