LW is a 32 year old female patient who comes to your medical clinic for primary care.  She has been on hormonal contraceptives for years, although she’s just been married and has stopped her pills in hopes of becoming pregnant.  Her PMHx includes obesity, HTN (diagnosed 3 years ago),

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Consider the following scenarios:

LW is a 32 year old female patient who comes to your medical clinic for primary care.  She has been on hormonal contraceptives for years, although she’s just been married and has stopped her pills in hopes of becoming pregnant.  Her PMHx includes obesity, HTN (diagnosed 3 years ago), familial hypercholesterolemia, and PCOS.  Her current medications are as follows: Metformin 2000 mg PO daily, Lisinopril 10 mg PO daily, rosuvastatin 5 mg PO daily, and a multivitamin.

GD is an 82-year-old patient is taking 2 mg of terazosin for BPH every morning. He comes in complaining of dizziness, generalized muscle weakness and persistent lower urinary tract symptoms (LUTS).

How should you advise these patients and manage their medications?  What was the process you went through to assess the current medications and to recommend an updated regimen?

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section NSG-533-Advanced Pharmacology Module III – Men’s and Women’s Health Discussion.

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      • Anna McMullen posted Sep 14, 2020 10:38 AM
      • Upon evaluating LW, I would assess the safety and necessity of her prescribed medications in relation to her medical history and her goals. LW wishes to get pregnant, therefore any medications that she is taking should be safe for pregnancy. LW also has HTN, and is taking Lisinopril 5mg po QD, so it is necessary for a medication to address her HTN be prescribed which is also safe for pregnancy. Currently, LW is taking metformin 200mg po QD, most likely for her PCOS since it is not indicated that she is T2DM; the necessity of this medication must be evaluated. She is also taking rosuvastatin 5mg po QD for familial hypercholesteremia, so the safety of this medication must be evaluated.  ACE inhibitors and ARBs are not considered safe during pregnancy, therefore lisinopril 5mg should be discontinued while LW is trying to conceive (Khalil et al., 2016). Women with pre-existing HTN should be carefully monitored throughout pregnancy and should have their BP stabilized before conception due to increased risk of preeclampsia; 22-25% of women with chronic HTN will develop preeclampsia during pregnancy (Khalil et al., 2016). Acceptable medications for the treatment of HTN during pregnancy are the beta-blocker labetalol and the alpha-2 agonist, methyldopa; however, labetalol is not considered safe to use during breast feeding, so if this is something LW plans to do, she may want to consider methyldopa as a first-line option (Khalil et al., 2016).LW should continue her multivitamin, ensuring that it has an adequate amount of folic acid, or consider switching to a prenatal multivitamin. Liu et al. (2018) found that women who supplemented with multivitamins with folic acid significantly reduced their risk of preeclampsia and gestational diabetes, both conditions that LW is at risk for developing during pregnancy.ReferencesBortnick, E., Brown, C., Simma-Chiang, V., & Kaplan, S. A. (2020). Modern best practice in the management of benign prostatic hyperplasia in the elderly. Therapeutic Advances in Urology, 12, 175628722092948. https://doi.org/10.1177/1756287220929486Herschorn, S., Staskin, D., Schermer, C. R., Kristy, R. M., & Wagg, A. (2020). Safety and tolerability results from the pillar study: A phase iv, double-blind, randomized, placebo-controlled study of mirabegron in patients ≥ 65 years with overactive bladder-wet. Drugs & Aging, 37(9), 665–676. https://doi.org/10.1007/s40266-020-00783-wLiu, C., Liu, C., Wang, Q., & Zhang, Z. (2018). Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: A meta-analysis. Archives of Gynecology and Obstetrics, 298(4), 697–704. https://doi.org/10.1007/s00404-018-4823-4Terazosin (oral route) side effects – mayo clinic. (2020, August 1) NSG-533-Advanced Pharmacology Module III – Men’s and Women’s Health Discussion . Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/terazosin-oral-route/side-effects/drg-20066315?p=1

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