Peer Responses:

    Length: A minimum of 150 words per post, not including references
    Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
    Citations need to be within 5 (Five)  years
    Context: Nursing in the USA
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Asthma
For Ms. Whitley I would prescribe an inhaled glucocorticoid for long term Asthma control of airway inflammation (Burchum & Rosenthal, 2019) Budesonide (Pulmicort Flexhaler) 360 -720 mcg bid will have few adverse effects and is an effective medication used in prophylaxis for asthma management. It is important to teach this patient to rinse and gargle with water after each use of the medication to avoid candidiasis or any speaking difficulty (Burchum & Rosenthal, 2019). She also needs to make sure she has adequate intake of calcium and vitamin D and continue in weight bearing activities to minimize bone loss. I would make sure she does not smoke as this is a major contributor to asthma complications and suggest a smoking cessation program if she does. Budesonide levels may increase with CYP3A4 inhibitors such as PPIs or macrolide antibiotics and should be avoided to reduce risk of hyperglycemia, weight gain, osteoporosis and chushings syndrome (Ajimura et al., 2018) Ms. Whitley should be advised that use of her short acting B2 agonist albuterol should not be needed more than 2 times per week if her asthma is well controlled. Frequent use can lead to overdose which may predispose the patient to tachydysrhythmias, cardiac arrest and even death (Burchum & Rosenthal, 2019).

Chronic Knee Pain
If Ms. Whitley finds occasional acetaminophen usage to adequately manage her knee pain, it is important to educate on not taking more than 4000mg/day as well as not drinking alcohol while taking acetaminophen to reduce risk of liver toxicity. Side effects are generally mild, and the medication may interact with coumadin and some AED medications. Other medications that may help with knee pain include OTC NSAIDS such as Ibuprofen (Motrin) 400 – 600mg q 6-8 hours. Ibuprofen can help with pain and inflammation, but side effects such as gastric ulceration, bleeding and renal injury may occur (Burchum & Rosenthal, 2019).

Birth control
When selecting a birth control method, it is important for the effectiveness, safety, and preference of the patient be accounted for (Burchum & Rosenthal, 2019). After sterilization, oral contraceptives are among the most effective and most widely prescribed. If Ms. Whitley was open to using an OC I would prescribe a combination preparation for their increased effectiveness and general tolerability. I would prescribe a continuous cycle OC for reduced scheduled bleeding time called Amethyst. This is a mixture of Ethinyl 20 mcg and Levonorgestrel 0.09 mg taken continuously until cessation or pregnancy is desired. I would educate Ms. Whitley that missing doses may lead to ovulation and to take her prescribed dose everyday (Burchum & Rosenthal, 2019). There are several mild side effects that may occur as a result of taking OCs and a thorough health history should be established to rule out contraindications to this medication prior to starting. Some of the side effecrts include thromboembolic disorders, hypertension, and uterine bleeding (Burchum & Rosenthal, 2019). There are also several drug interactions that may result in untherapeutic effects. Some of these medications include P450 inducers, coumadin, insulin, TCAs, diazepam, theophylline, and chlordiazepoxide.

Weight loss
The principal behind weight loss is to consume fewer calories than are burned for energy. I would discuss a weight loss program of diet and exercise modification with follow ups before any medications were prescribed as an adjunct to this program. Reducing calories, increasing exercise, and behavior modifications would be addressed and strategies outlined with Ms. Whitley. Utilizing technology to track calories and physical activities may help in monitoring and motivating for increased adherence (Burchum & Rosenthal, 2019). The benefits of adding a weight loss drug are generally mild and only recommended for patients with BMI of 30 or greater. The goal of weight loss is to reduce risks of health difficulties and prevent comorbidities (Burchum & Rosenthal, 2019). Finding strategies for long term sustainability is key in reducing weight and maintaining a healthy BMI.

References
Ajimura, C. M., Jagan, N., Morrow, L. E., & Malesker, M. A. (2018). Drug Interactions With Oral Inhaled Medications. The Journal of Pharmacy Technology : jPT : Official Publication of the Association of Pharmacy Technicians, 34(6), 273280. https://doi.org/10.1177/8755122518788809
Burchum, J. R., & Rosenthal, L. D. (2019). Lehns pharmacology for nursing care (10th ed.). Elsevier.
Halperin, K. (2015). What is Acetaminophen. Retrieved from
https://www.everydayhealth.com/drugs/tylenol