Women’s Health Prescribing Case

Ann is a 57 y/o female who presents today with c/o vaginal dryness and dyspareunia.  She says that this has been an issue for the last 2 years or so, but it has gotten worse.  She went through natural menopause at the age of 53—and did not take any oral estrogens—she said it was her preference not to, and that she really did not have any systemic signs/symptoms of menopause—just the vaginal dryness for the last 2 years or so.

She says that she has used OTC products without benefit—and she uses Astroglide or some type of lubricant when she is sexually active with her husband—but it is still uncomfortable because she just thinks her tissue are so dry.  Ann tells you that she usually does not have any itching or discharge but has in the last few days—which she attributes to a recent round of Amoxicillin for a tooth infection.  So she thinks she may need something for that also—she has not used any OTC meds for the discharge. 

Ann is healthy—she takes Lipitor 20 mg for high cholesterol; Vitamin D3 1000 IU and gets at least 1000 mg of Calcium per day in her diet.

She and her husband walk 4 miles most days of the week.  She works full time as a teacher—she does not smoke or drink. She has no allergies to food or medications.

Her parents are both still alive and healthy.  She has one son who is 21 years old and is in good  health. 

On exam, she is a young appearing 57 y/o female in no distress.

Vital Signs—97-80-14 and BP is 124/70  67 inches and 140  pounds

On pelvic exam, you do see atrophic vaginal tissues, without lesions. By manual exam in normal, pap is done, but you saw no cervical

abnormalities. You do see a small about of thick whitish discharge in the vaginal vault that is + for hyphae under your microscope.

1. What drug and drug class would be the best choice in this scenario? State name of drug and its mechanism of action.  

2. Cite any lab/diagnostic testing needed for before prescribing that are required and any needed for monitoring.  State patient education/counseling or side effect education that should be included.  Note pertinent any drug-drug interactions, Black Box warnings and life span considerations?