This is a case of a 26-year-old female, with a history of asthma and chronic knee pain. She has increased the use of her albuterol inhaler to 3-4 times a week and has been taking Acetaminophen as needed for the knee pain. Additionally, she is interested in a new birth control method and losing weight. The purpose of this paper is to highlight the treatment approaches to this patient case scenario.
The recommended regimen for this patient would include a low dose inhaled Budosenide/Formoterol (Symbicort) 80/4.5 mcg per inhalation as needed; Acetaminophen up to 4000 mg daily as needed; Naltrexone/Buproprion extended-release (Contrave) 8/90 mg tablet for 4 weeks; and subdermal etonogestrel implant (Nexplanon) or any other contraceptive according to the patient’s preference. Respectively, the medications belong to the following drug class: Corticosteroids/Long-acting Beta 2 Agonists, Analgesic, Sympathomimetic amine anorectic/sulfate substituted monosaccharide, and long-acting contraceptive (Curtis, 2016; Ennis et al., 2016; Falk et al., 2016; Lutz & Asarian, 2017; Rosenthal & Burchum, 2021).
The patient’s asthma is of mild persistent severity and not well-controlled according to her history. Since the earlier short-acting B2 Agonist medication albuterol is no longer effective, the Global Initiative for Asthma recommends an as-needed low dose of combined inhaled corticosteroids and the long-acting B2 agonist formoterol. This is in keeping with the stepwise approach to asthma management (Levy, 2021). In addition, she has been suffering from chronic knee pain following a soccer injury. The pain is most likely from traumatic osteoarthritis. Accordingly, she would benefit from continuing with a dose of acetaminophen on an as-needed basis since there are no complaints as to its effectiveness. Acetaminophen is the recommended first-line in chronic pain management. Regardless, she would also benefit from an orthopedic consult (Ennis et al., 2016).
As for her desired weight loss and birth control, she would benefit from Naltrexone/Buproprion (Contrave) as it is one of the most effective weight-loss regimens with very few adverse events and the least interaction with her other drugs (Lutz & Asarian, 2017; Rosenthal & Burchum, 2021). A contraceptive method that is similarly effective is the subdermal etonogestrel implant, which is a highly recommended long-acting contraceptive in her age group. However, considering safety and efficacy for all other methods available, the patient’s preference would take precedence (Curtis, 2016).
Potential Side Effects and Drug Interactions
The Budesonide/Formoterol combination may carry the risk of increasing asthma severity and asthma-related death (Rosenthal & Burchum, 2021). Budesonide may similarly cause localized oropharyngeal infections. Grapefruit juice, ketoconazole, and other CYP3A4 inhibitors should be avoided as they may lead to increased concentrations of budesonide (Kalola & Ambati, 2021). Some of the adverse events associated with the use of Nexplanon include irregular bleeding and risk of ovarian cysts in the long-term but it is relatively safe. The efficacy of Nexplanon may be reduced if the following drugs are used concomitantly such as barbiturate, phenytoin, or topiramate (Moray et al., 2021).
Side effect profile of acetaminophen may include, skin rash, hepatotoxicity, nephrotoxicity, metabolic and electrolyte imbalances. It may interact with glucuronidation inhibitors such as phenobarbital and may cause more toxicity when combined with other hepatotoxic drugs (Lemaitre et al., 2020). Naltrexone/Buproprion can cause gastrointestinal irritation and could reduce the effectiveness of opioid analgesics (Rosenthal & Burchum, 2021).
The patient would benefit from avoidance of environmental factors that could be triggers for her asthma such as cold and allergens. Furthermore, she may benefit from exercise and dietary changes that could increase the effectiveness of her weight loss medications. Additionally, this is beneficial for her chronic knee pain. Accordingly, she could also reduce her knee pain from physiotherapy (Ennis et al., 2016; Falk et al., 2016; Lutz & Asarian, 2017).
The patient should be educated on the importance of lifestyle modifications in the effectiveness of her management. Adherence is equally an important aspect of her treatment. She needs to understand that non-pharmacological interventions will go hand in hand with her medications for the best result (Falk et al., 2016; Lutz & Asarian, 2017).