NR508 Week 1 Discussions Latest

Discussion Part One (graded)

Emily, a relatively healthy 5’5”, 32-year-old young woman weighing 190 pounds, presents to your clinic with hirsutism, anovulation, oligomenorrhea, and at times amenorrhea. Biochemical blood tests reveal elevated luteinizing hormone (LH, without a mid-cycle surge) and androgen elevation.

She mentions that she also has a family history of irregular cycles, and that her grandmother experienced early menopause. She also states that she is sexually active, occasionally smokes (1 pack/month), and desires to be prescribed one medication to mitigate her symptoms, as well as, prevent her from becoming pregnant.

Please provide a list of differential diagnoses, as well as an indication of your primary diagnosis.
Once this has been completed, please indicate and describe your chosen pharmacological treatment with inclusion of dose and mechanism of action of your chosen prescription.

Discussion Part Two

You diagnose Emily with polycystic ovarian syndrome (PCOS) and decide to prescribe drospirenone-ethinyl-estradiol as a way to control both the PCOS symptoms, as well as to act as an oral contraceptive.

At what dose should this be prescribed?
What is the mechanism of drospirenone-ethinyl-estradiol, and why would, because of its mechanism, it be a good choice for her PCOS symptoms (Include the medication-altered physiology)?
How would you monitor for efficacy and toxicity?

At what dose should this be prescribed?

Discussion Part Three (graded)

Emily subsequently returns to your clinic 5 months later, and decides to inform you that within the first 3 months after treatment, she struggled with a severe bout of depression. Instead of returning to your clinic to be prescribed, yet another pharmaceutical, she consulted her herbalist who told her about the anti-depressant, over-the-counter, herbal formulation, St. John’s Wort. She decided to begin taking St. John’s Wort in conjunction with her prescribed oral contraceptive medication, and she has now reappeared at your clinic because she is pregnant, and is distraught about how this occurred since she took her oral contraceptive compliantly since its prescription.

Why then, is she pregnant?
Please include detailed pharmacological mechanisms of how this occurred, and your subsequent steps in her management.

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NR508 Week 2 Discussions Latest

Discussion Part One (graded)

Cynthia is a 65-year-old African American female who presents to the clinic for a check-up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results:

Social history: no smoking or alcohol consumption.

Physical examination:

GEN: well nourished, slightly obese female

VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6”

HEENT: PERRLA

COR: RRR, NMRG

CHEST: CTA

NEURO: monofilament test shows decreased peripheral sensation

EXT: normal

Laboratory (fasting):

Na 139 mEq/L

K 3.8 mEq/L

ALT 34 U/L

Ca 9.1 mg/dL

CL 102 mmol/L

HCO3 22 mEq/L

AST 39 U/L

TP 6 g/dL

BUN 33 mg/dL

SCr 2.0 mg/dL

Alb 4.1 g/dL

Cholesterol 254 mg/dL

BG 300 mg/dL

TSH 0.12 mU/mL

UA: SG 1.013 mg/24h, pH 6.5, +++ protein

What are the major problems in this patient, and what diagnoses do these values indicate?

Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?

Discussion Part Two (graded)

Cynthia has been prescribed a plethora of medications. How will you properly monitor each medication for efficacy and toxicity? Are you concerned with any drug-drug interactions? If so, what are they, and what is the mechanism of the interaction?

Discussion Part Three (graded)

Given Cynthia’s increased creatinine and renal deterioration, metformin is probably not optimal in this case. Therefore, upon subsequent visits, you decide to start her on a sulfonylurea. She reappears in your clinic fairly soon thereafter with complaints of shakiness, sweating, chills, clamminess, lightheadedness, and a moderately severe headache.

• What is the diagnosis given these symptoms and the medications she is currently taking from Parts One and Two, and how would you proceed?

• At this point, please also be sure to also provide an accurate summary of Cynthia’s medication plan.