NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay

NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay

NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay

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.

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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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Class,

Welcome to Week 4!

As an APRN, you will likely encounter patients presenting with symptoms affecting the GI tract. However, most symptoms concerning the GI tract are non-specific and therefore, diagnosis requires thoughtful and careful investigation. Similarly, hepatobiliary disorders may also mirror many of the signs and symptoms that patients present when suffering from GI disorders.

How might you evaluate specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?

This week you will examine diagnoses for patients with potential GI and hepatobiliary disorders. You will also develop a drug therapy plan based on patient history and diagnosis.

What do I have to do?

When do I have to do it?

Review your Learning Resources

Days 1-7, Week 4

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Submit your Assignment by Day 7 of Week 4

Assignment

By Day 7 of Week 4 (by Sunday, 11:59 pm MT)

Write a 1+ page paper that addresses the following:

Explain your diagnosis for the patient, including your rationale for the diagnosis. What labs would you order?

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Discuss each of the patient’s medications. Create an updated drug therapy plan.

Justify why you would recommend this drug therapy plan for the patient. Be specific and provide examples. Use and cite at least 4 sources for written assignments.

Case study assigned

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

Flagyl 500 mg TID

Metronidazole 250 mg daily

Vitals:

Temp: 98.8oF

Wt: 155 lbs

Ht: 5’7”

BP: 136/82

HR: 90 bpm

PE:

Eyes: EOMI

HENT: Normal

GI: Nondistended, minimal tenderness

Skin: Warm and dry

Neuro: Alert and Oriented

Psych: Appropriate mood

I look forward to reading your papers. The week 3 powerpoint has been graded.

Wishing you much success,

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorder

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.

WEEKLY 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.

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Rubric

NURS_6521_Week4_Assignment_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 to >22.25 pts

Excellent

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.

22.25 to >19.75 pts

Good

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.

19.75 to >17.25 pts

Fair

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.

17.25 to >0 pts

Poor

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.

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 to >26.7 pts

Excellent

The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

26.7 to >23.7 pts

Good

The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

23.7 to >20.7 pts

Fair

The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

20.7 to >0 pts

Poor

The response inaccurately and vaguely describes 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 to >26.7 pts

Excellent

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.

26.7 to >23.7 pts
Good

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.

23.7 to >20.7 pts

Fair

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.

20.7 to >0 pts

Poor

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.

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 to >4.45 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4.45 to >3.95 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts

This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair

Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

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 to >4.45 pts

Excellent

Uses correct APA format with no errors

4.45 to >3.95 pts

Good

Contains a few (1–2) APA format errors

3.95 to >3.45 pts

Fair

Contains several (3–4) APA format errors

3.45 to >0 pts

Poor

Contains many (≥ 5) APA format errors

5 pts

Total Points: 100