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Primary Care Medication Management

Primary Care Medication Management

Q1. What treatment should this patient receive to relieve symptoms during an asthma attack?

The patient should be given an inhaled albuterol. Albuterol is a short-acting beta antagonist that should be administered approximately fifteen minutes before the exercise (Aggarwal et al., 2018). It is considered the first-line agent for exercise-induced asthma. It relaxes smooth bronchial muscles, hence helping to relieve bronchospasms.

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

According to Aggarwal et al. (2018), therapy should be modified to include other medications, such as inhaled corticosteroids, mast cell stabilizers, and leukotriene antagonists. An example of an inhaled corticosteroid is Beclomethasone, whereas Cromolyn sodium is an example of a mast cell stabilizer (Aggarwal et al., 2018). An example of a leukotriene inhibitor is Montelukast. Mast cell stabilizers inhibit the release of histamine and other inflammatory mediators that can worsen the bronchospasm (Aggarwal et al., 2018). Inhaled corticosteroids minimize inflammatory cell mediators and reduce bronchoconstriction (Aggarwal et al., 2018). Leukotriene inhibitors prevent bronchoconstriction by binding to different types of leukotrienes, such as D4 (Aggarwal et al., 2018).

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?

Different parameters can be used to determine the patient’s eligibility for contraception. They include blood pressure, hepatic function, smoking status, breastfeeding status, history of cancer, and cancer or blood clots (Zhu et al., 2022). The patient should not be hypertensive and not have an account of cancer, blood clots, and hepatic disease. Furthermore, the patient should be a non-smoker and devoid of a history of breast cancer (Zhu et al., 2022). I will prescribe Desogen, a combination of 0.15 mg of desogestrel and 0.03 mg of Ethinyl estradiol in each tablet. The patient will take one pill daily for 21 days, followed by inactive pills from the 22nd to 28 days (Zhu et al., 2022). Ethinyl estradiol minimizes the release of luteinizing hormone-releasing hormone and inhibits the release of gonadotropin from the hypothalamus (Zhu et al., 2022). Desogen inhibits gonadotropin secretion and stops ovulation and follicular maturation (Zhu et al., 2022). Side effects of Desogen include venous thromboembolism, hypertension, migraine, nausea, breast tenderness, and melisma (Zhu et al., 2022).

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

According to Zhu et al. (2022), Desogen, a combination of 0.15 mg of desogestrel and 0.03 mg of Ethinyl estradiol in each tablet, will manage her acne. Desogen has an off-label use in the management of acne (Zhu et al., 2022). It helps to reduce the severity and the incidence of acne lesions. The dose prescribed for contraception will help in the management of acne. The patient will take one tablet daily for 21 days, followed by inactive pills from the 22nd to the 28th (Zhu et al., 2022).

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebrae 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 can be used orally or by the parenteral route. Examples of oral formulations include alendronate and risedronate (Fatoye et al., 2019). Parenteral formulations such as zoledronate are reserved for patients who cannot tolerate oral formulations (Fatoye et al., 2019). Bisphosphonates inhibit osteoclastic activity in the bone and minimize the release of minerals and the breakdown of the bone matrix (Fatoye et al., 2019). This leads to improved bone mineral density and prevents and treats osteoporosis.

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?

Indomethacin (Indocin) is given at 50 mg orally thrice daily for five days (Pillinger & Mandell, 2020). It blocks the synthesis of prostaglandins by blocking cyclooxygenase 1 and 2 (Pillinger & Mandell, 2020). It also inhibits chemotaxis and the release of inflammatory mediators, reducing inflammation.

Anakinra (Kineret) is given as 100 mg subcutaneous (Janssen et al., 2019). It inhibits the activity of interleukin -1 alpha and beta (Janssen et al., 2019). This reduces the inflammatory process.

Colchicine (Colcrys) is given orally at 1.2mg initially, then 0.6 mg one hour after the first dose (Pillinger & Mandell, 2020). It inhibits the polymerization of microtubules and averts neutrophil activation and migration (Pillinger & Mandell, 2020).

Prednisolone (Pediapred): The individualized dose is based on the weight of 0.1 -2 mg/kg/day (Pillinger & Mandell, 2020). The amount is tapered off with time. It alters protein synthesis and inhibits the movement of polymorphonuclear lymphocytes, preventing inflammation (Pillinger & Mandell, 2020).

References

Aggarwal, B., Mulgirigama, A., & Berend, N. (2018). Exercise-induced bronchoconstriction: prevalence, pathophysiology, patient impact, diagnosis and management. Npj Primary Care Respiratory Medicine, 28(1). https://doi.org/10.1038/s41533-018-0098-2

Fatoye, F., Smith, P., Gebrye, T., & Yeowell, G. (2019). Real-World Persistence and Adherence with Oral Bisphosphonates for Osteoporosis: A Systematic Review. BMJ Open, 9(4), 1–18. https://doi.org/10.1136/bmjopen-2018-027049

Janssen, C. A., Oude Voshaar, M. A. H., Vonkeman, H. E., Jansen, T. L. T. A., Janssen, M., Kok, M. R., Radovits, B., Van Durme, C., Baan, H., & Van De Laar, M. A. F. J. (2019). Anakinra for the Treatment of Acute Gout Flares: A Randomized, Double-Blind, Placebo-Controlled, Active-Comparator, Non-Inferiority Trial. Rheumatology (United Kingdom), 58(8), 1344–1352. https://doi.org/10.1093/rheumatology/key402

Pillinger, M. H., & Mandell, B. F. (2020). Therapeutic Approaches in the Treatment of Gout. Seminars in Arthritis and Rheumatism, 50(3), S24–S30. https://doi.org/10.1016/j.semarthrit.2020.04.010

Zhu, S., Ma, X., Ding, X., Gan, J., Deng, Y., Wang, Y., & Sun, A. (2022). Comparative Evaluation of Low-Level Light Therapy and Ethinyl Estradiol and Desogestrel Combined Oral Contraceptive for Clinical Efficacy and Regulation of Serum Biochemical Parameters in Primary Dysmenorrhoea: A Prospective Randomised Multicentre Trial. Lasers in Medical Science, 0123456789. https://doi.org/10.1007/s10103-021-03490-z

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Question 


Primary Care Medication Management.

Primary Care Medication Management.

A 12-year-old boy has occasional episodes of mild asthma while playing soccer with his friends.

Q1. What treatment should this patient receive to relieve symptoms during an asthma attack?

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

A 19-year-old college student is asking for contraceptives.

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?

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

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebrae 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?

A 48-year-old man has occasional episodes of gout that are painful and debilitating. He requires drugs to treat the symptoms of acute gout attacks and prevent recurrent attacks.

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?

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