Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
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Gastrointestinal and Hepatobiliary Disorders
The scenario presents patient HL with the following symptoms: nausea, vomiting, and diarrhea due to Prednisone. The patient also has a history of drug abuse and possible signs of Hepatitis C. The history of drug abuse could also be the reason that is causing malfunction in the body, which leads to vomiting and nausea (Asrani et al., 2019). The paper determines the three differential diagnoses and explains the pharmacological way to treat them.
Diagnosis
Despite the absence of a physical and comprehensive examination, the available symptoms such as diarrhea, nausea, and vomiting can be used to diagnose the patient. Based on the presented symptom, the primary patient diagnosis is acute gastroenteritis. Acute gastroenteritis is caused by parasitic, direct viral, and bacterial (Amjad, 2020). In this case, the stomach and intestine suffer inflammation and irritation due to bacteria inflammation leading to food contamination (Amjad, 2020). Acute gastroenteritis can be spread by drinking contaminated beverages or foods (Amjad, 2020).
The patient history of drug abuse can help diagnose the patient to suffer from acute hepatitis C flare-up. Hepatitis C causes liver infection caused by a virus (Axley et al., 2018). Therefore, a patient history of drug abuse gives room for a high rate of contracting hepatitis C. The symptoms associated with a patient with Hepatitis C flare-up include nausea, vomiting, and diarrhea (Axley et al., 2018). The patient could also be diagnosed with a hepatobiliary disease caused by bacterial, virus, or alcohol consumption. The symptom is abdomi
nal pain, nausea or vomiting, fatigue, and loss of appetite (Axley et al., 2018). However, HL suffered from Hepatitis C flare-up and acute gastroenteritis based on the symptom presented.
Drug Therapy and Treatment Plan: assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The primary aim is to overcome the patient’s symptoms and reduce complications. The patient should continue using Synthroid 100 mcg daily, which effectively restores thyroid hormone and helps treat Hepatitis C (Rosenthal & Burchum, 2020). Thyrotropin is released in hormone (TRH), leading to the anterior pituitary stimulation (Rosenthal & Burchum, 2020). The thyroid is secreted to 80% thyroxine (T4), while 20 % represents the L-triiodothyronine (Rosenthal & Burchum, 2020). The patient should also be prescribed promethazine 25mg daily to treat acute gastroenteritis (Amjad, 2020). The drug is also effective in the drug abuse history of HL. Promethazine 25mg daily does not produce any sedative effects, which is essentially dealing with the patient history of drug which causes an effect in the liver (Rosenthal & Burchum, 2020). The promethazine alienates the peripheral and central effects by using histamine receptors (Rosenthal & Burchum, 2020). The patient should reduce the intake of Nifedipine 30mg daily since it is used to treat hypertension (Ainuddin et al., 2019). ssignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Prednisone 10mg is known to cause side effects such as vomiting, nausea, and diarrhea. Prednisone helps lower inflammation, which is achieved by decreasing the capillary permeability and the migration of the polymorphonuclear leukocytes (Rosenthal & Burchum, 2020). The drug therapy will involve taking the drug in three days and being encouraged to return to the clinic for further evaluation to determine the drugs’ effectiveness. The use of antiemetics will effectively deal with vomiting and nausea (Rosenthal & Burchum, 2020). However, the side effect of antiemetic use is that it increases electrolyte and dehydration imbalance (Rosenthal & Burchum, 2020).
Justifying the Recommendation Drug Therapy: Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The newer agent for curing hepatitis C infection is the antimotility agent, which effectively treats acute non-bloody diarrhea (Aksan et al., 2021). The agents in this category include loperamide (Imodium) and bismuth subsalicylate, which help rehydrate symptomatic relief (Aksan et al., 2021). The most reabsorption agent is loperamide, which helps alter intestinal motility by giving time for the reabsorption of water in the intestines, thus declining the volume of stools (Ayele et al., 2021). Oral Rehydration Salts are also effective in dealing with dehydration since they contain trisodium citrate, sucrose, and potassium chloride dehydrate. The amount given should depend on the intensity and frequency of diarrhea.
Conclusion
Zinc supplements effectively deal with gastroenteritis, which leads to diarrhea. Patients suffering from gastroenteritis face severe zinc deficiency (Hitch & Fleming, 2018). In this case, zinc will act as a micronutrient that helps the cell grow, boost immunity, and help intestinal transport. It is also essential in water and electrolyte transportation.
References
Ainuddin, J., Javed, F., & Kazi, S. (2019). Oral labetalol versus oral nifedipine for the management of postpartum hypertension a randomized control trial. Pakistan Journal of Medical Sciences, 35(5), 1428. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717493/
Aksan, A., Farrag, K., Blumenstein, I., Schröder, O., Dignass, A. U., & Stein, J. (2021). Chronic intestinal failure and short bowel syndrome in Crohn’s disease. World Journal of Gastroenterology, 27(24), 3440. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8240052/
Amjad, M. (2020). An overview of the molecular methods in the diagnosis of gastrointestinal infectious diseases. International Journal of Microbiology, 2020. https://doi.org/10.1155/2020/8135724
Asrani, S. K., Devarbhavi, H., Eaton, J., & Kamath, P. S. (2019). Burden of liver diseases in the world. Journal of Hepatology, 70(1), 151-171. https://www.sciencedirect.com/science/article/pii/S0168827818323882
Axley, P., Ahmed, Z., Ravi, S., & Singal, A. K. (2018). Hepatitis C virus and hepatocellular carcinoma: a narrative review. Journal of Clinical and Translational Hepatology, 6(1), 79. https://doi.org/10.14218/JCTH.2017.00067
Ayele, T. M., Abebe, E. C., & Kassie, A. B. (2021). Investigation of Antibacterial and Anti-Diarrhoeal Activities of 80% Methanol Leaf and Fruit Extract of Leonotis ocymifolia (Burm. F) Iwarsson (Lamiaceae). Journal of Experimental Pharmacology, 13, 613. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254535/
Hitch, G., & Fleming, N. (2018). Antibiotic resistance in travellers’ diarrhoeal disease, an external perspective. Journal of Travel Medicine, 25(Suppl_1), S27-S37. https://doi.org/10.1093/jtm/tay014
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences.
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.
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.
Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare:
- Review the case study assigned by your Instructor for this Assignment
- Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
- Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
- Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4
Write a 1-page paper that addresses the following:
- Explain your diagnosis for the patient, including your rationale for the diagnosis.
- Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
- Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm
Links to an external site.). All papers submitted must use this formatting.
submission information
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The case study depicts a 46-year-old female patient with a chief complaint of RUQ pain for the last 24 hours. The RUQ pain began an hour after dinner, and she had nausea and vomiting x1 before the pain started. The abdomen is non-distended but has mild tenderness. Lab results revealed a high WBC count and Direct bilirubin. The purpose of this paper is to discuss the patient’s diagnosis and treatment plan.
Diagnosis
Hepatitis A is the identified diagnosis for this case. It is caused by the hepatitis A virus (HAV) transmitted via the fecal-oral route through person-to-person contact and ingesting contaminated food or water. The classical presentation in adults includes anorexia, RUQ pain, jaundice, and hyperbilirubinemia (Abutaleb & Kottilil, 2020). Hepatitis A is the presumptive diagnosis based on pertinent positive symptoms of nausea, vomiting, RUQ pain, abdominal tenderness, and high direct bilirubin levels. Besides, an elevated WBC count indicates an underlying infection.
Drug Therapy Plan
Treatment of Hepatitis A is usually supportive. I would recommend Acetaminophen 500 mg per oral twice daily to relieve pain. Pain relief is important to promote quality patient care in the acute phase of Hepatitis A (Ntouva et al., 2019). In addition, I would recommend Metoclopramide 10 mg PRN. Metoclopramide is an antiemetic and will be important to alleviate nausea and vomiting. In addition, inactivated Hepatitis A vaccine will be administered for active immunization against diseases associated with HAV (Ntouva et al., 2019).
Conclusion
The patient presented with symptoms consistent with Hepatitis A, such as nausea, RUQ pain, mild abdominal tenderness, hyperbilirubinemia, and an elevated WBC count. Hepatitis A could be due to transmission of HAV from contaminated food or water. The treatment plan will include supportive measures such as pain control and alleviating nausea and vomiting using an analgesic and antiemetic.
References
Abutaleb, A., & Kottilil, S. (2020). Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterology clinics of North America, 49(2), 191–199. https://doi.org/10.1016/j.gtc.2020.01.002
Ntouva, A., Sibal, B., Balogun, K., Mandal, S., & Harding, N. (2019). Hepatitis A in primary care: working in partnership for diagnosis, management, and prevention of outbreaks. The British journal of general practice : the journal of the Royal College of General Practitioners, 69(687), 521–522. https://doi.org/10.3399/bjgp19X705965
| Excellent | Good | Fair | Poor | |
|---|---|---|---|---|
| Explain your diagnosis for the patient, including your rationale for the diagnosis. |
23 (23%) – 25 (25%)
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
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20 (20%) – 22 (22%)
The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.
|
18 (18%) – 19 (19%)
The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.
|
0 (0%) – 17 (17%)
The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
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| Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. |
27 (27%) – 30 (30%)
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
|
24 (24%) – 26 (26%)
The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
|
21 (21%) – 23 (23%)
The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
|
0 (0%) – 20 (20%)
The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
|
| Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. |
27 (27%) – 30 (30%)
The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. The response includes specific, accurate, and detailed examples that fully support the justification provided. |
24 (24%) – 26 (26%)
The response provides a basic justification for the recommended drug therapy plan for this patient. The response includes only 1-2 examples that fully support the justification provided. |
21 (21%) – 23 (23%)
The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. The response may include examples, which may inaccurately or vaguely support the justification provided. |
0 (0%) – 20 (20%)
The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. The response does not include examples that support the justification provided, or is missing. |
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. |
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
|
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
|
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
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0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
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| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
|
4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors
|
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors
|
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. |
5 (5%) – 5 (5%)
Uses correct APA format with no errors
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4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors
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3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors
|
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors
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| Total Points: 100 |
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