Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System
Differential diagnosis
My primary diagnosis for this patient would be Polycystic ovary syndrome (PCOS). Research shows that the disease is associated with various disorders that include polycystic ovaries, ovulatory dysfunction, and hyperandrogenism among other (Williams, Mortada & Porter, 2016). Hyperandrogenism is related to different types of issues such as hirsutism, androgenic alopecia as well as excess acne among others. In response to serum testosterone elevation, can trigger a chemical reaction resulting in the condition. The presence of oligomenorrhea accounts for ovulation dysfunction. This results in menstrual cycles that are less than six months apart, but more than 35 days apart (Mendoza et al., 2014). The presence of amenorrhea also accounts for ovulatory dysfunction. This results in failure of the menstrual cycle for the period of 6 to 12 months. The polycystic ovary is associated with ovary with twelve or more than twelve follicles over two to nine follicles in diameter or the ovary whose with volume more than ten mL based on ultrasonography. The follicle stimulating hormone and LH levels assist in the determination of this diagnosis.
Other diseases that I can diagnose patients include hypothyroidism. Hypothyroidism is characterized by the inability of the thyroid gland to produce enough hormones that are important. The thyroid, in this case, is underactive. The condition affects women especially with more than 60 years of age. The condition upsets the normal chemical balance in the body. Untreated hypothyroidism can pause various health complications such as the heart disease, infertility, joint pains, and infertility. In the female, the disorder can cause amenorrhea and oligomenorrhea. Because Emily is 32 years of age, and the fact that she is experiencing irregular menstrual cycle, it is less likely that she is suffering from hypothyroidism.
Another disorder I would diagnose Emily for is hyperprolactinemia. The condition is associated with elevated level of serum prolactin. The lactotroph cells of the anterior pituitary gland produce prolactin 198-amino acid protein of 23-KD. It plays a crucial role in enhancing lactation induction and breast enhancement during pregnancy. Prolactin can also bind to specific receptors in the liver, lymphoid cells, and gonads. The condition, especially in women, is associated with amenorrhea and oligomenorrhea in females (Gaitonde, Rowley & Sweeney 2012). It is less likely that Emily is suffering from this condition because she has the irregular menstrual cycle.
Treatment and drug mechanism of action
The treatment of the condition highly depends on whether they want to become pregnant or not. In this case, Emily doesn’t want to be pregnant. I would, therefore, prescribe ethinly-estradiol/norgestimate. Ortho Tri-Cyclen is an oral contraceptive which would prevent the pregnancy as well as treat Polycystic Ovary Syndrome. According to Capozzi et al, (2015), the drug contains both progesterone and estrogen. The drug causes the decrease in gonadotropic-releasing hormones and suppresses the hypothalamic-pituitary system. The progesterone present in this contraceptive stops the release of the luteinizing hormone. Importantly, estrogen, also present in the contraceptive lowers the production of follicle-stimulating hormone from the anterior pituitary gland. Additionally, Ortho Tri-Cyclen prevents the sperms entrance to the uterus. It increases the cervical mucus viscosity, prevents ovulation and egg maturation.
Dosage
Emily is supposed to take one active pill for 21 days and one inactive pill for the month last seven days. The composition of each pill includes varying amount of progesterone and 35 micrograms of estrogen (Physician Desk Reference, 2017). The pill taken in the first seven days contain 0.18 milligrams of progesterone and the pill taken in the second seven days contain 0.125 milligrams of progesterone and the pill taken in the third seven contain o.25 milligrams of progesterone.
Reference
Capozzi, A., Scambia, G., Pontecorvi, A., Lello, S. (2015). Hyperprolactinemia: Pathophysiology and therapeutic approach. Gynecological Endocrinology: The Official Journal of the International Society of Gynecological Endocrinology, 31(7), 506-510. doi:10.3109/09513590.2015.1017810
Gaitonde, D. Y., Rowley, K. D., & Sweeney, L. B. (2012). Hypothyroidism: An update. American Family Physician, 86(3), 244-251. http://www.aafp.org/afp/2012/0801/p244.html
Mendoza, N., Simoncini, T., & Genazzani, A. (2014). Hormonal contraceptive choice for women with PCOS: a systematic review of randomized trials and observational studies. Gynecological Endocrinology, 30(12), 850-860.
Physician’s Desk Reference. (2017). Ethinyl estradiol/norgestimate- Drug summary. Retrieved from http://www.pdr.net/drug-summary/Ortho-TriCyclen-Lo-ethinyl-estradiol-norgestimate-1363#15
Williams, T., Mortada, R., & Porter, S. (2016). Diagnosis and Treatment of Polycystic Ovary Syndrome. American Family Physician, 94(2), 106-113.
