Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The case study describes client HL having nausea/vomiting and diarrhea complaints. HL admits to using illicit drugs and had a likely Hepatitis C infection. His current medications are Nifedipine 30 mg, Synthroid 100 mcg, and Prednisone 10 mg. This paper will discuss the client’s diagnosis and the pharmacological treatment plan.
Assessment and Diagnosis
To correctly diagnose HL, advance practitioner must do a detailed physical examination and complete history for the diagnosis of the health conditions .Most GI disorders has the same presentation symptoms and many other diseases may mimic Gastrointestinal disorder. Also, questions about onset and duration of the symptoms should be asked to determine if the symptoms are caused by the home medications or another underlining cause. The APRN, focus will be on finding the cause while treating the presenting symptoms. Diagnostic tools will include lab work to diagnose Hepatitis C, stool test for C-Diff, urinalysis for drug test, and imaging test such as ultrasound to assess liver problems. Due to the presenting symptoms, I will give a primary diagnosis of the condition as acute gastroenteritis.
Hepatitis C is the most likely diagnosis for HL. Hepatitis C is characterized by liver inflamm
Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
ation from infection by Hepatitis C virus (HCV). The HCV is an RNA virus found in blood and is spread parenterally (Manns et al., 2017). Most HCV infections are caused by exposure to infected blood through unsafe injections, recycling syringes for drug users, transfusion of unscreened blood, unsafe health care practices, and unsafe sexual practices (Ghany et al., 2019). Acute symptomatic persons exhibit malaise, anorexia, nausea, vomiting, jaundice, abdominal discomfort, myalgia, pale feces, and dark urine (Ghany et al., 2019). HL presents with nausea and vomiting, which are consistent with Hepatitis C. The patient abuses illicit drugs and had a Hepatitis C infection, increasing the risk of developing Hepatitis C.
Drug Therapy Plan
The treatment plan for HL will include a combination of Elbasvir/Grazoprevir for 12 weeks. The Elbasvir/Grazoprevir combination is used for patients who have never been on Hepatitis C treatment in the presence or absence of asymptomatic cirrhosis (Panel et al., 2018). It is also used for patients having stage 4/5chronic kidney disease.
Conclusion
HL has a diagnosis of Hepatitis C based on symptoms of nausea and vomiting and a history of using illicit drugs and HCV infection. HCV transmission occurs when one is exposed to contaminated blood from unsafe injections and transfusion. The treatment will include a combination of Elbasvir/Grazoprevir.
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References
Ghany, M. G., Marks, K. M., Morgan, T. R., Wyles, D. L., Aronsohn, A. I., Bhattacharya, D., … & Gordon, S. C. (2019). Hepatitis C guidance 2019 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology, 71(2), 686-721. https://doi.org/10.1002/hep.31060
Manns, M. P., Buti, M., Gane, E. D., Pawlotsky, J. M., Razavi, H., Terrault, N., & Younossi, Z. (2017). Hepatitis C virus infection. Nature reviews Disease primers, 3(1), 1-19. https://doi.org/10.1038/nrdp.2017.6
Panel, A. I. H. G. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 67(10), 1477. https://doi.org/10.1093/cid/ciy585
The patient in the case study presents with nausea, vomiting, and diarrhea. He has a drug abuse history and likely Hepatitis C. The current drug therapy includes Synthroid, Nifedipine, and Prednisone. The purpose of this assignment is to discuss the diagnosis and appropriate pharmacotherapy for the patient.
Diagnosis
Hepatitis C infection is the presumptive diagnosis. This is a liver inflammation caused by Hepatitis C virus (HCV). It is spread through sexual intercourse with infected persons, sharing personal items, and sharing drug-injection equipment (Ghany et al., 2020). Most infected persons are asymptomatic. Symptomatic cases present symptoms like fatigue, fever, reduced appetite, nausea, vomiting, abdominal discomfort, pale feces, dark urine, myalgia, and jaundice (Jin, 2020). Therefore, Hepatitis C is the primary diagnosis because of the positive symptoms of nausea, vomiting, and diarrhea and the client’s history of drug abuse and Hepatitis C infection.
Appropriate Drug Therapy
The recommended drug therapy will include a combination of Ombitasvir/paritaprevir/ritonavir (Technivie) for 12 weeks to treat Hepatitis C infection. Technivie is indicated for HCV infection in patients without cirrhosis. Ombitasvir inhibits HCV NS5A, which is needed for Hepatitis C viral replication. Paritaprevir inhibits NS3/4A serine protease required for proteolytic cleavage of the HCV-encoded polyprotein into mature forms (Wu et al., 2019). Ritonavir is a protease inhibitor that elevates paritaprevir serum levels. Nifedipine would be reduced to 10 mg and Prednisone to 5 mg since they are associated with GI side effects.
Conclusion
The patient’s nausea, vomiting, and diarrhea symptoms are consistent with Hepatitis C infection. Besides, the history of Hepatitis C and drug abuse make HCV infection the likely diagnosis. A combination of Ombitasvir/paritaprevir/ritonavir will be recommended to treat the HCV infection,
References
Ghany, M. G., Morgan, T. R., & AASLD‐IDSA hepatitis C guidance panel. (2020). Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology, 71(2), 686–721. https://doi.org/10.1002/hep.31060
Jin, J. (2020). Screening for Hepatitis C Virus Infection. JAMA, 323(10), 1008-1008. doi:10.1001/jama.2020.1761
Wu, J., Huang, P., Fan, H., Tian, T., Xia, X., Fu, Z., … & Zhang, Y. (2019). Effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir for HCV in HIV/HCV coinfected subjects: a comprehensive analysis. Virology journal, 16(1), 1–10.