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DISCUSSION POST # 1 Reply to Elaine

A 19-year-old college student is asking for contraceptives.  

Q3.  According to Rosenthal & Burchum (2019), the key factors in determining contraceptive measures are safety, efficacy, and patient preference. A thorough history should determine a patient’s eligibility and risk factors. This includes a history of deep vein thrombosis, pulmonary embolism, stroke, high blood pressure, cardiovascular disease, diabetes, migraines, systemic lupus, irritable bowel syndrome, gallbladder disease, length of the menstrual cycle, irregular or heavy bleeding, patient and family history of breast cancer, in addition to lifestyle question such as the history of smoking, desired method, pills compliance, and sexual activity (CDC, 2022; Kaunitz, 2021). For example, many health conditions would eliminate certain oral contraceptives as options, while multiple sexual partners or a history of pelvic inflammatory disease would eliminate intrauterine devices.  

          For the patient in this case study, I would recommend starting with the NuvaRing. NuvaRing is a combined estrogen and progestin vaginal ring that is inserted monthly and provides continuous hormonal release with a one-week break during week 4 in which it is removed (Kaunitz, 2022; Rosenthal & Burchum, 2021). It contains 2.7mg of ethinyl estradiol and 11.7mg of etonogestrel. The NuvaRing has a similar mechanism of action to combined oral contraceptives (COC). “The chief mechanism of action is the inhibition of gonadotropins and prevention of ovulation along with effects on cervical mucus and endometrial histology” (Wieder & Pattimakiel, 2010, p. 403). The most common side effects of the NuvaRing are similar to that of COC including nausea, vaginitis, headache, and weight gain but to a less degree than with COC. There is an increased risk for serious venous thrombotic events as with COC but according to Wieder & Pattimakiel (2010), there is no significant increase in blood pressure in studies assessing patients using the vaginal ring. 

DISCUSSION POST # 2 Reply to Astrid

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?

 

            Osteoporosis is a condition in which bone mineral density and bone mass decrease, resulting in weakened and brittle bones (Rosen, 2022). With osteoporosis, the body breaks down bones faster than builds new ones. Bisphosphonates are used to prevent bone resorption and osteoporotic fractures. They inhibit bone resorption by reducing the number and activity of osteoclasts once incorporated into bone. Rosen (2022) also states that alendronate, sold under the brand names Fosamax and Binosto, is one of the bisphosphonates that is shown to increase bone mineral density and decrease the risk of vertebral fractures in postmenopausal women. Food decreases the absorption of oral bisphosphonates (Rosenthal & Burchum, 2021). Coffee, orange juice, calcium, magnesium, and iron also decrease the absorption and bioavailability of bisphosphonates. Therefore, they must be taken first thing in the morning, on an empty stomach, with a full glass of water.

            Furthermore, vitamin D deficiency and inadequate calcium consumption are prevalent in osteoporosis patients (Rosen, 2022). Therefore, individuals taking bisphosphonates should take calcium and vitamin D supplements. However, calcium, other mineral supplements (e.g., magnesium, iron), and antacids can interfere with the absorption of oral bisphosphonates and should not be taken for at least two hours after bisphosphonates. In addition, performing regular weight-bearing exercises, consuming a healthy diet, and avoiding alcohol and smoking are lifestyle measures that can promote bone health (Rosenthal & Burchum, 2021).

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