Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

DC, a 46-year-old female patient, came with complaints of a 24-hour history of nausea,  vomiting, and right upper quadrant pain. The patient reports a past medical history of type 2 diabetes, gout, hypertension, and a history of deep venous thrombosis caused by the use of oral birth control pills. The lab results show slightly elevated liver enzymes and elevated white blood cells. This paper will explain the patient’s diagnosis, the appropriate drug therapy, and the justification for the recommended drug therapy.

Diagnosis

Upon considering the symptoms and medical history, the patient’s clinical manifestation indicates acute cholecystitis, most likely triggered by a large dinner. The right upper pain, nausea, and vomiting are expressive of gallbladder involvement (Yokoe et al., 2018). According to the lab results, the patient had elevated white blood cells of 13,000/mm3, which shows signs of infection, while elevated Alk Phos, AST, and ALT show signs of hepatobiliary involvement. Elevated liver enzymes and white blood cell count are common findings of patients with acute cholecystitis (Yokoe et al., 2018).

Appropriate Drug Therapy

Acetaminophen is the drug of choice to help manage pain, given that the patient is allergic to codeine. Non-steroid inflammatory drugs (NSAIDs) should not be given to prevent exacerbation of hypertension and possible renal complications since the patient has diabetes (Jones et al., 2023). As an antiemetic therapy, ondansetron is prescribed to help prevent nausea and vomiting. Also, ondansetron has no significant interactions with the patient’s current medications. Antibiotic therapy is key to treating any possible infection associated with acute cholecystitis. The most appropriate antibiotic is metronidazole (Jones et al., 2023). Lastly, ursodeoxycholic acid can be used to manage gallstones by dissolving cholesterol gallstones and preventing relapse. The use of ursodeoxycholic acid is a conservative strategy for managing gallstones without conducting invasive procedures considering the patient’s health status (Pisano et al., 2020).

In summary, the drug therapy plan proposed addresses the patient’s underlying diagnosis, symptoms, and medical history, ensuring a comprehensive approach to her current health issues. Also, close monitoring and regular follow-up will be crucial to assess the effectiveness of the prescribed medication and make other changes needed.

 References

Jones, M. W., Genova, R., & O’Rourke, M. C. (2023). Acute cholecystitis. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459171/

Pisano, M., Allievi, N., Gurusamy, K. S., Borzellino, G., Cimbanassi, S., Boerna, D., Coccolini, F., Tufo, A., Di Martino, M., Leung, J., Sartelli, M., Ceresoli, M., Maier, R. V., Poiasina, E., De Angelis, N., Magnone, S., Fugazzola, P., Paolillo, C., Coimbra, R., . . . Ansaloni, L. (2020). 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World Journal of Emergency Surgery, 15(1). https://doi.org/10.1186/s13017-020-00336-x

Yokoe, M., Hata, J., Takada, T., Strasberg, S. M., Asbun, H. J., Wakabayashi, G., Kozaka, K., Endo, I., Deziel, D. J., Miura, F., Okamoto, K., Hwang, T. L., Huang, W. S. W., Ker, C. G., Chen, M. F., Han, H. S., Yoon, Y. S., Choi, I. S., Yoon, D. S., . . . Yamamoto, M. (2018). Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholecystitis (with videos). Journal of Hepato-Biliary-Pancreatic Sciences, 25(1), 41–54. https://doi.org/10.1002/

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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

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.htmLinks to an external site.). All papers submitted must use this formatting.