Appropriate Drug Therapy Plan Assignment Paper

Appropriate Drug Therapy Plan Assignment Paper

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.

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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. Appropriate Drug Therapy Plan Assignment Paper
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.

Case Study:
DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation. Appropriate Drug Therapy Plan Assignment Paper

PMH: Vitals:

HTN Temp: 98.8oF

Type II DM Wt: 202 lbs

Gout Ht: 5’8”

DVT – Caused by oral BCPs BP: 136/82

HR: 82 bpm

Current Medications: Notable Labs:

Lisinopril 10 mg daily WBC: 13,000/mm3

HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL

Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL

Multivitamin daily Alk Phos: 100 U/L

AST: 45 U/L

ALT: 30 U/L

Allergies:

Latex
Codeine
Amoxicillin
PE:

Eyes: EOMI
HENT: Normal
GI:bNondistended, minimal tenderness
Skin:bWarm and dry
Neuro: Alert and Oriented
Psych:bAppropriate mood

Diagnosis

RUQ pain results in various conditions. It is critical to consider age, sex and general condition in determining a probable diagnosis. History and assessment will help arrive at a differential diagnosis. Symptomatic presentation such as weight loss, urinary or bowel symptoms, acute or chronic onset, pyrexia, and general malaise should be considered. Based on the presentation of the patient, i.e., DC, the RUQ pain is potentially caused by Cholelithiasis (biliary colic). Biliary colic is an intense, dull discomfort located in the epigastrium or RUQ or epigastrium and characterized by nausea, vomiting, and diaphoresis (Doherty et al.,2022). A patient presenting with biliary colic is generally well-appearing. Biliary colic involves abdominal pain due to obstruction that is often caused by stones in the common bile duct or cystic duct of the biliary tree. Biliary colic typically happens after eating a large or fatty food that elicits gallbladder contraction (Sigmon, Dayal, and Meseeha,2022)Appropriate Drug Therapy Plan Assignment Paper.

During meal ingestion, the gallbladder squeezes the bile into the small bowel for fat digestion. The gallstones can get stuck in the cystic duct. As the gallbladder contracts to move the bile, the blockage caused by gallstones leads to pain, vomiting and nausea. The RUQ resulting from gallstones can diffuse to the back or the right shoulder. The continued blockage of the cystic duct or common bile duct can lead to cholecystitis and choledocholithiasis, respectively, or gallstone pancreatitis, depending on when the stone is impacted. Risk factors such as over-eating, physical inactivity, liver cirrhosis, a low-fibre diet, obesity, sudden weight decline, long time fasting and diabetes increase exposure to gallstone formation (Doherty et al.,2022)Appropriate Drug Therapy Plan Assignment Paper.

Based on lab results, DC has a high white blood cell count, indicating infection, while bilirubin levels are within normal limits. Thus, liver function is remarkably good., which rules out hepatic-related disorders such as Acute hepatitis, liver abscess and portal vein thrombosis. However, AST is elevated. Although hepatic disorders may lead to elevated AST, acute extrahepatic obstruction can increase AST values.

Management/Therapy

Most people with gallstones have no prior symptoms; thus, preventive interventions may not be feasible (Baiu & Hawn,2018). However, treatment is necessary for patients with symptoms of biliary colic. Medication such as ursodiol can deter the formation of new stones but doesn’t apply to patients with existing stones (Baiu & Hawn,2018). The definitive intervention for managing gallstones is cholecystectomy, where the whole gallbladder is removed. Biliary colic may disappear a few hours after intake of meals, but clinicians need to monitor for continuous pain that is severe, which is accompanied by fever, jaundice, vomiting, or darkening of the urine, and such pain does not decline even after administration of pain medication (Baiu & Hawn,2018). For such a case, urgent medical evaluation and attention are warranted. Medication with NSAIDs is recommended. Spasmolytics or nitro-glycerine can be added, but if the pain is severe, opioids may be used.

Thus, the pharmacological intervention in managing biliary colic can involve: Appropriate Drug Therapy Plan Assignment Paper

Oral Ibuprofen 400 mg QID

Oral Donnatal elixir 5ML QID OR sublingual Nitro-glycerin 2.5 to 6.5 milligrams (mg) 3 to 4 times a day.

Since the patient has elevated WBC (13,000/mm3), she can continue with antibiotic therapy.

Metronidazole 500mg IV/P. O TDS for 5 to 10 days (for managing infection), amoxicillin should be avoided due to allergy.

DC will continue with the rest of the medication:

Lisinopril 10 mg daily

HCTZ 25 mg daily

Allopurinol 100 mg daily (reduces the amount of uric acid)

Multivitamin daily                                          

References

Baiu, I., & Hawn, M. T. (2018). Gallstones and biliary colic. JAMA, 320(15), 1612-1612.

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Doherty, G., Manktelow, M., Skelly, B., Gillespie, P., Bjourson, A. J., & Watterson, S. (2022). The Need for Standardizing Diagnosis, Treatment and Clinical Care of Cholecystitis and Biliary Colic in Gallbladder Disease. Medicina, 58(3), 388.

Sigmon DF, Dayal N, Meseeha M. Biliary Colic. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430772 Appropriate Drug Therapy Plan Assignment Paper