Week 7 peer reply

What medication recommendations will you make? Include the drug class, generic and trade name and starting dose range. Provide rationale for your choices.

Ms. Whitleys asthma is not being effectively controlled just by using her Albuterol inhaler. I would suggest using an anti-inflammatory reliever medication such as Symbicort 80/4.5 mcg (budesonide/formoterol), two puffs in the morning, and two puffs in the afternoon. She should continue using the albuterol as needed. According to the Global Initiative for Asthma (2021), every adult and adolescent with asthma should have an ICS-containing controlled medication to reduce the risk of severe exacerbations and a reliever inhaler for as-needed use. Patients using ICS-LABA as maintenance should use a SABA as the appropriate reliever (Global Initiative for Asthma, 2021). Symbicort is a combination of an inhaled corticosteroid (ICS) and a long-acting beta2 adrenergic agonist (LABA). Albuterol is a short-acting beta-agonist (SABA) bronchodilator.
 In terms of her knee pain, continuing the analgesic Tylenol (acetaminophen) 500 mg 1 tablet every 4-6 hours as needed for pain might still be appropriate. Advil (ibuprofen) is a non-steroidal anti-inflammatory (NSAID) medication that might also help alleviate her discomfort. She can take 400-800 mg three times a day as needed. Alternating acetaminophen and NSAIDs may provide pain relief with lower doses of both, minimizing the side effects of both (Harvard Health Publishing, 2021).
Identifying a birth control method that would suit Ms. Whitleys needs is an important conversation. I would provide information on oral medications, barrier methods, intrauterine devices, and injectables, among other options (Bansode et al., 2021).  The most effective form of contraception is the etonogestrel contraceptive implant (Nexplanon), a rod containing 68mg of synthetic progestin that is implemented subdermally (Bansode et al., 2021).
 Medication to help with weight loss is an alternative in some cases, but I need to explore what Ms. Whitley has done to lose weight thus far and what exactly her goals are. Phentermine-topiramate (Qsymia) is a combination drug and one of the few medications approved for obesity management. Phentermine is a sympathomimetic amine that works as an appetite suppressant and topiramate is an anticonvulsant. The initial dose is phentermine 7.5mg/topiramate 23 mg once daily every morning for 14 days, and maintenance is phentermine 7.5 mg/topiramate 46mg (Khera et al., 2016).

Discuss any potential side effects and drug interactions for this patient.

Potential side effects of Symbicort include allergic reactions, breathing problems, changes in vision, chest pain, nervousness, high blood pressure, and tachycardia (Cleveland Clinic, 2021). This medication may interact with erythromycin, cimetidine, diuretics, grapefruit juice, and some vaccines (Cleveland Clinic, 2021). Albuterol’s side effects include nervousness, headache, throat or nasal irritation, and muscle aches (Global Initiative for Asthma, 2021).
Taking too much acetaminophen can result in liver damage, and the patient may experience abdominal pain, nausea and vomiting, fatigue, and unusual bleeding (American Addiction Centers, 2020). Ibuprofen may cause peptic ulcers and gastric bleeding, so taking the medication with food is important (Harvard Health Publishing, 2021).
The Nexplanon implant’s side effects include spotting, longer and heavier periods, headaches, nausea, and weight gain (Planned Parenthood Federation of America, 2021). Qsymia side effects include birth defects, tachycardia, suicidal thoughts, and serious eye problems (Khera et al., 2016).

What non-pharmacological interventions would you suggest?

Non-pharmacological interventions that might be appropriate for Ms. Whitley include using heat/cold to alleviate her knee pain and the non-pharmacological contraceptive alternatives like abstinence during fertile periods or withdrawal, although less effective (Bansode et al., 2021).  Diet and exercise are other interventions Ms. Whitley can consider to lose weight and reach her ideal weight goal.

What patient education would you provide?

Patient education should include information on lifestyle changes, weight loss goals, and contraceptive alternatives. Educating Ms. Whitley on medication adherence, timing, and side effects is necessary. Instructing her to communicate with the office with any questions, concerns, adverse effects, and worsening condition is also essential.
American Addiction Centers. (2020, September 17). How bad is acetaminophen for the liver? Retrieved September 9, 2021, from https://americanaddictioncenters.org/over-the-counter-medications/acetaminophen
Bansode, O. M., Sarao, M. S., & Cooper, D. B. (2021). Contraception. Treasure Island (FL): StatPearls Publishing. Retrieved September 9, 2021, from: https://www.ncbi.nlm.nih.gov/books/NBK536949/
Cleveland Clinic. (2021). Budesonide; formoterol inhalation. Retrieved September 9, 2021, from https://my.clevelandclinic.org/health/drugs/19039-budesonide-formoterol-inhalation
Global Initiative for Asthma. (2021). Pocket management for asthma management and prevention. Retrieved September 9, 2021, https://ginasthma.org/wp-content/uploads/2021/05/GINA-Pocket-Guide-2021-V2-WMS.pdf
Harvard Health Publishing. (2021, February 12). Where to turn for pain relief acetaminophen or NSAIDs? Retrieved September 9, 2021, from https://www.health.harvard.edu/pain/where-to-turn-for-pain-relief-acetaminophen-or-nsaids
Khera, R., Murad, M. H., Chandar, A. K., Dulai, P. S., Wang, Z., Prokop, L. J., Loomba, R., Camilleri, M., & Singh, S. (2016). Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA, 315(22), 24242434. https://doi.org/10.1001/jama.2016.7602
Planned Parenthood Federation of America. (2021). What are the side effects of the birth control implant? Retrieved September 9, 2021, from https://www.plannedparenthood.org/learn/birth-control/birth-control-implant-nexplanon/nexplanon-side-effects

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