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.
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 DiseasesLinks 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.
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
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Explain your diagnosis for the patient, including your rationale for the diagnosis.
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25 pts
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Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
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30 pts
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Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.
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30 pts
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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.
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5 pts
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Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
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5 pts
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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.
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5 pts
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Total Points: 100
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Mar 21, 2023, 7:46 AM (11 days ago)
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DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.
| PMH: | Vitals: |
|---|---|
| HTN | Temp: 98.8oF |
| Type II DM | Wt: 202 lbs |
| Gout | Ht: 5’8” |
| DVT – Caused by oral BCPs | BP: 136/82 |
| HR: 82 bpm |
| Current Medications: | Notable Labs: |
|---|---|
| Lisinopril 10 mg daily | WBC: 13,000/mm3 |
| HCTZ 25 mg daily | Total bilirubin: 0.8 mg/dL |
| Allopurinol 100 mg daily | Direct bilirubin: 0.6 mg/dL |
| Multivitamin daily | Alk Phos: 100 U/L |
| AST: 45 U/L | |
| ALT: 30 U/L |
Allergies:
- Latex
- Codeine
- Amoxicillin
PE:
- Eyes: EOMI
- HENT: Normal
- GI:bNondistended, minimal tenderness
- Skin:bWarm and dry
- Neuro: Alert and Oriented
- Psych:bAppropriate mood
Solution
Case study
The case is of a 46-year-old female with a 24-hour history of RUQ pain. She had nausea and one instance of vomiting before the presentation. She has a history of HTN, Type II DM, Gout, and DVT caused by oral BCPs. She is on lisinopril 10 mg daily, HCTZ 25 mg daily, allopurinol 100 mg daily, and a multivitamin daily. Labs show WBC 13,000/mm3, total bilirubin 0.8 mg/dL, direct bilirubin 0.6 mg/dL, Alk Phos 100 U/L, AST 45 U/L, and ALT 30 U/L. Eyes, HENT, GI, skin, neuro, and psych are unremarkable on physical examination.
Patient Diagnosis.
The patient in the case study is likely suffering from acute cholecystitis. According to Jones et al. (2022), acute cholecystitis is a condition that causes the gall bladder to be inflamed, thus causing severe pain, nausea, vomiting, and fever. Based on the symptoms presented by the patient, such as RUQ pain, nausea, and vomiting, the patient is likely suffering from acute cholecystitis. Further, the patient has elevated liver enzymes and bilirubin levels, which are indicators of acute cholecystitis (Jones et al., 2022). Lastly, the patient’s history of hypertension, type 2 diabetes, and gout are possible risk factors for acute cholecystitis (Anderloni & Fugazza, 2022)
Appropriate Drug Therapy Plan
The appropriate drug therapy for acute cholecystitis will include broad-spectrum antibiotics and painkillers. Specifically, this patient can have a combination of clavulanic acid and metronidazole, which should be
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