Answer

Advanced Pharmacology

Is there any additional information you would want to collect?

Evidence-based practice requires that patients are given holistic care considering all the aspects surrounding their wellbeing. Details on EP’s allergies to certain drugs should be obtained to guide the course of any treatment that will be selected. Information should also be obtained on her nutritional status and the level of physical activity so that appropriate plans can be made to educate her on how to maintain healthy life despite her age. Information on the factors that could have aggravated EP’s symptoms should be collected to assist in diagnosis. Sternfeld, Guthrie, Ensrud, LaCroix, Larson, Dunn, & Reed (2014) posit that insomnia, night sweats, mood disturbance, and hot flashes are the first line manifestations of menopause that usually occurs at an average age of 51. Therefore, EP could be experiencing symptoms of menopause. As such, information should be obtained on when she last experienced her menses and the regularity of her menstrual flow. Insomnia and diaphoresis are also common side effects of paroxetine and therefore, she should be asked the duration of persistent of the hot flashes to ascertain menopausal manifestations. Information on current use of over-counter-drugs should also be obtained. Lastly, the cause of her depression should also be identified for appropriate care planning and referrals.

What are the variables you would take into account before deciding how to help her?

The variables for consideration would include EP’s geriatric age, her current polypharmacy, her negative beliefs on hormonal therapies, ability to comply with medications, and her chief complaints. EP is 50 years old, and administration of several drugs concurrently could lead to drug interactions and she might also forget to take some medications or fail to adhere. Her belief in the adverse effects of hormonal therapies would necessitate education on the safe of such treatment options before they are recommended for her recovery. Her health status regarding weight, pulse, and blood pressure should also be considered. Finally, the course of treatment would take into account her chief complaints of night sweats, insomnia, and frequent hot flashes.

What treatment will you recommend?

EP is within the age bracket of women experiencing menopausal signs and symptoms. Therefore, the treatment plan would focus on alleviating the signs and symptoms of menopause she experienced. Despite her concern for starting any hormonal course of treatment, hormonal replacement therapy will be the first treatment choice in alleviating EP’s advanced menopausal symptoms. According to the clinical guidelines by Hauk (2014), vasomotor symptoms of menopause are best managed using systemic hormone therapy and several studies have proved its effectiveness. The chief complaints; hot flashes, diaphoresis, and insomnia are interlinked vasomotor symptoms that could be managed by hormonal therapy. The drug of choice would be 0.45mg/20mg per day bazedoxifene (Duavee) administered orally for four weeks. However, EP should be educated about the menopausal symptoms and given comprehensive information on the benefits and risks of the hormonal therapy.

What non-pharmacological treatment would you suggest?

Cognitive Behavioral Therapy (CBT) will be appropriate in helping EP change her lifestyle to practice regular physical exercises and eat a balanced diet. NICE (2015) opines that CBT alleviates psychological symptoms such as low moods due to menopause. Therefore, CBT could help EP overcome insomnia, eat balanced and healthy diet, and perform daily physical exercises. The CBT should focus on these lifestyle changes that could improve her health.