Response – Treatment Strategies for Asthma and Gout

Response – Treatment Strategies for Asthma and Gout

Hello,

Thank you for your post. Congratulations on attempting all the questions provided for discussion and for your clear responses. For question one, the consideration of inhaled glucocorticoids as the first line of care for the child is a good choice. As you have noted, inhaled glucocorticoids provide long-term asthma treatment in children and can be used by children of all ages. Additionally, considering the inhaled form of glucocorticoids for children is also good as it is easier to administer and it is hard for them to overdose. To add to your response to question one and contribute to the question two response, it is essential to consider the type of asthma, including the factors contributing to the asthmatic symptoms, before the decision for the treatment plan is made. In this way, you will ensure that you address not only the symptoms but also the underlying causal factors by selecting the right therapeutic approach to utilize, as well as the required changes to therapy.

Consistently, the approaches you have mentioned in responses to questions three, four, and five including asking the patient about her health and medical history, answering her question on birth control options with acne management properties, as well as providing her with information on indicate adherence to the responsibility of medication prescription and administration. According to Rosenthal and Burchum (2021), the safety and competency of medication prescription and management is based on better knowledge of medications and the conditions they are used to manage. To add to the response to question 6, allopurinol is a good choice for managing future gout as it has other benefits, as it also prevents recurrent kidney stones in patients with hyperuricosuria (Qurie et al., 2023).

References

Qurie, A., Preuss, C. V., & Musa, R. (2023). Allopurinol. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499942/

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier.

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PEER RESPONSE 1

Q1. What treatment should this patient receive to relieve symptoms during an asthma attack? Inhaled glucocorticoids are the preferred long-term treatment for children of all ages. For kids preferred to be inhaled form of glucocorticoids.(Roshenthal & Burchum, 2021, p. 561). During an asthma attack, as an emergency rescue inhaler such as short-acting Beta2-Adregenic Agonist that acts as a bronchodilator like Albuterol (Xopenex HFA), (Rosenthal & Burchum, 2021, pp. 567-569). Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA), a Beta2-Adrenegic Agonist, a bronchodilator, can be used as a prevention of exercise-induced bronchospasm or to treat an exacerbation of Asthma. Kids 12 and older can use an adult dose. For acute or severe asthma, metered dose or dry powder inhaler, 90 mcg/actuation, 4 to 8 inhalations every 20 minutes for up to 4 hours, then every 1 to 4 hours as needed. As a nebulizer, 2.5 to 5 mg every 20 minutes for 3 doses, then 2.5 to 10 mg every 1 to 4 hours as needed (Lexicomp, 2017, pp. 79- 84).

Treatment Strategies for Asthma and Gout

Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate? Asthma and Allergy Foundation of America (2021), recommends that every patient with asthma should have an Asthma Action Plan. This treatment plan should have not only the patient but their family members, school, and school nurse, that includes information such as medicines, recognizing the symptoms getting worse, and what needs to be done in an emergency. The goal for our 12 y o patient should be asthma attack prevention New NHI (2020) guidelines give us 3 options how to achieve that goal: 1.Take ICS every day to control asthma, and to use quick-relief medicine at the first sign of asthma symptoms. 2. Take ICS controller medicines as needed. Take ICS and quick-relief medicine at the same time when you have symptoms. 3. Be SMART (which stands for single maintenance and reliever therapy). Use SMART as one inhaler that combines a controller and long-acting reliever medicine. The inhaler contains an ICS and a medicine called formoterol, (AAFA Community Services, 2020).

Q3. I would ask my patient about their sexual life and amount of sex partners and would educate them on safe sex methods and safety preventive methods. (Rosenthal & Burchum, 2021, p. 437). Effectiveness, safety and personal preference of the patient will eventually determine the choice of the contraceptive (Rosenthal & Burchum, 2021, p. 437). One of the important questions to ask is if they are smoking. I will also use Planned Parenthood’s step-by-step computerized selection tool to help my patient. I think I would let my patients use it and try to choose a method for them. I tried Planned Parenthood’s quiz for our 19-year-old, and it gives me choices of IUDs and implants, skipping the oral contraceptives. I think I would prescribe my patient a progestin[1]only oral contraceptives, known as “minipills” because they will not cause thromboembolic disorders, and have less side effects than the other combination OCs (Rosenthal & Burchum, 2021, p. 442). Brand Name Generic Name Type Route Frequency Dose Camila norethindrone minipill oral Daily in 28 day cycles 0.35 mg/day (Mayne Pharma, Inc., 2018) Mechanism of action: this progestin only minipill suppresses ovulation by thickening the cervical mucus making difficult for the sperms to move toward the egg, lowers the mid-cycle LH and FSH peaks, slows the movement of the ovum through the fallopian tubes, and alters the endometrium (Mayne Pharma, Inc., 2018). Adverse effects: Menstrual irregularity, frequent and irregular bleeding, headaches, breast tenderness, nausea, dizziness, and androgenic side effects such as acne, hirsutism, and weight gain are rare occurrences (Mayne Pharma, Inc, 2018).

Q4. The patient states she heard a pill can help her acne. What would you prescribe and your rationale?.

Estrostep -Fe Combination of norethindrone acetate and ethinyl estradiol Combination OC, with first-generation progestin, Oral, Daily, 21 contraceptive pills in a box and 7 Ferrous Fumarate pills Changes during the cycle per pill, according to their shape and color. (Allergan USA, Inc., 2017).

Q5. Before I would discuss the bisphosphonates with my patient, I would explain the importance of calcium intake with vitamin D. Also,  I would advise my patient not to smoke, limit alcohol, and prevent falls at home and outside by taking care of loose rugs, and wearing a slip safe shoes (NYSOPEP Resource Center, 2020). The bisphosphonates have a phosphate-carbon-phosphate core and bind strongly to calcium. Their mechanism of action is not understood, but they are easy to use, and they have a strong avidity to the skeleton. They inhibit the bone resorption. I witnessed patients prescribed Alendronate (Fosamax), N-containing, 10 mg per day, for treatment and prevention of PMO and GIO. 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? American College of Rheumatology (2020) recommends urate-lowering therapy (ULT) with allopurinol as the preferred first-line therapy. It can cause esophagitis and upper GI problems (Greenspan, et al., 2000). Mechanism of action: Allopurinol is a urate-lowering medication. It is metabolized in the liver and turned into oxypurinol. Oxypurinol’s half-life is 15 hours. Both allopurinol and oxypurinol are excreted from the kidneys. Both chemicals inhibit xanthine oxidase, and therefore uric acid building in the body (Quire, Goyal and Musa, 2021).