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What drug therapy would you prescribe?
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please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer: Bacterial Vaginosis Case Study
1. List specific goals of treatment for this patient.
This week the case study is about R.S. is a 32-year-old White woman who seeks treatment for a vaginal discharge that she has had for the past month. This patient states that she is sexually active and has had the same partner for the past 6 months. Her signs and symptoms include an odor, especially after sexual intercourse. Her history reveals that she has been using a commercial douche on a bi-weekly basis during the past year for hygienic purposes in an attempt to prevent vaginal infections. Although the patient denies any other associated symptoms, her vaginal PH is higher than normal at 5.5. the normal vaginal pH is between 3.5 – 5.0 (Jones 2019) The goals of treatment for R.S. include relieving the symptoms such as the vaginal odor and discharge, preventing complications that arise from the condition, and normalizing vaginal pH (Jones, 2019).
2. What drug therapy would you prescribe? Why?
I would prescribe Metronidazole (Flagyl) 750 mg extended-release tablet once daily for seven days or 500 mg twice daily for seven days for treatment of bacterial vaginosis. (Jones 2019) This drug is available in other forms such as an oral pill or cream that can be inserted into the vaginal canal (Woo & Robinson, 2020G). Metronidazole (Flagyl) is an antibiotic that diffuses into bacteria and inhibits protein synthesis by binding onto DNA and causing strand breakage, preventing protein synthesis, and inhibiting growth (Ceruelos, Romero-Quezada, Ledezma & Contreras, 2019). Growth inhibition is key in treating BV, as the condition is caused by the overgrowth of anaerobic bacteria. Therefore, the drug is effective against Gardnerella vaginalis, the organism that is commonly implicated in causing Bacterial Vaginosis (BV) (Jones, 2019).
3. What are the parameters for monitoring the success of the therapy?
The parameters for monitoring the success of the therapy include assessing for the effectiveness by obtaining a sample of the patient’s vaginal secretions to assess for smell and to determine whether these secretions contain clue cells. The absence of clue cells will indicate the success of the treatment (Jones, 2019). Secondly, testing the vaginal pH by placing a pH test strip in the patient’s vagina can indicate the treatment’s success. A pH reading of 4.5 and higher indicates BV, with a reduced value from the baseline value (5.5) indicating the treatment’s success (Jones, 2019).
4. Discuss specific patient education based on the prescribed therapy.
The specific patient education base on Metronidazole therapy will include avoiding any sexual intercourse during therapy to prevent reducing the strength of the medication. Avoid consumption of any alcohol products during the treatment period and encourage patient to wait at least a couple of days after completion of therapy to resume drinking alcohol. I chose the extended-release form for a easy admission as patients tend to for miss doses if they are prescribed multiple times during the day. I would educate R.S to take medication as prescribed, maintain proper vaginal hygiene, continue to monitor for odor and secretion amount, report to the provider if the symptoms have not resolved after seven days.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
Metronidazole is one of the drugs that cause a Disulfiram-like effect (Woo & Robinson, 2020G). Disulfiram is a drug used to treat chronic alcohol addiction by producing sensitivity to ethanol. Therefore, Metronidazole would cause the body to be unable to process the ethanol in alcohol, causing side effects such as abdominal pain, nausea, and vomiting (Ceruelos et al., 2019). The severe side effects that would cause discontinuation of the drug include easy bleeding and bruising, and painful urination.
6. What would be the choice for second-line therapy? Provide rationale?
An appropriate second-line therapy option for the patient’s condition is Clindamycin ovules 100 mg intravaginally once daily at bedtime for three to seven days (Jones 2019). Clindamycin is a bacteriostatic antibiotic that inhibits protein synthesis by binding to the 50S ribosomal subunit (Jones, 2019). The drug is effective in managing anaerobic bacterial overgrowth in BV.
7. What OTC or alternative medications would be appropriate for this patient?
The appropriate OTC alternative medication would be Tinidazole 2 gram once daily for two days or 1 gram once daily for five days. Tinidazole is an antiprotozoal OTC medication that is active against BV. The drug has a longer half-life than Metronidazole, allowing it to be used for a shorter period in treating the condition.
8. What dietary or lifestyle changes should be recommended?
I would advise the patient to avoid the douching she has been doing with the commercial products on a bi-weekly basis. Douching strips, the vaginal canal of essential bacteria that are necessary to maintain a balance between aerobic and anaerobic vaginal bacteria (Jones, 2019). Stripping away these bacteria causes the symptoms that the patient is currently experiencing. Other lifestyle pointers I would provide include wiping from front to back, not using soap to clean the vaginal canal, and using unscented pads and tampons (Jones, 2019).
9. Describe one or two drug–drug or drug–food interaction for the selected agent.
Apart from the reaction with ethanol (alcohol) noted above, Metronidazole also interacts with Omeprazole and other proton pump inhibitors (PPIs). These drugs reduce the acidic concentration of the stomach and are used in managing peptic ulcer disease (Shah & Gossman, 2019). However, Metronidazole requires acidic conditions to facilitate absorption; therefore, these drugs reduce Metronidazole’s absorption (Shah & Gossman, 2019).