NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The case concerns patient HL who presents with complaints of nausea, vomiting, and diarrhea. HL has a positive history of drug abuse and likely Hepatitis C. The patient is currently on: Synthroid 100 mcg OD, Nifedipine 30 mg OD, Prednisone 10 mg OD, Flagyl 500 mg TDS, and Metronidazole 250 mg OD. On abdominal exam, the abdomen has minimal tenderness but is non-distended. The purpose of this paper is to discuss the patient’s diagnosis and propose an appropriate medication plan.
Diagnosis for the Patient
Hepatitis C Virus (HCV) infection is the identified clinical impression for this patient. The clinical features of HCV infection are fever, fatigue, night sweats, chills, myalgia, arthralgia, pruritus, lymphadenopathy, and spider nevi (Dermont et al., 2022; Rabaan et al., 2020). In addition, patients present GI symptoms like changes in appetite, nausea, abdominal discomfort/pain, indigestion diarrhea, and jaundice. Persons at risk of HCV infection include drug users due to unsafe injection practices (Manns & Maasoumy, 2022). The patient has GI symptoms that are consistent with HCV infection. Besides, his history of drug abuse and probable HCV infection increases the probability of HCV infection as the primary diagnosis.
Appropriate Drug Therapy Plan
Medication therapy for this patient will aim to eliminate the HCV infection and preventing its progression to complications like liver cirrhosis, liver failure, or hepatocellular carcinoma. My recommended medication therapy to treat the HCV infection is a combination of Sofosbuvir/Peginterferon/Ribavirin for 12 weeks (Chung et al., 2018). The drug combination has a positive treatment response and is recommended for patients with a history of drug abuse since it lowers the risk of self-injection (Hojati et al., 2018). Besides, the drug combination is linked with few side effects, which promotes treatment adherence (Yazdani et al., 2022). Nifedipine and Prednisone are associated with side effects of nausea. Nausea is a side effect of Nifedipine and Prednisone, while diarrhea is a side effect of Synthroid. Thus, I would recommend reducing doses to alleviate nausea, Nifedipine to 10 mg and Prednisone to 5 mg. Synthroid is associated with diarrhea. Therefore, I would reduce the dose from 100 mcg to 50 mcg.
Conclusion
The patient likely has HCV infection owing to the GI symptoms, drug abuse history, and probable history of Hepatitis C. The recommended drug therapy is a combination of Sofosbuvir/Peginterferon/Ribavirin for 12 weeks. Besides, Nifedipine and Prednisone doses will be lowered to alleviate nausea, whereas Synthroid dose will be reduced to alleviate nausea.
References
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A.I., Bhattacharya, D., Broder, T., Falade-Nwulia, O.O.,& Fontana, R. J. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases.
Dermont, M., Sullivan, R., Sibal, B., Foster, G., & Mandal, S. (2022). Hepatitis C diagnosis and management: a primary care and public health partnership approach. British Journal of General Practice, 72(715), 89-92. https://doi.org/10.3399/bjgp22X718529
Hojati, S. A., Maserat, E., Ghorbani, M., Safarpour, A., & Fattehi, M. R. (2018). Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective? Medical archives (Sarajevo, Bosnia, and Herzegovina), 72(5), 325–329. doi:10.5455/medarh.2018.72.325-329
Manns, M. P., & Maasoumy, B. (2022). Breakthroughs in hepatitis C research: from discovery to cure. Nature Reviews Gastroenterology & Hepatology, 1-18. https://doi.org/10.1038/s41575-022-00608-8
Rabaan, A. A., Al-Ahmed, S. H., Bazzi, A. M., Alfouzan, W. A., Alsuliman, S. A., Aldrazi, F. A., & Haque, S. (2020). Overview of hepatitis C infection, molecular biology, and new treatment. Journal of Infection and public health, 13(5), 773-783. https://doi.org/10.1016/j.jiph.2019.11.015
Yazdani, K., Dolguikh, K., Zhang, W., Shayegi-Nik, S., Ly, J., Cooper, S., … & Salters, K. (2022). Knowledge of hepatitis C and awareness of reinfection risk among people who successfully completed direct-acting antiviral therapy. Plos one, 17(3), e0265811. https://doi.org/10.1371/journal.pone.0265811
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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.
Learning Resources
Required Readings
- Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
- Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597)
- Chapter 65, “Laxatives” (pp. 598–604)
- Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616)
- Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
- Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases
- Links to an external site.. Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.29367
This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder.
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
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_6521_Week4_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning Outcome Explain your diagnosis for the patient, including your rationale for the diagnosis. |
|
25 pts | ||||
| This criterion is linked to a Learning Outcome Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. |
|
30 pts | ||||
| This criterion is linked to a Learning Outcome 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 pts | ||||
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning Outcome 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 pts | ||||
| Total Points: 100 | ||||||