Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Diagnosis and Rationale

The patient, DC, presents with a complex clinical picture involving right upper quadrant (RUQ) pain, nausea, and vomiting, which began approximately one hour after a substantial dinner. A thorough assessment of her medical history, vitals, and laboratory results suggests a diagnosis of acute cholecystitis (Gallaher & Charles, 2022). The RUQ pain, particularly exacerbated after a large fatty meal, indicates gallbladder inflammation. The patient’s medical history, including obesity (as evidenced by her weight of 202 lbs) and type II diabetes, serves as significant risk factors for gallbladder dysfunction. The elevated white blood cell count (WBC) of 13,000/mm³ suggests an inflammatory process, further supporting the likelihood of acute cholecystitis (Gallaher & Charles, 2022).

The normal bilirubin levels and the elevation in alkaline phosphatase (Alk Phos) and transaminases (AST and ALT) indicate hepatocellular injury, possibly secondary to gallbladder inflammation. Notably, the patient is on lisinopril and HCTZ for hypertension, which could potentially contribute to electrolyte imbalances, thereby exacerbating gallbladder dysfunction (Gallaher & Charles, 2022). This underlines the interconnectedness of her comorbidities with the gastrointestinal and hepatobiliary system disorder, specifically acute cholecystitis.

However, a comprehensive diagnosis should also consider potential confounding factors. Pregnancy, drugs, or psychological disorders could contribute to similar symptoms. In this case, there is no indication of pregnancy or drug-induced liver injury. The patient’s psychological assessment, described as having an appropriate mood and being alert and oriented, suggests that psychological factors are less likely contributors. Therefore, the preponderance of evidence supports a primary diagnosis of gastrointestinal and hepatobiliary systems, specifically acute cholecystitis (Gallaher & Charles, 2022).

Drug Therapy Plan

A multifaceted drug therapy plan is essential for DC, addressing both the acute cholecystitis and her concurrent medical conditions. The initial focus is on immediate pain relief and prophylaxis against infection. Acetaminophen, a suitable analgesic, can be administered to alleviate pain. Given the potential for infection, broad-spectrum antibiotics such as ciprofloxacin or levofloxacin can be prescribed until culture results confirm the specific pathogen (Mou et al., 2019). Considering the patient’s hypertension, the continuation of lisinopril is reasonable, but the use of HCTZ should be reevaluated. HCTZ, a diuretic, has been associated with gallstone formation, which may exacerbate the gallbladder condition (Mou et al., 2019). Therefore, considering alternative antihypertensive agents that do not have this potential side effect is advisable.

Maintaining continuity in the pharmacotherapy for comorbid conditions is crucial. Allopurinol for gout management should be continued, ensuring its appropriateness in acute cholecystitis. While generally beneficial, multivitamins need careful consideration to avoid exacerbating gallbladder issues (Mou et al., 2019). A cautious approach involves monitoring the patient’s response and adjusting the multivitamin composition if necessary.

Justification of the Drug Therapy Plan

The drug therapy plan is justified by its comprehensive approach to addressing the immediate concerns associated with acute cholecystitis while taking into account the patient’s comorbidities. Acetaminophen and antibiotics directly target the primary issue of pain and infection (Rosenthal & Burchum, 2021). Adjustments in antihypertensive medications, with reconsideration of HCTZ, aim to minimize potential exacerbating factors related to gallstone formation.

The rationale behind discontinuing HCTZ is rooted in its association with gallstone formation, as it promotes cholesterol precipitation. Substituting it with alternative antihypertensive agents ensures blood pressure management without compromising the gallbladder condition (Rosenthal & Burchum, 2021). The decision to continue allopurinol aligns with the need for consistent management of gout, acknowledging the importance of balancing multiple medical conditions. Subsequently, continuing multivitamins, though generally beneficial, require ongoing evaluation to ensure they do not contribute to gallbladder issues. This approach emphasizes personalized care, recognizing the interconnectedness of the gastrointestinal and hepatobiliary systems with concurrent medical conditions (Rosenthal & Burchum, 2021).

In summary, the diagnosis of acute cholecystitis is supported by a comprehensive assessment of the patient’s presentation, medical history, and laboratory findings. The drug therapy plan is tailored to address immediate concerns while optimizing the management of comorbid conditions, illustrating a holistic approach to DC’s health.

References

Gallaher, J. R., & Charles, A. (2022). Acute cholecystitis: a review. Jama, 327(10), 965-975. 10.1001/jama.2022.2350

Mou, D., Tesfasilassie, T., Hirji, S., & Ashley, S. W. (2019). Advances in the management of acute cholecystitis. Annals of gastroenterological surgery, 3(3), 247-253. https://doi.org/10.1002/ags3.12240

Rosenthal, L.D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for Advanced Practice Nurses (2nd ed.). St. Louis, MO: Elsevier.

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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.

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.