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.

NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Case Overview

DC is a 46-year-old female with RUQ pain associated with nausea. She has hypertension, diabetes mellitus, gout, and DVT. She is currently on Lisinopril, HCTZ, Allopurinol, and multivitamin. She is allergic to amoxicillin, codeine, and latex. Her vital are the temperature at 98.8, weight 202Ibs, heart rate 82, and blood pressure at 136/82 mmHg. Her laboratory findings are WBC at 13000, total bilirubin 0.8mg/dl, direct bilirubin at 0.6mg/dl, alkaline phosphate at 100u/l, AST at 40u/l, and ALT 30u/l. on examination, Eyes: EOMI, HENT: Normal, GI: non-distended, minimal tenderness, Skin: warm and dry, Neuro: Alert and Oriented, and Psych: appropriate mood.

Diagnosis for the Patient

Amebic liver disease is an extra-intestinal manifestation of Entamoeba histolytica. The presenting signs and symptoms are abdominal pain of acute onset. The pain is usually constant, dull, and aching at the right upper quadrant NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders. The pain may radiate to the right shoulder or scapular. The pain increases after eating, coughing, and walking. It is associated with fever, nausea, and vomiting. Upon examination, the patient is usually febrile, has jaundice, and has right upper quadrant abdominal tenderness (Prahraj & Anand, 2021). This is the patient’s diagnosis because she has pain at the RUQ of acute onset whose trigger is taking food. The pain is associated with fever, nausea, and vomiting. Upon examination, the patient has fever and tenderness at the RUQ. The WBC indicates the presence of an infection. In addition, the direct bilirubin is high. However, the liver enzymes are within the normal range.

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Appropriate Drug Therapy for This Patient

The patient has amoebic liver disease due to his clinical presentations and laboratory evaluation. In her plan of treatment, I will put into consideration other preexisting diseases; gout, DVT, hypertension, and diabetes mellitus.

• Metronidazole 400mg PO TDS for five days to treat amoebic liver disease
• Aspirin 81mg PO OD for gout pain, DVT, and fever
• Colchicine 0.6mg PO OD for gout
• Amlodipine 10mg PO OD for hypertension
• Healthy diet for diabetes mellitus

Reason For Recommending This Drug Therapy

The previous drug list had Lisinopril 10mg OD, HCTZ 50 OD, Allopurinol 10MG OD, and multivitamin. The patient’s blood pressure is well controlled. However, I changed lisinopril and HCTZ because they increase the risk of bradycardia. The recommended dose for lisinopril when co-administering with a diuretic is 5mg (Lysenko, 2021). HCTZ is not appropriate in diabetic patients because it inhibits insulin production, hence hyperglycemia. Therefore, amlodipine is the best drug for a hypertensive patient with diabetes mellitus. Allopurinol and lisinopril are not appropriate in liver disease. Colchicine is effective in treating gout and it is appropriate in liver disease. Metronidazole is an antiprotozoal and antibacterial agent recommended for tissue infections and liver abscess (Goel et al, 2021). Aspirin is an anticoagulant and NSAID that helps relieve fever, pain, and DVT NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders.

References

Goel, V., Jain, A., Sharma, G., Jhajharia, A., Agarwal, V. K., Ashdhir, P., & Chauhan, V. (2021). Evaluating the efficacy of nitazoxanide in uncomplicated amebic liver abscess. Indian Journal of Gastroenterology, 40(3), 272-280.

Lysenko, V. A. (2021). Are there benefits of low doses of ACE inhibitors, MRAs, diuretics and statins in the treatment of heart failure?

Prahraj, D., & Anand, A. C. (2021). Tropical liver diseases: an overview. Clinical Liver Disease, 18(3), 138 NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders.