WEEK 10 : Hormone Replacement Therapy -Menopause

WEEK 10 : Hormone Replacement Therapy -Menopause

 Menopause is the permanent cessation of menstrual cycles following the loss of ovarian funicular activity. Although it can occur at any age or gender, said onset usually occurs when a in the age of early 50s (Abernethy, 2015). Some of the multiple symptoms that menopausal patients will report are symptoms such as night sweats, difficulties with sexual pleasure, and difficulty sleeping. A FDA- approved symptom reliever of menopause is Hormone replacement therapy (HRT) that includes estrogen or estrogen with progestin.

            Patients to chose to treat menopausal symptoms with HRT reports an increase in quality of life by relieving other symptoms such as mood swings, insomnia, vaginal dryness,  erectile dysfunction, and most important, hot flashes. As benefits are reported, so are negative effects such as bone density atrophy and increase risk for blood clots, increased risk for cardiovascular disease, and breast cancer. Due to the detrimental negative risk some chose not to use this therapy and seek other treatments such as supplements and organic/natural products..NURS 6521 Advanced Pharmacology Discussion

            The decision to prescribe HRT should be a joint one between the provider and the patient and the patient should be informed of the risks. Patients should also start with the lowest dose possible because the benefits of hormone therapy are dose related (Arcangelo & Peterson, 2013). As the Advanced Nurse Practitioner, I would be sure to complete, and document a meticulous assessment of the patient’s medical history (past, present, and family). I would be sure to advocate for my patients by providing detailed education regarding natural remedies, vitamins, and supplements that aids in management of symptoms and transitions associated with menopause. Education on Monitoring caffeine intake, dietary changes, and routine assessments of changes in the body should also be included. As every patient is unique, Hormone therapy continues to be a valid treatment option for patients who are significantly troubled by menopausal symptoms; however, the risks and benefits of such treatment vary according to age and medical history (Abernethy, 2015).

WEEK 11 : Off-Label Drugs

According to the American Academy of Pediatrics (2014), less than half of medications have specific instructions for children, which leaves the provider to determine the appropriate treatment for the child. The term off-label use, means that the drug is being used for something that was not included in the package insert or approved labeling (Neville, 2014). 

Children are not like adults, as their age and weight change rapidly, which can affect dosing of medications, as can body fat, amount of water in a child’s body, plasma, and hormones (Mir, & Geer, 2016).  Pharmacokinetics and pharmacodynamics differ in children as well, such as drug absorption and metabolism (Mir, & Geer, 2016).  The use of off-label medications in children is done mainly because there are not enough available medications used to treat children (Mir, & Geer, 2016).  NURS 6521 Advanced Pharmacology Discussion

There has been recent and on-going concern regarding the use of SSRI antidepressants in children as they may cause a higher incidence of suicide ideation (National Institute of Mental Health [NIMH], n.d.).  The Food and Drug Administration (FDA) has issued a black box warning for all SSRI antidepressants, for the potential increase in suicidal thoughts when taken by teens (NIMH, n.d.).  Fluoxetine is currently the only SSRI antidepressant that is approved for adolescents ages 8-18 (Drugs.com, 2017).  Venlafaxine has also been prescribed to kids, as an off-label treatment, although it has not been approved by the FDA for use in children (NIMH, n.d.).  A placebo-controlled study was completed on 766 pediatric patients and the data gathered was not adequate enough to support the use of venlafaxine in children (Drugs.com, 2017).  As well as the safety of the drug has not been evaluated beyond treatment longer than six months in children (Drugs.com, 2017).  There are many drugs that need further evaluation and research done to clarify the efficacy in children, such as opioids and cardiovascular drugs (Kimland, 2012).

Technology and electronics may play a role in the use of off-label drug use in children in the future.  Computerized documentation, which can include measured outcomes, will assist in tracking the use and side effects of off-label drug use in children (Kimland, 2016).

References

American Academy of Pediatrics.  (2014).  AAP makes recommendation on off-label