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

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Advanced practice registered nurses (APRNs) are responsible for conducting patient physical examinations, making diagnoses based on the patient's complaints, ordering diagnostic tests, prescribing medications, and offering educational counseling. Direct patient care is provided by APRNs, who are required to carefully assess patients' complaints to properly prescribe a pharmacological therapy that focuses on the condition's source rather than its symptoms. The first step towards assuming legal responsibility for prescription pharmaceuticals is for healthcare professionals to be knowledgeable about the risks, side effects, and contraindications. The most typical complaint is abdominal pain. A variety of illnesses may cause abdominal pain. In this case study, I will assess the patient's condition based on their symptoms, medical history, and the medications they are currently taking. I will then develop a potential diagnosis based on the findings of the diagnostic tests and then treat the illness with the appropriate drug therapy. Explain the diagnosis and the rationale Her medical history and physical examination indicate that this 46-year-old woman may have acute cholecystitis or gall bladder inflammation. The presenting signs and symptoms of gallbladder inflammation include right upper quadrant (RUQ) pain that appeared after eating a large meal and was followed by nausea and vomiting, as well as an increase in white blood count (WBC), a marker of inflammation. The gallbladder's function is to secrete bile to break down fats, but when a patient has a blockage in the gallbladder ducts, pressure can build up after eating a lot of fat and result in pain 3 as the gallbladder contracts to release the bile. Her age, sex, and weight are additional risk factors that could make her more susceptible to this condition (4Fs: Fat, Female, Forty, Fertile). Describe the appropriate drug therapy plan based on the patient's history, diagnosis, and drugs currently prescribed. The patient's high blood pressure medication regimen, which included 10 mg of lisinopril and 25 mg of HCTZ per day, should be continued. It's important to continue taking allopurinol, which is used to treat gout and is given 100 mg daily. To maintain general health, multivitamin supplements should continue to be taken at the exact dosage of 1 tablet per day. The patient is safe to continue taking these medications in the prescribed dosage. Patients may exhibit signs and symptoms of acute cholecystitis such as fever, leukocytosis, abnormal liver functions, and high alkaline phosphate levels. According to the Tokyo recommendations for the severity of cholecystitis, this patient is now considered to have Grade I mild cholecystitis because she appears stable without organ dysfunction. The Tokyo guidelines 2018 oral antimicrobial therapy recommendations for acute biliary infection state that initiating an anti-infective agent such quinolones like levofloxacin 500 mg daily plus metronidazole 500 mg twice daily for seven days constitutes suitable pharmacological therapy. Since the patient had a penicillin (PCN) allergy, these antibiotics were the treatment of choice. Analgesics and antipyretic drugs are also effective for symptomatic relief. Acetaminophen 500 mg will be administered to the patient if they have pain or a fever of 101 degrees or higher every 4-6 hours. Since the patient has a codeine allergy, pain medications with codeine must be avoided. It is also necessary to prescribe antiemetics. For nausea and vomiting, use 25 mg of promethazine every 4 to 6 hours as needed. 4 Drug therapy recommendations. Despite having diabetes (DM) type II, this patient is not taking any meds. Before giving drugs, additional tests should be performed. A1C and blood glucose tests should be part of blood chemistry. She can take 500 mg of metformin daily, which is considered safe for this case. The patient should be instructed that if the condition does not improve and starts to get worst in 24 hours, she should go to the nearest emergency room for an emergent intervention or for a possible cholecystectomy (open or closed, depending on the surgeon's recommendation). Pregnancy tests, a CBC, a liver profile, an amylase/lipase test, and another laboratory testing should also be suggested. To further confirm the diagnosis, the patient should be advised to undergo an abdominal ultrasound or CT scan. 5 References: Bloom, A. (2021). Cholecystitis medication. medication?reg=1#2 Liao KF, Chuang HY, Lai SW. (2017). Metformin Use Correlates with Reduced Risk of Gallstones in Diabetic Patients: A 12-Year Follow-up Study. Frontiers in Pharmacology, 24(8), 765. Markotic F, Grgic S, Poropat G, Fox A, Nikolova D, Vukojevic K, Jakobsen JC, Gluud C. (2020). Antibiotics for adults with acute cholecystitis or acute cholangitis, or both. Cochrane Database of Systematic Reviews 2020, 6. Rosenthal, L. D., & Burchum, J. R. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.