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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.
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After completing this case study, the reader should be able to:
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Recognize the signs and symptoms of hyperprolactinemia.
Recommend appropriate treatment options for hyperprolactinemia.
Design a plan to monitor the response to the pharmacologic treatment of hyperprolactinemia.
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“I haven’t had my period for almost a year.”
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Susan Oliver is a 31-year-old woman with a history of oligomenorrhea (menstrual cycle every 2–6 months) since menarche at age 14. She presents to her gynecologist after 11 months of amenorrhea and a small amount of milky discharge from her left breast, which she first noticed 1–2 months ago. The patient and her husband would like to have a baby, but she is concerned that she may be unable to have children. The patient states that she and her husband have not used birth control for more than 1 year, and she has had several negative home pregnancy tests.
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Father died at age 58 from an AMI; mother (age 62) has type 2 DM and HTN. Patient has two brothers (ages 33 and 35) who are alive and well.
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The patient is employed as an administrative assistant. She does not smoke and has less than one drink of alcohol per month. She has been married for 5 years and lives with her husband and two stepdaughters (ages 7 and 9).
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Omeprazole 20 mg PO daily
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Desloratadine 5 mg PO daily
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Fluoxetine 20 mg PO daily
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Prenatal vitamins one tablet PO daily
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Acetaminophen 500 mg PO PRN
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Galactorrhea of the left breast and amenorrhea for 11 months as described in the HPI. No active GERD.
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The patient is a WDWN white woman in NAD.
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BP 124/71 mm Hg, P 72 bpm, RR 13, T 37.1°C; Wt 72 kg, Ht 5′8″
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Normal, intact, warm, and dry
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PERRLA, EOMI, normal funduscopic exam, normal visual fields
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Normal thyroid, no lymphadenopathy