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

Introduction The provided case study presents a 46-year-old female who is having right upper quadrant pain that started an hour after eating dinner with her family. The patient’s past medical history, current medications, and lab values have been reviewed. The purpose of this paper is to diagnose the patient, formulate an effective drug therapy plan based on the diagnosis, and explain why the recommended therapy plan was chosen. Patient Diagnosis Based on the information provided about the patient, the patient in this case most likely has gallstones and cholecystitis, or inflammation of the gallbladder. Nausea, vomiting, right upper quadrant pain, and an elevated alkaline phosphatase level and white blood cell count are indicative of the presence of gallstones (McCance & Huether, 2019). The patient is at high risk for developing gallstones. She is female, over the age of 40, has a history of gout and diabetes, and was prescribed allopurinol. Estrogen increases cholesterol levels. The build-up of cholesterol or bilirubin, caused by hemolysis, results in the formation of gallstones. Gout can cause high levels of uric acid that can form uric acid stones. The patient’s history of diabetes also increases her risk for uric acid stones. Allopurinol is believed to cause cholecystitis due to the Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome (Batista et al., 2018). Drug Therapy Plan A definitive diagnosis of cholecystitis must first be determined by cholescintigraphy, ultrasound, or MRI. Upon definitive diagnosis, the drug therapy plan should focus on controlling the patient’s pain, correcting fluid and electrolyte imbalance, and getting rid of the infection and inflammation. Acetaminophen or ibuprofen may be given for pain relief. Intravenous fluids may be given to prevent dehydration and replace electrolytes. Ondansetron or metoclopramide may 3 be given to relieve the patient’s nausea and vomiting. Cephalosporins, carbapenems, quinolones, glycopeptides, aminoglycosides, or metronidazole may be given to get rid of the infection (Markotic et al., 2020). It is recommended that patients have a cholecystectomy in comparison to taking antibiotics alone because it accelerates sepsis resolution and improves the treatment success rate (Wang et al., 2019). Bowel rest and a change in diet are also recommended. The patient may continue taking her lisinopril, HCTZ, and multivitamin as prescribed. However, I would discontinue her allopurinol due to the adverse effect of DRESS Syndrome. Conclusion Based on the patient’s past medical history, symptoms, and lab values, the patient seems to have developed cholecystitis. The patient has many factors that put her at risk for developing this disease. Early diagnosis and treatment are important to prevent severe, life-threatening complications. 4 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. Markotic, F., Grgic, S., Poropat, G., Fox, A., Nikolova, D., Vukojevic, K., Jakobsen, J. C., & Gluud, C. (2020). Antibiotics for adults with acute cholecystitis or acute cholangitis or both. The Cochrane Database of Systematic Reviews, 2020(6), CD013646. McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. 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.