NR508 Week 1 Discussion 1 ,2,& 3 Latest 2017 November

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.

You diagnose Emily with polycystic ovarian syndrome (PCOS) and decide to prescribe drospirenone-ethinyl-estradiol as a way to control both the PCOS symptoms, as well as to act as an oral contraceptive.

• At what dose should this be prescribed?
• What is the mechanism of drospirenone-ethinyl-estradiol, and why would, because of its mechanism, it be a good choice for her PCOS symptoms (Include the medication-altered physiology)?
• How would you monitor for efficacy and toxicity?

Emily subsequently returns to your clinic 5 months later, and decides to inform you that within the first 3 months after treatment, she struggled with a severe bout of depression. Instead of returning to your clinic to be prescribed, yet another pharmaceutical, she consulted her herbalist who told her about the anti-depressant, over-the-counter, herbal formulation, St. John’s Wort. She decided to begin taking St. John’s Wort in conjunction with her prescribed oral contraceptive medication, and she has now reappeared at your clinic because she is pregnant, and is distraught about how this occurred since she took her oral contraceptive compliantly since its prescription.

• Why then, is she pregnant?
• Please include detailed pharmacological mechanisms of how this occurred, and your subsequent steps in her management.