NR 508 Week 1 TD and Quiz
, NR 508 Week 1 TD and Quiz
PART 1:
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.
“The diagnosis of PCOS is confirmed once other conditions with features similar to
PCOS have been excluded, such as NCCAH, thyroid disease, and hyperprolactinemia”
(Barbieri, R. & Ehrmann, D, 2017)
“OCs containing one of the original progestins, norethindrone or norethindrone acetate,
are also good options; while they are not as low in androgenicity, they have not been
associated with excess VTE risk.” (Barbieri, R. & Ehrmann, D, 2016)
Primary Dx: PCOS Microgestin? Norethindrone? Clomiphene citrate?
Metformin, Spironolactone,
Differentials: NCCAH, thyroid dz, hyperprolactinemia, IF SEVERE
hyperandrogenism and virillization, then consider androgen-secreting
ovarian and adrenal tumors and ovarian hyperthecosis.
, Tx: Ortho Tri-Cyclen (norgestimate/ethinyl estradiol) 0.25 mg/35 mcg daily.
Encourage patient to stop smoking and make her aware of all the risks
involved with smoking and oral contraceptives. Or Yasmin
“We typically start with an OC containing 20 mcg of ethinyl estradiol
combined with a progestin with minimal androgenicity (such as
norgestimate). Other progestins with minimal androgenicity or
antiandrogenic properties include desogestrel and drospirenone, but both
have been associated with a possible higher risk of venous
thromboembolism (VTE) (table 1). OCs containing one of the original
progestins, norethindrone or norethindrone acetate, are also good options;
while they are not as low in androgenicity, they have not been associated
with excess VTE risk.”
“Although transdermal or vaginal ring preparations are potential options,
they have not been well studied for the management of hirsutism and there
are concerns about an excess risk of VTE with both regimens.”
PRIMARY DIAGNOSIS:
Polycystic Ovary Syndrome (PCOS) is a very common metabolic/endocrine
disorder in women that causes an increased amount of androgen secretion,
irregular menstrual cycles, and is commonly the cause of infertility (Azziz,
2017). Most often, true PCOS cases will present clinically with menstrual
irregularity (oligomenorrhea, amenorrhea, or excessive bleeding),
hyperandrogenism (acne and hirsutism), polycystic ovarian features
(visualized via an ultrasound), and obesity (Solomon, McCartney, &
Marshall, 2016). Many patients will also present with an increased
luteinizing hormone and a normal or low follicle-stimulating hormone
(Barbieri & Ehrmann, 2017). Emily presents to the office with classic
features of PCOS.
PCOS has become regarded as an intricate and complicated genetic trait
because several genetic branches and environmental elements are combined,
which then facilitates one developing the disorder (Azziz, 2017). Multiple
studies have correlated an increase in PCOS cases with patients who have a
close relative, such as a mom or sister that also has PCOS. According to
, NR 508 Week 1 TD and Quiz
PART 1:
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.
“The diagnosis of PCOS is confirmed once other conditions with features similar to
PCOS have been excluded, such as NCCAH, thyroid disease, and hyperprolactinemia”
(Barbieri, R. & Ehrmann, D, 2017)
“OCs containing one of the original progestins, norethindrone or norethindrone acetate,
are also good options; while they are not as low in androgenicity, they have not been
associated with excess VTE risk.” (Barbieri, R. & Ehrmann, D, 2016)
Primary Dx: PCOS Microgestin? Norethindrone? Clomiphene citrate?
Metformin, Spironolactone,
Differentials: NCCAH, thyroid dz, hyperprolactinemia, IF SEVERE
hyperandrogenism and virillization, then consider androgen-secreting
ovarian and adrenal tumors and ovarian hyperthecosis.
, Tx: Ortho Tri-Cyclen (norgestimate/ethinyl estradiol) 0.25 mg/35 mcg daily.
Encourage patient to stop smoking and make her aware of all the risks
involved with smoking and oral contraceptives. Or Yasmin
“We typically start with an OC containing 20 mcg of ethinyl estradiol
combined with a progestin with minimal androgenicity (such as
norgestimate). Other progestins with minimal androgenicity or
antiandrogenic properties include desogestrel and drospirenone, but both
have been associated with a possible higher risk of venous
thromboembolism (VTE) (table 1). OCs containing one of the original
progestins, norethindrone or norethindrone acetate, are also good options;
while they are not as low in androgenicity, they have not been associated
with excess VTE risk.”
“Although transdermal or vaginal ring preparations are potential options,
they have not been well studied for the management of hirsutism and there
are concerns about an excess risk of VTE with both regimens.”
PRIMARY DIAGNOSIS:
Polycystic Ovary Syndrome (PCOS) is a very common metabolic/endocrine
disorder in women that causes an increased amount of androgen secretion,
irregular menstrual cycles, and is commonly the cause of infertility (Azziz,
2017). Most often, true PCOS cases will present clinically with menstrual
irregularity (oligomenorrhea, amenorrhea, or excessive bleeding),
hyperandrogenism (acne and hirsutism), polycystic ovarian features
(visualized via an ultrasound), and obesity (Solomon, McCartney, &
Marshall, 2016). Many patients will also present with an increased
luteinizing hormone and a normal or low follicle-stimulating hormone
(Barbieri & Ehrmann, 2017). Emily presents to the office with classic
features of PCOS.
PCOS has become regarded as an intricate and complicated genetic trait
because several genetic branches and environmental elements are combined,
which then facilitates one developing the disorder (Azziz, 2017). Multiple
studies have correlated an increase in PCOS cases with patients who have a
close relative, such as a mom or sister that also has PCOS. According to
