NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

A Sample Answer For the Assignment: NURS 6521 Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

 Menopause is a complex period of life which is associated with many physical and psychological changes and hot flushes are one of the most common bothersome symptoms related to menopause which has affected 85% of menopausal women with various frequency, severity and duration that needs to be addressed. Hormone replacement Therapy is considered one of the most effective treatments of choice to treat or manage these menopausal associated symptoms however there are exceptions that prevents its use.

One of the example is the patient condition in the given scenario is compatible with exceptions that could prevent its use from using this treatment regimen that is Hormonal Replacement Therapy as patient in the given scenario is at risk for developing breast cancer due to her family history of breast cancer and prescribing her with HRT could potentially make her more prone to developing breast cancer and hence non hormonal based treatment regimen should be considered. Some of the non-hormonal based options include use of antidepressants such as SSRIs (paroxetine) and SNRIs and other one is the use of Gabapentin and Clonidine can also be used.

Looking back at the patient scenario patient has a history of high blood pressure and is currently on amlodipine and Hydrochlorothiazide however patient still is experiencing high blood pressure and hence I believe addition of clonidine in the patient’s current drug therapy regimen, along with amlodipine and hydrochlorothiazide can be beneficial in achieving effective blood pressure control and reduction in adverse reactions. Adding Clonidine (alpha adrenergic agonist) to the drug therapy will be useful in controlling blood pressure as well as treating symptoms such as hot flashes that are related to premenopausal symptoms.

I think a lot of women; about 51% seek complementary and alternative medicine (CAM) for managing the symptoms associated with menopause as they consider it as safe and effective option with no risk associated with it, as it’s natural. However the majority of the women using CAM do not discuss it with their health care provider.

Hence it is very important to reconcile their current medication list at each visit and educate patient on importance of informing their health care provider if they are using any alternative or complementary treatments such as plant estrogens, bioidentical hormones, black cohosh etc in managing their symptoms of menopause to prevent any adverse effects resulting from drug interactions.

References

Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of evidence-based integrative medicine, 24, 2515690X19829380. https://doi.org/10.1177/2515690X19829380

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2^nd ed.) St. Louis, MO: Elsevier.   

What antibiotics have dietary precautions?

Antibiotics

Links to an external site.are a type of medication used to treat bacterial infections. They work by stopping the infection or preventing it from spreading. There are many different types of antibiotics. Some are broad-spectrum, meaning they act on various disease-causing bacteria. Others are designed to kill certain species of bacteria.

While many foods are beneficial during and after antibiotics, some should be avoided. Some antibiotics require specific dietary precautions to ensure their effectiveness and prevent interactions or side effects(Huizen, 2021). The following are some common antibiotics and their dietary precautions.

Tetracyclines (e.g., doxycycline, minocycline): These antibiotics should not be taken with dairy products (milk, cheese, yogurt) or antacids containing calcium, magnesium, aluminum, or iron. These substances can bind to tetracyclines, reducing their absorption and effectiveness. Take tetracyclines at least 1-2 hours before or 4-6 hours after consuming dairy products or antacids.

Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Avoid taking fluoroquinolones with dairy products, calcium-fortified foods, or mineral supplements (calcium, magnesium, zinc) as they can reduce the absorption of the antibiotic. Take these medications at least 2 hours before or 6 hours after consuming such products.

Macrolides (e.g., erythromycin, clarithromycin, azithromycin): Macrolides should generally be taken on an empty stomach, about 1 hour before or 2 hours after meals. However, some forms of macrolides, such as azithromycin, can be taken with or without food.

 Linezolid: Avoid foods rich in tyramine while taking linezolid. Tyramine-rich foods include aged cheeses, cured meats, fermented, or pickled foods, soy products, and alcoholic beverages. Linezolid can interact with tyramine and lead to a potentially dangerous increase in blood pressure.

 Metronidazole: Alcohol should be avoided while taking metronidazole and for at least 72 hours after completing the course of the antibiotic. Combining alcohol and metronidazole can cause severe nausea, vomiting, and flushing.

Sulfonamides (e.g., sulfamethoxazole/trimethoprim): The patient needs to drink plenty of fluids while taking sulfonamide antibiotics to prevent crystal formation in the urine, which can lead to kidney problems.

Cephalosporins: Cephalosporins generally are not associated with significant dietary restrictions, but it’s always best to follow the specific instructions your healthcare provider or pharmacist gives.

Patients should always read the medication label and follow the instructions provided by their healthcare provider or pharmacist.

What antibiotics cause photosensitivity? 

Certain antibiotics can cause photosensitivity, a condition in which the skin becomes more sensitive to sunlight and may result in an exaggerated sunburn-like reaction. Exposure to sunlight while taking these antibiotics can lead to skin rash, redness, itching, and even blistering. The following antibiotics are known to cause photosensitivity:   

Tetracyclines (e.g., doxycycline, minocycline):

 Tetracyclines are well-known for causing photosensitivity reactions. If you are prescribed a tetracycline antibiotic, taking precautions and avoiding excessive sun exposure is essential. Wearing protective clothing, using sunscreen with high SPF, and staying out of direct sunlight during peak hours can help reduce the risk of photosensitivity reactions.

Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Some fluoroquinolone antibiotics have been associated with photosensitivity reactions. Protecting your skin from excessive sunlight is essential when taking antibiotics like tetracyclines.

Sulfonamides (e.g., sulfamethoxazole/trimethoprim): Sulfonamides, especially sulfamethoxazole, can cause photosensitivity in some individuals. Take necessary precautions and avoid direct sunlight as much as possible when on this medication.

Macrolides (e.g., erythromycin, clarithromycin): While macrolides are not as strongly associated with photosensitivity as tetracyclines and fluoroquinolones, some cases of photosensitivity have been reported with these antibiotics.

 Doxycycline and Retinoids Combination: It’s worth noting that taking doxycycline along with certain retinoids used for acne treatment can increase the risk of photosensitivity.

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 Use sunscreen with a high sun protection factor (SPF), wear protective clothing like hats and long sleeves, and seek shade to minimize the risk of photosensitivity reactions. Educate patients to Contact healthcare providers for guidance if they experience skin changes or reactions while on antibiotics (Kowalska et al., 2021)

What patient counseling would you provide?

Doctors provide patient counseling when prescribing antibiotics to ensure safe and effective medication use. Here are some common points that a doctor may cover during antibiotic counseling:

Indication: Explain the reason for prescribing the antibiotic. Discuss the specific infection or condition it is meant to treat.

 Dosage and Schedule: Provide clear instructions on how and when to take the antibiotic. Emphasize the importance of taking the medication as prescribed and completing the full course, even if the patient feels better before finishing.

 Administration: Instruct the patient on whether to take the antibiotic with or without food and if any specific dietary restrictions or precautions are necessary.

 Potential Side Effects: Discuss common side effects of the antibiotic and what to do if they occur. Also, inform the patient about severe or rare side effects requiring immediate medical attention.

Allergies and Adverse Reactions: Ask the patient about known allergies to antibiotics or other medications. Inform them of possible allergic reactions and what to do in case of an adverse reaction.

Drug Interactions: Inform the patient about any potential drug interactions with the prescribed antibiotic and other medications they may be taking. This includes over-the-counter medications, herbal supplements, and recreational drugs.

Photosensitivity (if applicable): If the antibiotic is known to cause photosensitivity, advise the patient to protect their skin from sunlight and ultraviolet (UV) light exposure.

 Pregnancy and Breastfeeding: If the patient is pregnant or breastfeeding, discuss the safety of the antibiotic and whether there are any potential risks.

 Storage: Provide instructions on how to store the antibiotic properly, including temperature requirements and keeping it out of reach of children.

 Missed Doses: Advise the patient on what to do if they miss a dose. It’s essential to avoid doubling up on doses but to take the next scheduled dose and continue the course as prescribed.

Follow-Up: Schedule a follow-up appointment to assess the patient’s progress and ensure the treatment works effectively.

Reference

Huizen, J. (2021, December 17). What are the side effects of antibiotics? https://www.medicalnewstoday.com/articles/322850

Kowalska, J., Rok, J., Rzepka, Z., & Wrześniok, D. (2021). Drug-Induced Photosensitivity—From light and chemistry to biological reactions and clinical symptoms. Pharmaceuticals, 14(8), 723. https://doi.org/10.3390/ph14080723

NYSDOH NY. (2016, October 28). Educating patients about antibiotic use [Video]. YouTube. https://www.youtube.com/watch?v=YHYmb2OKoMU

Case Study

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 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 one month ago.

Treatment Regimen

After analyzing the symptoms, I concluded that the patient is experiencing peri-menopausal symptoms. For many people, menopause begins around age 45 though the onset of symptoms varies across different people. She is undergoing the early stages of menopause which is a stage that begins with experiencing changes in the uterus, breasts, increased fat deposit, and the urogenital tract undergoing several changes such as a shrinking cervix, and reduced muscle tone in the pelvic area.

At that age, the level of estrogen production is low hence, leading to hot flashes and night sweats. Therefore, her treatment regime will focus on taking into consideration the patient has Hypertension already. Hormone therapy will be eliminated and prescribe vaginal cream that would help her manage genitourinary symptoms such as vaginal dryness and dyspareunia (Yoo et al., 2020).

Mood changes and hot flashes are common symptoms of menopause hence the patient will be prescribed low-dose antidepressants such as venlafaxine and sertraline. Besides, herbal treatment has been proven to be effective in managing vasomotor symptoms hence the patient can be prescribed black cohosh which helps in reducing many menopausal symptoms (Mahady, et al., 2002).

As people continue to age, their bones become weak and this increases their chances of suffering born fractures. Therefore, the patient will be given vitamin D supplements to the increase production of estrogen which reduces with age and reduces cases of bone fractures.

During the clinical interview, I realized that the patient is taking Norvasc 10 mg and hydrochlorothiazide (HCTZ) 25 mg. I would advise her to discontinue taking Norvasc since the drug acts as a calcium blocker hence leading to hypertension and besides, its side effects increase menopause symptoms. Since she has hypertension, I would recommend that she takes lisinopril 20 mg daily. This should help alleviate the flushing that the patient has been experiencing (Li et al., 2016).

Additionally, the patient has a history of ASCUS, hence I will advise her to continue with her PAP smear exams. With her blood pressure being high currently, and the fact that she is taking Norvasc, she will be encouraged to stop Norvasc but increase the HTCZ dosage to 50mg daily. The patient is expected to come regularly for assessment and examination of the drugs and symptoms.

Patient Education Strategies

Patient education has become an effective strategy to influence patients’ behavior to start living a quality life. The patient will be educated on ways to maintain weight through diet modification, become physically active, and practice relaxation as one way to reduce the severity of menopause symptoms and chances of getting breast cancer (Paterick et al., 2017).

The patient will be educated about things she needs to avoid such as the use of exogenous hormones to reduce getting breast cancer going to her family history (Stuenkel et al., 2015). All this information will be passed to the patient through her patient portal which is deemed the best instructional method for her as she can access the information from the comfort of her home.

References

Li, R. X., Ma, M., Xiao, X. R., Xu, Y., Chen, X. Y., & Li, B. (2016). Perimenopausal syndrome and mood disorders in perimenopause: prevalence, severity, relationships, and risk factors. Medicine, 95(32).

Mahady, G. B., Fabricant, D., Chadwick, L. R., & Dietz, B. (2002). Black cohosh: an alternative therapy for menopause?. Nutrition in Clinical Care, 5(6), 283-289.

Paterick, T. E., Patel, N., Tajik, A. J., &Chandrasekaran, K. (2017, January). Improving health outcomes through patient education and partnerships with patients. In Baylor University Medical Center Proceedings (Vol. 30, No. 1, pp. 112-113). Taylor & Francis.

Manson, J. E., &Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. N Engl J Med, 374(9), 803-6.

Stuenkel, C. A., Davis, S. R., Gompel, A., Lumsden, M. A., Murad, M. H., Pinkerton, J. V., & Santen, R. J. (2015). Treatment of symptoms of the menopause: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 100(11), 3975-4011.

Yoo, T. K., Han, K. D., Kim, D., Ahn, J., Park, W. C., &Chae, B. J. (2020). Hormone replacement therapy, breast cancer risk factors, and breast cancer risk: a nationwide population-based cohort. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1341-1347.

Response

This is an in-depth and exceptional post about the case study. I agree with you that the patient is experiencing peri-menopausal symptoms. There are myriad treatment options for patients experiencing menopause, which usually depend on the seriousness of the symptoms. One of the treatment options that can be applied in this case is hormone replacement therapy to assist in replacing the lost estrogen and managing the symptoms of menopause (Cagnacci & Venier, 2019). Hormone replacement therapy is crucial in averting osteoporosis, lowering vasomotor symptoms, and preventing bone degeneration.

It is important for the healthcare provider to collect a host of information before starting this treatment including data on BP, cardiovascular and breast screening, lipid panel, TSH, and HR. Reduction in estrogen is associated with bone degeneration and an increase in cardiovascular issues (Biglia et al., 2019). Therefore, the patient should be educated on the benefits of reducing weight, intake of sufficient calcium and Vitamin D, and avoidance of alcohol. The patient should also be educated on the benefits of consistently receiving mammograms due to her family history of breast cancer.

References

Biglia, N., Bounous, V. E., De Seta, F., Lello, S., Nappi, R. E., & Paoletti, A. M. (2019). Non-hormonal strategies for managing menopausal symptoms in cancer survivors: an update. ecancermedicalscience, 13. Doi: 10.3332/ecancer.2019.909

Cagnacci, A., & Venier, M. (2019). The controversial history of hormone replacement therapy. Medicina, 55(9), 602. https://doi.org/10.3390/medicina55090602

Dietary Precautions and Antibiotics

Tetracyclines: There are seven broad-spectrum antibiotics that are similar in structure and antimicrobial action to tetracycline, including doxycycline, minocycline, demeclocycline, eravacycline, omadacycline, and sarecycline. These antibiotics bind to calcium, iron, and magnesium in the digestive tract, which can decrease their absorption. 
Patient Education: Educate the patient to avoid dairy products, antacids, or iron supplements 1 hour prior and 2 hours after taking the antibiotic (Shutter & Akhondi, 2022).

Fluoroquinolones: Like tetracyclines, fluoroquinolones (ciprofloxacin and levofloxacin) can also bind to calcium, iron, and magnesium, reducing their effectiveness.
Patient Education: Educate the patient to avoid dairy products, antacids, or iron supplements 1 hour before and 2 hours after taking the antibiotic.

Macrolides: Erythromycin, a type of macrolide, can cause epigastric pain, nausea, vomiting, and diarrhea, so it’s often recommended to take it with food. However, only if the patient is taking erythromycin ethylsuccinate, an enteric-coated formulation, due to its ability to tolerate stomach acid and its increase in bioavailability. 
Patient Education: Avoid GI disturbances by taking them with meals. 

Linezolid: This antibiotic can interact with tyramine in certain foods like aged cheeses and fermented products, potentially leading to a hypertensive crisis. 
Patient Education: Avoid eating aged cheeses, cured meats, fermented or pickled vegetables, and fermented alcohol while taking linezolid. 

Sulfonamides: Broad-spectrum antimicrobial often used for urinary tract infections. Significant side effects include urinary crystal formation; therefore, patient education is necessary on avoiding caffeine and drinking at least eight glasses of water daily while taking the sulfonamides. 

Cephalosporins (cefazolin and cefotetan): B-lactam antibiotics mixed with alcohol can cause a disulfiram-like reaction which is brought on by the accumulation of acetaldehyde. 
Patient Education: The patient should be instructed to avoid alcohol in any form while taking these antibiotics. 

Sun Exposure and Antibiotics

Photosensitivity, or an increased sensitivity to sunlight, is a known side effect of certain antibiotics. Antibiotics can cause phototoxicity (cell damage) or photoallergy (immune response initiated by photosensitivity). This can result in sunburn, rashes, or other skin reactions when exposed to sunlight or ultraviolet light. In severe cases, blistering and hyperpigmentation can occur. Antibiotics that can increase an individual’s photosensitivity include:

Tetracyclines

•    All tetracyclines can increase the skin’s sensitivity to UV light resulting in exaggerated sunburn. This can occur several weeks after drug exposure. Doxycycline has been found to be the most frequent sensitizer of the tetracyclines. Recent studies have found an 11% increase in the risk of developing basal cell carcinoma with the use of tetracyclines and sun exposure (Lozzi. Et al., 2020).

Fluoroquinolones

•    Phototoxicity, which is seen most often with lomefloxacin, sparfloxacin, and clinafloxacin, is a dose-dependent phenomenon and requires exposure to ultraviolet A (UVA) light (Mandell & Tillotson, 2018).

Sulfonamides

•    Sulfamethoxazole and Sulfasalazine can cause photosensitivity. 

Macrolides

•    Erythromycin

Patient Education: 

Educate the patient on the importance of avoiding the sun by staying out of direct sunlight for prolonged periods, wearing protective clothing, and using sunscreen with an SPF of 30 or higher. Avoid tanning beds (Rosenthal & Burchum, 2021). In general, patients should continually be educated on medication dose, indication, interactions, side effects, and the importance of completing the entire course of the prescribed amount to avoid bacteria resistance (Patel et al., 2023).

References

Lozzi, F., Di Raimondo, C., Lanna, C., Diluvio, L., Mazzilli, S., Garofalo, V., Dika, E., Dellambra, E., Coniglione, F., Bianchi, L., & Campione, E. (2020). Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations. Pharmaceutics, 12(11), 1104. https://doi.org/10.3390/pharmaceutics12111104

Mandell, L., & Tillotson, G. (2018). Safety of fluoroquinolones: An update. The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses, 13(1), 54–61. https://doi.org/10.1155/2002/864789

Links to an external site.

Patel, P., Wermuth, H.R., Calhoun, C., & Hall, G.A. (2023). Antibiotics. In StatPearls. StatPearls Publishing.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.)

Shutter, M.C., & Akhondi, H. (2022). Tetracycline. In StatPearls. StatPearls Publishing.

Reply

Your discussion was very insightful. Just to piggyback on what you said, the patient is probably experiencing premenopausal symptoms evident by hot flash, night sweats, and genitourinary symptoms. According to Smail et al. (2019), menopause is the period from when a woman has stopped menstruating for a period of twelve conservative months.

Smail 2019 explains that during this time there is drop in the production of the ovarian hormones’ estrogen and progesterone leading symptoms and diseases like vaginal infections, increased risk for osteoporosis and cardiovascular diseases, sleep disorders, mood alterations, hot flashes, depression, and urinary tract infections. Roberts & Hickey (2016) also discusses that during menopause common findings such as genitourinary syndrome of menopause, sleep disturbances, vasomotor symptoms (VMS), and mood disturbances are common.

Treatment Regimen Choice or Pharmacotherapeutics Recommendation

To control the patient blood pressure and the patient’s obesity, I will encourage patient to keep to current medication prescription regimen, make lifestyle changes, and monitor blood pressure reading regularly. VMS treatments would be based on how disturbing the symptoms are (Roberts & Hickey, 2016). Currently the most effective treatment for VMS is moderate dose estrogen-containing hormone therapy (HT), and that also improves vaginal dryness (Rob