Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

Posted: November 24th, 2022

Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

Patients with endocrine and musculoskeletal disorders often require long-term treatment and care resulting in the need for extensive patient education. By appropriately educating patients, advanced practice nurses can assist patients with the management of their disorders. In clinical settings, patients with endocrine and musculoskeletal disorders typically seek treatment for symptoms that pose problems to their everyday lives as ordinary tasks may become difficult to complete. For instance, patients might have difficulty walking short distances, preparing meals, or even running errands. To reduce these symptoms and additional health risks, it is essential to develop drug therapy plans with individual patient factors in mind. Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay.  To prepare: Select one of the following endocrine or musculoskeletal disorders: thyroid disease, osteoarthritis, rheumatic arthritis, gout, multiple sclerosis, or fibromyalgia. Consider the types of drugs that would be prescribed to patients to treat symptoms associated with this disorder. Select one of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how this factor might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects. With these thoughts in mind: By Day 3 Post a description of the endocrine or musculoskeletal disorder you selected including types of drugs that would be prescribed to patients to treat associated symptoms. Then, explain how the factor you selected might impact the effects of prescribed drugs, as well as any measures you might take to help reduce negative side effects. For Week 6: The topic of learning for the discussion board is about the pharmacology of endocrine and musculoskeletal disorders. Here are some items you will need to include in your initial discussion board posting: Include one of the factors (genetics, gender, ethnicity, age or behavior) A brief description of your selected endocrine or musculoskeletal disorder from the list below in your write up. Select one of the following: thyroid disease, osteoarthritis (OA), rheumatic arthritis (RA), multiple sclerosis (MS), or fibromyalgia (FM). Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay. Make sure you clearly state your factor in your initial discussion board posting. Your care plan for your virtual patient must be specific (drug, dose, frequency), contain goals of your therapy, concise and in the SOAPE format. If your care plan were part of the patient’s health history chart, other healthcare providers (dietary, PT/OT, nursing, medicine and pharmacy) will be reading this information and making decisions based on the information you provide. Looking ahead to the Week 6 formal paper, the assignment asks to explain “juvenile diabetes”. The term “juvenile diabetes” is now confusing as children could be diagnosed with type 2 diabetes or type 1 diabetes. (Please take note of the nomenclature for type 1 and type 2 diabetes…Roman numerals I and II are no longer utilized.) There will be points deducted for using Roman numerals in your discussion of type 1 and type 2 diabetes. The way you might want to approach this part of the writing assignment, is to include a one or two line statement in the opening paragraph or paragraph number 2, about JDRF (formerly known as the Juvenile Diabetes Research Foundation…now known as JDRF) and/or the National Diabetes Association (NDA) position on the terminology of “juvenile diabetes”. The healthcare community (or community standard as it might be called) no longer uses the phrase “juvenile diabetes”. It was back in the 1990’s that the terminology of type 1 and type 2 diabetes was changed from Roman numerals (I, II) to alphanumeric values of 1 and 2. For your paper, you will be indicating “type 1” and “type 2” for the different classifications of diabetes as well as gestational diabetes. (Hope this makes sense). Friendly reminder: When referring to patients and their disease states, it is also incorrect verbiage to define the patient as their disease state. By this I mean, your patient is not a “diabetic” but a person with diabetes. A second example is the patient is not a “hypertensive” but a person with hypertension. Joint Commission surveyors are quick to point this out when reading through patient’s charts. Sources:: Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.. English, C. & Aloi, J.J. (2015). New FDA-Approved Disease-Modifying Therapies for Multiple Sclerosis. Clinical Therapeutics. 37(4). 691-715. Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

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Discussion: Pharmacotherapy for Endocrine and Musculoskeletal Disorders

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that is typified by inflammation of joints, joint damage and joint pain which leads to joint damage, permanent disability, and reduced quality of life. The joint damage caused by rheumatoid arthritis normally occurs on both sides of the body which means if a joint is affected in the arm or the limb, the same joint the other arm or limb is likely to be affected as well (Pisetsky, 2017). Siebert et al (2016)) also described RA as a systematic inflammatory disease typified by polyarticular joint involvement with extra-articular manifestations such as accelerated cardiovascular disease. The disease is perceived as an autoimmune disease because some specific autoantibodies are expressed such as antibodies to citrullinated proteins (ACPAs) and rheumatoid factors (RFs) (Siebert et al, 2016). Symptoms of rheumatoid arthritis include inflammation of the joints; joint stiffness; swelling of the joint; joint pain and loss of joint function (Pisetsky, 2017). Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

The prescribed treatment for a patient with rheumatoid arthritis would be methotrexate. Methotrexate works by inhibiting dihydrofolate reductase a cytokine responsible for promoting the inflammatory cascade that causes RA symptoms. Therefore, methotrexate interrupts the process that results in inflammation of the RA; a process that damages the joints and body organs with time (Bello et al, 2017). Additionally, methotrexate helps to relieve RA symptoms such as fatigue, joint swelling, and joint pain, and can also aid in preventing joint and organ damage. For the methotrexate medication, the patient should start with a weekly dose of 7.5–10 mg and then the dose can be increased to 25 mg/wk. Evidence has shown that there is a link between methotrexate dose and its efficacyin the treatment of RA symptoms and hence if oral medication does not control the symptoms of RA, the medication can be administered through injection (Bello et al, 2017).

Gender

Sex hormones have an impact on the immune system and therefore sex hormones are vital modulators in autoimmune diseases such as RA. Females experience more sex hormone fluctuations when compared to males, for example during puberty, menses, contraceptive use, pregnancy,and lactation as well.  Higher exposure to proinflammatory hormones in females has been attributed to a higher incidence of RA in females when compared to males (Alpízar-Rodríguez et al, 2017). Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

During the prescription of medication for rheumatoid arthritis, the gender factor should be considered. For example, medical management of RA before and during pregnancy as well as during lactation and afterward can be challenging(Alpízar-Rodríguez et al, 2017).  For instance, all DMARDs which are considered as the mainstay for RA treatment should not be prescribed for pregnant women, apart from sulfasalazine and hydroxychloroquine because DMARDs are generally considered unsafe during pregnancy(Aurrecoechea et al, 2015). Additionally, during prescription, contraception the woman is using should be taken into account. In addition, some RA medications such as some DMARDs such as leflunomide and methotrexate should be stopped at least three-six month prior to conception. Moreover, during lactation, some DMARDs have been shown to adversely affect babies because of the medication excretion within the breast milk due to the immunosuppressive impacts of some DMARDs (Aurrecoechea et al, 2015). Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

Care Plan for Patient AA (50-Year-Old Female)

Subjective

The patient reports that she is always fatigued even when she has not had a busy day. She also reports that she has been experiencing joint pain that is unbearable even with after taking painkillers. The patient also expressed her concerns about joint stiffness that makes it difficult to walk. She reported that “I rarely go shopping or do household chores due to the joint stiffness”.  The patient also expressed frustrations over not being able to perform activities of daily living.

Objective

• Fever
• Edema in the joints
• Joint swelling
• Warmth in the joints
• Evident deformity of joints. Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

Assessment

Rheumatoid arthritis as evidenced by joint swelling, joint pain, joint stiffness, as well as joint deformities. Inflammation of the joints and joint deformity as evidenced by the patient’s limited ability to carry out the activities of daily living, impaired mobility, joint pain and discomfort, fall risk, self-care deficits, as well as altered body image (Wilsdon, 2017).

Warm compressors and pillow support provided to loosen stiff joints by relaxing muscles. Cold compresses will be provided to numb the patient’s pain as well as decrease joint swelling. The pain will be managed as necessary by administering the appropriate PRN pain medications as necessary.

Prescribe prednisone (25 mg/day orally) to decrease inflammation and slow the progress of the joint damage. Prescribe methotrexateof 7.5–10 mg/wk forslowing the progress of rheumatoid arthritisand prevent permanent damage on the joints and tissues (Bello et al, 2017).

Planning

• Controlled joint pain
• Ability to perform activities of the daily living
• Perform exercises to loosen joints
• Adopt a healthy lifestyle
• Adhere to the treatment regimen

Evaluation

The pain joint and joint stiffness will reduce as evidenced by the ability to perform activities of daily living and self-care activities. After one week, the patient will report lifestyle changes such as healthy diet choices, avoiding smoking and alcohol. During the next review, the patient will have adhered to the prescribed treatment regimen (Pisetsky, 2017). Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

References

Alpízar-Rodríguez D, Nicola P, Canny G, Gabay C & Axel F. (2017).The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology. 56(8),1254–1263,

Aurrecoechea E, llorcadiaz J, Diezlizuain ML, Mcgwin G, Calvo-alen J. (2015). Impact of Gender in the Quality of Life of Patients with Rheumatoid Arthritis. J Arthritis. 4(160).

Bello A, Perkins E, Jay R & Petros E. (2017). Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis. Open Access Rheumatol. 1(9), 67–79. Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay

Pisetsky D. (2017). Advances in the Treatment of Rheumatoid Arthritis. North Carolina Medical Journal September. 78(5), 337-340.

Siebert S, Lyall D, Mackay D, Porter D, Iain B, Sattar N & Pell J. (2016). Characteristics of rheumatoid arthritis and its association with major comorbid conditions: a cross-sectional study of 502 649 UK Biobank participants. RMD Open. 2(1), e000267.

Wilsdon T. (2017). Managing the drug treatment of rheumatoid arthritis. Aust Prescr. 40(2), 51–58. Pharmacotherapy for Endocrine and Musculoskeletal Disorders Essay