NURS 6521 Week 4 Assignment - Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Introduction With the provided case study, this paper will address my interpretation of the 46-year-old female presenting with RUQ discomfort after consuming a substantial, presumably fatty, dinner. As I review the patient's medical records, diagnoses, and current medications, I will formulate an effective drug therapy plan. Finally, I will explain why the recommended treatment approach was chosen and present supporting evidence. Patient Diagnosis & Rationale Acute cholecystitis seems to be the most likely diagnosis for this patient based on her medical history and presenting symptoms and labs. This condition typically affects overweight and reproductive-aged women older than 40. Considering her elevated WBC count, it likely indicates probable inflammation and infection. The diagnosis of cholecystitis is also supported by her history of gout and allopurinol usage. The patient's lower right quadrant pain, nausea, and vomiting are most likely due to calcification of the gallbladder. Patients with cholecystitis typically have higher levels of AST, alkaline phosphatase, and total bilirubin, in addition to elevated AST levels. Drug Therapy Plan & Justification Before initiating pharmaceutical interventions, ultrasound imaging should be performed for proper diagnosis. Upon definitive diagnosis of cholecystitis, intravenous fluids, pain medication (acetaminophen or ibuprofen), antibiotics (amoxicillin or piperacillin), and antiemetics (ondansetron or metoclopramide) are standard components of supportive therapy for cholecystitis. However, compared to antibiotic treatment alone, cholecystostomy is highly recommended to speed up the resolution of sepsis and boost treatment success rates (Wang et al., 2019). In addition, if the pain is severe, the patient may require a potent analgesic to manage pain adequately. Lisinopril and HCTZ can be continued since they are unlikely to interact negatively with other medications used to treat cholecystitis. However, allopurinol should be stopped due to the possibility of the patient developing a Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) (Batista et al., 2018). References Batista, M., Cardoso, J. C., Oliveira, P., & Gonçalo, M. (2018). Allopurinol-induced DRESS syndrome presented as a cholecystitis-like acute abdomen and aggravated by antibiotics. BMJ case reports, 2018, bcr. 226023 Wang, C.-H., Wu, C.-Y., Lien, W.-C., Liu, K.-L., Wang, H.-P., Wu, Y.-M., & Chen, S.-C. (2019). Early percutaneous cholecystostomy versus antibiotic treatment for mild and moderate acute cholecystitis: A retrospective cohort study. Journal of the Formosan Medical Association, 118(5), 914–921.