Discussion: Advanced Pharmacology: Prompt 3/NUR 419
Discussion: Advanced Pharmacology: Prompt 3/NUR 419
Advanced Pharmacology Prompt #3
The case study patient is a male who is 54 years and presents himself in the clinic for the fifth time with a gout flare. His right foot’s big toe is swollen, warm and red. His other medical history concerns his hydrochlorothiazide 25 mg daily intake to control his prevailing hypertension condition. According to Lee et al. (2021), gout exacerbation refers to sudden swelling, severe pain attacks, tenderness, and redness of joints, especially on the big toe. Therefore, the primary diagnosis for the patient is monoarthritis since the patient experiences pain, swelling, and warmth on the affected toe, proving that gout might be the cause considering that the patient is under hydrochlorothiazide which might have interfered with the patient’s uric acid excretion. However, in treating the patient’s gout exacerbation, there will be a need to examine the differential diagnosis that the patient may have, including osteoarthritis, septic arthritis, and pseudo gout, which presents symptoms like increased pain, swelling, and joint tenderness.
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The main way to prevent the future occurrence of mono arthritis is by providing the patient with anti-inflammatory and systematic steroid drugs to suppress the crystal-induced arthritis immune system (Woo &Robinson, 2015). Also, the patient may be administered uricosuric drugs like probenecid to prevent the disease’s future recurrence. The main patient education is seeking help from a primary caregiver to determine if there is a need to consult other specialists like a rheumatologist. The treatment plan for mono arthritis depends on the disease’s etiology. The treatment plan will first subject the patient to lowering his uric acid and providing him with non-steroidal anti-inflammatory drugs (NSAIDS) as the first-line treatment using drugs like diclofenac 50 mg, ibuprofen 600 mg, or naproxen 250 mg. However, drugs like colchicine and corticosteroids are essential in treating gout’s acute flare and can be used as the second option. However, due to the patient’s hypertension condition, they need to be used sparingly. In conclusion, the patient’s condition must be managed through the collaboration of the patient and the healthcare provider to prevent it from recurring.
References
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Lee, K., Elahi, S., Mashhouri, S., & Ye, C. (2021). Gout presenting as a chronic inflammatory arthritis from immune checkpoint inhibitors: case series. Rheumatology, 60(12), e441-e443.
Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers. FA Davis.
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Reply to one of the following prompts.
In the subject line of your posts, please identify which prompt you are responding to, for example, prompt #2.
1. Melissa is a 31-year-old recently married female who presents to your office for an annual visit. She has three children ages 2, 5, and 8. Her new husband wants to wait at least a year before they try to have a child of their own. She has used combined oral contraceptives (COCs) for more than 10 years. Since the birth of her last child, she has been using COCs intermittently. She finds it too difficult to remember to take the pills regularly and wants an easier method. Menses are regular, although her periods seem heavier than usual, and she gets more irritable when she is not taking the COCs. She rarely exercises and admits to smoking and drinking occasionally. She is overweight. She has no medical history. What additional information do you need to obtain? Discuss her options and provide evidence for your rationale. Include patient education in your discussion.
2. Bridget is 16-year-old female who comes to the clinic for a sports physical with her mom. When her mom leaves the room during the examination, Bridget asks for a prescription for birth control. She requests that you do not tell her mother. Bridget is healthy with no allergies. She is at the 50th percentile for body mass index (BMI). Her blood pressure is 112/68 mmHg, and her examination is normal except for mild acne on her face and upper chest. What is Bridget’s initial treatment plan? What is the legal age in your state when adolescents can self-consent for contraception? What education does she need?
3. Javier is a 54-year-old male who comes to the clinic with his fifth gout flare this year. He presents with a red, warm, swollen big toe to his right foot. His only other medical history is that he has hypertension that has been controlled by hydrochlorothiazide 25 mg daily. He states the pain is a 5 out of 10. How would you treat his gout exacerbation? Is there anything you can do to help prevent future occurrences? What education does this patient need? Discuss your treatment plan and which clinical guidelines you used to help develop you plan.
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. In your peer replies, please reply to at least one peer who chose a different topic.
Textbook: Pharmacotherapeutics For Advanced Practice Nurse Prescribers
• Author: Woo, T. & Robinson, M.
• Publisher: F. A. Davis
• Edition: 5th
o Ch. 20: Drugs Affecting the Reproductive System
o Ch. 21: Drugs Affecting the Bones and Joints
o Ch. 33: Contraception
o Ch. 47: STDs and Vaginitis
• Recommended Reading
o Ch. 50: Urinary Tract Infections
o Ch. 51: Women as Patients
o Ch. 52: Men as Patients
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