I need comments about this Q&A.

What treatment should this patient receive to relieve symptoms during an asthma attack?

In this scenario, the given patient has mild asthma and notes that the patient has Exercise-Induced Bronchospasm (EIB) or other known as Exercise-Induced Asthma. It happens mostly to people with asthma. Thus, exercise causes bronchospasm, wherein the airways in the lungs narrow when a person exercises, making it harder to breathe (Rosenthal & Burchum, 2021). For adults and adolescents like this patient, it is recommended to use low-dose Inhaled Corticosteroid (ICS)- formoterol, commonly used budesonide-formoterol in a single inhalation of 200/6 mcg (delivered dose 160/4.5). Thus, it relieves the bronchospasm by using a bronchodilator with corticosteroids to prevent any reoccurring and severe exacerbation attacks(Rosenthal & Burchum, 2021). However, suppose this medication is not available. In that case, a patient could still use Short-acting Beta-agonists, but a patient needs to inhale a low dose of ICS (Global Initiative for Asthma, 2021). Furthermore, one must be cautious, as past recommendations of inhaling only Short-acting Beta-agonists (SABA) that had been found to increase asthma attack death due to exacerbation of asthma. That is why corticosteroids were added in low doses for the attack to lessen the inflammation and decrease the aggravation.

Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate?

In starting asthma medication therapy, a patient needs to be reexamined 2-3 months after or whenever there is a frequent attack. Suppose these attacks occur more frequently than exercise; to provide the best quality care, Healthcare professionals need to assess the patient’s medication adherence, inhalation techniques, or any environmental stimuli that can cause aggravation or asthma attacks. If identified any problems, the patient needs a proper education or reinforcement before stepping up with the medications (Global Initiative for Asthma, 2021).

If identified, with assessment and evaluation, depending on how frequent asthmatic episodes are without any problem with techniques or adherence, the patient might consider taking low doses of budesonide-formoterol or daily low dose of ICS with SABA pre-exercise. Thus, this will consider a maintenance and reliever treatment (MART). If the patient is taking SABA, consider adding ICS-Long-acting Beta Agonist (LABA) with as-needed SABA. Moreover, consider checking within 2-3months. If this does not reduce asthma attacks and episodes more frequently, consider increasing medication, adding moderate ICS, adding long-acting muscarinic antagonists, adding sublingual allergen immunotherapy, and refer for phenotyping (Global Initiative for Asthma, 2021).

Q3. What will you assess to determine if this patient is a good candidate for contraceptives, and what will you prescribe? (Include brand and generic name, route, frequency, and dose). What is the mechanism of action of the contraceptive you prescribed and the adverse effects?

Healthcare providers need to assess the patient physically, mentally, emotionally, socially, and financially. Healthcare professionals need to identify physical needs, determining patients’ age, body, weight, vital signs, and any past and present medical conditions that are contraindicated for specific contraceptives to evaluate patients for any pregnancy or any Sexually transmitted disease that might be advantageous or disadvantageous on choosing a contraceptive method. Additionally, healthcare professionals need to explain the side effects of diverse kinds of contraception. Another area is the patient’s emotional needs, readiness, and goals, whether the patient’s plan for future pregnancy or not, whether the patient is willing to do it daily, or wants it for a more extended period if she has any problems with needles or any okay with inserting IUD. Socially, whether the patient is considering any protection for STD or whether being sensitive to others seeing it. And financially, the cost and availability of various kinds of contraceptives.

Given the patient’s age and being a college student, I would consider her to use Intrauterine Device (IUD), the most reliable birth control. I would prescribe a hormone-free copper (Paragard). With this age and busy with college, a hormonal IUD might benefit her since it does not carry any risk of side effects of hormonal birth control medications. The primary mechanism of action of this IUD is that it causes a foreign body reaction and chemical changes that are toxic to sperm. The good thing about this IUD is that it can last for 10years (Rosenthal & Burchum, 2021). A non-surgical procedure is done during a routine visit to be inserted from the cervical canal to the uterine cavity.

Moreover, if a patient decides to get pregnant, the patient can be pregnant right away once the IUD is taken away. Additionally, the ParaGard can be used as emergency contraception if inserted five days after unprotected sex. However, there are some side effects of this method. It includes Bleeding between periods, Cramps, Severe menstrual pain, and heavy bleeding (Mayo Clinic, 2022). Another essential thing to understand is that IUDs cannot protect patients from STDs—Healthcare professional needs to discuss this and provide another secondary contraceptive against STDs like a condom to protect against STDs.

Q4. The patient states she heard a pill can help her acne. What would you prescribe and your rationale? (Include brand and generic name, dose, route, and frequency).

To guide the patient more clearly, I would like to assess further and evaluate the patient’s condition and concerns. I am torn between two medications for acne. I am caught between Isotretinoin and hormonal agent. However, as a young woman like her, I prefer to give her a hormonal agent. That means it could function as an oral contraceptive and help with her acne. I would recommend combinations of Oral contraceptives (OCs)- drospirenone/Ethinyl estradiol (generic), YAZ (brand name), 28-day pack 3mg/20mcg tab x24, then inert tab x4. Patient to start on day one of the menstrual cycle or 1st Sunday after the onset of menses. The patient using the copper IUD does not have any hormones, so it would be fine if she chose to take OCs for acne and still wanted to get a copper IUD (Planned Parenthood, 2014).

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?

Bisphosphonates work in target areas of higher bone turnover by slowing down the cells which break down bone (osteoclasts). Therefore, they slow down bone loss, allowing the bone-building cells (osteoblasts) to work more effectively. Thus, it can help strengthen the bone and help to prevent it from getting any weaker. Be mindful of taking this medication with a full glass of water and remain upright for 30 minutes (Cancer Research UK, 2019). To prevent osteoporosis after menopause, the patient needs to be mindful of recommended Vitamin D and Calcium. Vitamin D is for absorption. The patient needs to adjust needs for calcium increases to 1200 mg/day. At the same time, a patient needs to increase his lifestyle on promoting bone health, including walking, weight-bearing exercise, avoiding excessive alcohol, and smoking (Rosenthal & Burchum, 2021).

Q6. How would you treat this patient’s acute gouty attack? Please list the trade and generic name and the dose of therapy. What is the mechanism of action of your choice of prescription?

In acute gout attacks, the main priority is to reduce inflammation and pain. Thus, the patient needs Nonsteroidal Anti-inflammatory Drugs (NSAIDs). It is considered the first choice and much tolerable. I will use Indomethacin (generic name) and Indocin (brand name). The mechanism of action of this medication inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis. For acute gout, the patient could start with 50 mg three times a day until the pain is tolerable, then reduce dosage and continue dosing for 3-5 days (Rosenthal & Burchum, 2021).

References:

Cancer Research UK. (2019, November 27). How bisphosphonates work. How bisphosphonates work | Cancer Research UK. Retrieved April 13, 2022, from https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/bisphosphonates/how-bisphosphonates-work

Global Initiative for Asthma. (2021, June 17). 2021 Gina Main Report – Global Initiative for Asthma. GINA. Retrieved April 13, 2022, from https://ginasthma.org/gina-reports/