Wk 10 Pharm
Discussion: Women and Men’s Health, Infectious Disease, and Hematologic Disorders
CASE STUDY 1
HH is a 68 yo M who has been admitted to the medical ward with community-acquired
pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and
diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3)
and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved,
with decreased oxygen requirements. He is not tolerating a diet at this time with complaints
of nausea and vomiting.
Ht: 5’8” Wt: 89 kg
Allergies: Penicillin (rash)
CASE STUDY 2
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on
yearly mammograms. She has a history of HTN. She complains of hot flushing, night
sweats, and genitourinary symptoms. She had felt well until 1 month ago and she
presented to her gynecologist for her annual gyn examination and to discuss her
symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap
smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd.
Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month
ago.
Main Post
HH has COPD, which is a progressive and persistent chronic disease restricting his airflow.
COPD and pneumonia are often comorbid (Scholl, 2018). Pneumonia is the main contributor to
hospitalization for acute exacerbation of COPD and is correlated with unfortunate outcomes
(Shin, 2019). Inpatient death in COPD complicated by community-acquired pneumonia is
estimated at 12.2% (Yang, 2017).
After the 3rd day of treatment with antibiotics, HH’s pulse ox improved slightly from 90 to 93.
The goal is usually 96% for most patients. Combining treatment for COPD may improve his
outcome. Systemic corticosteroids (oral and IV) are the standard of care in managing an acute
exacerbation of chronic obstructive pulmonary disease (Scholl, 2018). The value of
corticosteroids has a beneficial effect on severe acute exacerbations of COPD patients. However,
comparisons of systemic corticosteroids in pneumonia have shown conflicting outcomes, while
others have shown no advantages with a rise in side effects, especially hyperglycemia (Yang,
2017).
According to Yang, research has confirmed that a fixed-dose combination of inhaled
corticosteroids (ICS) and long-acting β2-agonists (LABA) can dramatically reduce the risk of
COPD exacerbation and not have the systemic conflict of mistreatment of community-acquired
pneumonia. There are two fixed-dose combinations of inhaled LABA and ICS available as a
treatment for COPD, namely budesonide/formoterol (Symbicort) and fluticasone/salmeterol
(Seretide). Both combinations have been shown to result in fewer exacerbation episodes and
improve life (Yang, 2017).
References
This study source was downloaded by 100000869833475 from CourseHero.com on 08-04-2023 19:37:44 GMT -05:00
https://www.coursehero.com/file/77617560/Wk-10-discussiondocx/
, Scholl, T., Kiser, T. H., & Vondracek, S. F. (2018). Evaluation of Systemic Corticosteroids in
Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia. Chronic
obstructive pulmonary diseases (Miami, Fla.), 5(1), 57–65.
https://doi.org/10.15326/jcopdf.5.1.2017.0157
Shin, B., Kim, S. H., Yong, S. J., Lee, W. Y., Park, S., Lee, S. J., Lee, S. J., & Lee, M. K. (2019).
Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary
disease with community-acquired pneumonia. Chronic respiratory disease, 16,
1479972318809480. https://doi.org/10.1177/1479972318809480
Yang, H. H., Lai, C. C., Wang, Y. H., Yang, W. C., Wang, C. Y., Wang, H. C., ... & Yu, C. J.
(2017). Severe exacerbation and pneumonia in COPD patients treated with fixed
combinations of inhaled corticosteroid and long acting beta2 agonist.
International journal of chronic obstructive pulmonary disease, 12, 2477.
2nd Response
Hello colleague,
Your response was informative. While researching medications to help with menopausal
symptoms, intravaginal estrogen therapy was an unfamiliar course of treatment. There is a
beautiful advertisement online, but after reading the risk factors and warnings, it is hard to
believe a woman would want to try it.
Approximately 70% of postmenopausal women report clinical manifestations associated with
VVA, vulva, and vaginal atrophy (Constantine, 2018). VVA results from vaginal dryness,
irritation, itching, dysuria, and pain or bleeding with sexual activity. Significant changes to
vaginal tissues cause the condition of VVA. Before menopause, the vaginal lining is moist and
thick with rugal folds; the mucosa is well vascularized, adequate vaginal secretions, and
lubrication produced during sexual stimulation. After menopause, the vagina becomes shorter
and narrower; the vaginal lining becomes thinner, less elastic, fewer rugal folds, diminished
blood flow, less vaginal secretions, and reduced lubrication during sexual stimulation.
The medication is IMVEXXY. The name looks like, IM SEXXY. IMVEXXY is a prescriptive
estradiol medicine in a rounded gel capsule for vaginal insertion with a disposable applicator.
This study source was downloaded by 100000869833475 from CourseHero.com on 08-04-2023 19:37:44 GMT -05:00
https://www.coursehero.com/file/77617560/Wk-10-discussiondocx/
Discussion: Women and Men’s Health, Infectious Disease, and Hematologic Disorders
CASE STUDY 1
HH is a 68 yo M who has been admitted to the medical ward with community-acquired
pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and
diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3)
and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved,
with decreased oxygen requirements. He is not tolerating a diet at this time with complaints
of nausea and vomiting.
Ht: 5’8” Wt: 89 kg
Allergies: Penicillin (rash)
CASE STUDY 2
A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on
yearly mammograms. She has a history of HTN. She complains of hot flushing, night
sweats, and genitourinary symptoms. She had felt well until 1 month ago and she
presented to her gynecologist for her annual gyn examination and to discuss her
symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap
smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd.
Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month
ago.
Main Post
HH has COPD, which is a progressive and persistent chronic disease restricting his airflow.
COPD and pneumonia are often comorbid (Scholl, 2018). Pneumonia is the main contributor to
hospitalization for acute exacerbation of COPD and is correlated with unfortunate outcomes
(Shin, 2019). Inpatient death in COPD complicated by community-acquired pneumonia is
estimated at 12.2% (Yang, 2017).
After the 3rd day of treatment with antibiotics, HH’s pulse ox improved slightly from 90 to 93.
The goal is usually 96% for most patients. Combining treatment for COPD may improve his
outcome. Systemic corticosteroids (oral and IV) are the standard of care in managing an acute
exacerbation of chronic obstructive pulmonary disease (Scholl, 2018). The value of
corticosteroids has a beneficial effect on severe acute exacerbations of COPD patients. However,
comparisons of systemic corticosteroids in pneumonia have shown conflicting outcomes, while
others have shown no advantages with a rise in side effects, especially hyperglycemia (Yang,
2017).
According to Yang, research has confirmed that a fixed-dose combination of inhaled
corticosteroids (ICS) and long-acting β2-agonists (LABA) can dramatically reduce the risk of
COPD exacerbation and not have the systemic conflict of mistreatment of community-acquired
pneumonia. There are two fixed-dose combinations of inhaled LABA and ICS available as a
treatment for COPD, namely budesonide/formoterol (Symbicort) and fluticasone/salmeterol
(Seretide). Both combinations have been shown to result in fewer exacerbation episodes and
improve life (Yang, 2017).
References
This study source was downloaded by 100000869833475 from CourseHero.com on 08-04-2023 19:37:44 GMT -05:00
https://www.coursehero.com/file/77617560/Wk-10-discussiondocx/
, Scholl, T., Kiser, T. H., & Vondracek, S. F. (2018). Evaluation of Systemic Corticosteroids in
Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia. Chronic
obstructive pulmonary diseases (Miami, Fla.), 5(1), 57–65.
https://doi.org/10.15326/jcopdf.5.1.2017.0157
Shin, B., Kim, S. H., Yong, S. J., Lee, W. Y., Park, S., Lee, S. J., Lee, S. J., & Lee, M. K. (2019).
Early readmission and mortality in acute exacerbation of chronic obstructive pulmonary
disease with community-acquired pneumonia. Chronic respiratory disease, 16,
1479972318809480. https://doi.org/10.1177/1479972318809480
Yang, H. H., Lai, C. C., Wang, Y. H., Yang, W. C., Wang, C. Y., Wang, H. C., ... & Yu, C. J.
(2017). Severe exacerbation and pneumonia in COPD patients treated with fixed
combinations of inhaled corticosteroid and long acting beta2 agonist.
International journal of chronic obstructive pulmonary disease, 12, 2477.
2nd Response
Hello colleague,
Your response was informative. While researching medications to help with menopausal
symptoms, intravaginal estrogen therapy was an unfamiliar course of treatment. There is a
beautiful advertisement online, but after reading the risk factors and warnings, it is hard to
believe a woman would want to try it.
Approximately 70% of postmenopausal women report clinical manifestations associated with
VVA, vulva, and vaginal atrophy (Constantine, 2018). VVA results from vaginal dryness,
irritation, itching, dysuria, and pain or bleeding with sexual activity. Significant changes to
vaginal tissues cause the condition of VVA. Before menopause, the vaginal lining is moist and
thick with rugal folds; the mucosa is well vascularized, adequate vaginal secretions, and
lubrication produced during sexual stimulation. After menopause, the vagina becomes shorter
and narrower; the vaginal lining becomes thinner, less elastic, fewer rugal folds, diminished
blood flow, less vaginal secretions, and reduced lubrication during sexual stimulation.
The medication is IMVEXXY. The name looks like, IM SEXXY. IMVEXXY is a prescriptive
estradiol medicine in a rounded gel capsule for vaginal insertion with a disposable applicator.
This study source was downloaded by 100000869833475 from CourseHero.com on 08-04-2023 19:37:44 GMT -05:00
https://www.coursehero.com/file/77617560/Wk-10-discussiondocx/
