Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay
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.
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 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.
Additional Assignment Explanation and Case Study from instructor:
The patient case that is assigned this week will challenge you to diagnose this patient correctly, and then treat accordingly. Many patients, especially elderly patients, will have impaired renal and hepatic function. There are many medications that are metabolized in the liver. How will these diseases impact the use of these treatments? Do not always assume that if a patient has a liver disease that certain medications will be contraindicated. For example, acetaminophen and statins can be used safely with some types of liver disease. From the pharmacokinetic discussions we have had, you also know that elderly patients have reduced gastric acid secretion. Keep this in mind as you go through your readings to understand how GI drugs can help with this or further exacerbate some problems.
Make sure to use peer-reviewed journal articles (nursing or medical) <5 years for current research (at least 2-3 journal articles, and then you can also use 1 source as your textbook)
Obectives
- Evaluate diagnoses for patients with gastrointestinal and hepatobiliary disorders
- Justify drug therapy plans based on patient history and diagnosis
WEEK 4 PATIENT CASE
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
Diagnosing can be tricky so as you go through your readings think about all of the differential diagnoses that can apply to this patient. You are not given much information for this case, such as tests and labs, so this will be part of your discussion. What additional information do you need to confirm a diagnosis? Then if this diagnosis is confirmed, what would be the first line treatment? Remember from the last case, if you do not have a diagnosis for a treatment the patient is on, how would you assess the patient to establish the necessary diagnosis? Finally, you will adjust the current therapy based on this information and recommend new treatments for the suspected diagnosis.
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.
SAMPLE ESSAY
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Sample Essay
Patient Diagnosis and Rationale
As per the pertinent case scenario, the patient can be diagnosed with acute pancreatitis. The context is per the presented history of RUQ painful events, feelings of nausea together with vomiting. Another context entails heightened bilirubin together with pancreatic enzyme extents. Also, there is a medical history of gout together with the utilization of allopurinol (Szatmary et al., 2022). The presented signs are attributed as significant pointers for acute pancreatitis, which aligns with the inflammation of one’s pancreas.
Effective Drug Therapeutic Intervention
From the presented case scenario, it can be highlighted that the patient is presently under Lisinopril 10 mg every day, HCTZ 25 mg every day, and allopurinol 100 mg every day, together with multivitamins for each day. In this regard, there can be the consideration of supportive care for the patient together with discontinuing lisinopril (Syed et al., 2021). There should therefore be the integration of thiazide diuretics (Ernst & Fravel, 2022). In this regard, there should be the integration of Imipenem 500 mg thrice daily for the next two weeks as an antibiotic, and acetaminophen as a pain reliever, together with the encouragement of insulin.
Justification of the Applied Drug Therapeutic Intervention
Discontinuing lisinopril is significant as it is proven as a potential risk factor for triggering extended detrimental outcomes of pancreatitis. A significant aspect may be attributed to the underlying obstruction action of the drug on angioedema due to elevated extents of bradykinins coupled with autodigestion from catalyzed pancreatic enzyme action (Syed et al., 2021). Opting for a thiazide diuretic is significant as it is effective in managing hypertension and the drug does not induce further negative outcomes of the illness (Ernst & Fravel, 2022). Imipenem 500 mg, on the other hand, helps in handling the underlying pancreatic infection (Walkowska et al., 2022). Acetaminophen is significant for handling pain while insulin recommendation is for aiding in the reversal of the stress-linked production of fatty acids within the adipocytes (Sawalha & Kunnumpurath, 2020).
References
Ernst , M. E., & Fravel , M. A. (2022). Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. American Journal of Hypertension, 35(7), 573–586. https://doi.org/ 10.1093/ajh/hpac048
Sawalha, K., & Kunnumpurath , A. (2020). The Efficacy of Intravenous Insulin Infusion in the Management of Hypertriglyceridemia-Induced Pancreatitis in a Rural Community Hospital. Journal of Investigative Medicine, 8(2324709620940492). https://doi.org/ 10.1177/2324709620940492
Syed, S. B., Reyes, J. V. M., & Baig, M. (2021). Lisinopril-Induced Acute Necrotizing Pancreatitis. Cureus, 13(4), e14642. https://doi.org/10.7759/cureus.14642
Szatmary, P., Grammatikopoulos, T., & Cai, W. (2022). Acute Pancreatitis: Diagnosis and Treatment. Drugs, 82, 1251–1276. https://doi.org/https://doi.org/10.1007/s40265-022-01766-4
Walkowska, J., Zielinska, N., & Tubbs, R. S. (2022). Diagnosis and Treatment of Acute Pancreatitis. Diagnostics, 12(8), 1974. https://doi.org/10.3390/diagnostics12081974
NURS_6521_Week4_Assignment_Rubric
| NURS_6521_Week4_Assignment_Rubric | ||||||
| Criteria | Ratings | Pts | ||||
| This criterion is linked to a Learning OutcomeExplain your diagnosis for the patient, including your rationale for the diagnosis. |
|
25 pts | ||||
| This criterion is linked to a Learning OutcomeDescribe 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 OutcomeJustify 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 OutcomeWritten 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 OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten 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 | ||||||