Question: Woo, Pharmacotherapeutics for APN Prescribers, 4e Instructor Case Study-22-1 Chapter 22 Drugs Affecting the Reproductive System Instructor Case Study 1 A 43-year-old African American male has a history of hypertension, hypertriglyceridemia, and avitaminosis D. Current medications include ezetimibe 10 mg daily, niacin SR 1,000 mg at bedtime, HCTZ/lisinopril 25/20 mg daily, and vitamin D3 over the counter 5,000 units twice a day. He had a previous testosterone level drawn at another facility that he reports as being low. He endorses a feeling of fogginess, lack of energy, core weight gain, decrease in erections, and decrease in semen consistency. Labs reveal testosterone 180 ng/dL (193-836 ng/dL), and thyroid-stimulating hormone/thyroxine, vitamin D, follicle-stimulating hormone/luteinizing hormone, and prostate-specific antigen within normal levels. Conversational Guideline
Questions: 1. Is this patient a good candidate for testosterone therapy? Why or why not?
2. What are his risk factors for having erectile dysfunction?
3. What if any of these medications are contributing to his symptoms?
4. Write your prescription using the Blank below.
Case StudyComplaint"It hurts when I urinate." History Janice is a 26-year-old married woman who presents at clinic with symptoms of dysuria, frequency, and urgency. Further history yields 2 days of these symptoms but no fever, chills, or flank pain. She describes a burning discomfort during and immediately following urination and feeling the need to void every half hour. There is no vaginal discharge, itching, or odor. Janice uses a diaphragm and spermicide for birth control. She requests "a urine culture and some sulfa pills." When asked to explain, she says that she has had many "bladder infections" over the past 3 years and "sulfa pills usually work." She was evaluated approximately 5 years ago with an IV pyelography and cystogram, and "nothing was wrong."
1. What is your diagnosis?
2. Is it appropriate to prescribe a medication regimen for her? If so, what is your medication choice. Fill out the prescription blank.
3. When should she return to the clinic?
4. What lifestyle changes can Janice make to help prevent this in the future?