Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

This is what I put together myself. It has 19% similarity when I submitted it to Turn-in.

Rationale for diagnosis

The clinical manifestations of gastroenteritis are diarrhea, vomiting, dysuria, abdominal pain, and infection. Patient HL has symptoms of nausea, vomiting and diarrhea. Although HL has history of drug abuse and hepatitis C. The neuro and psych assessment show normal results that means he is not undergoing drug abuse again. The Synthroid 100 mcg daily is probably for the patient's hypothyroid problem. Symptoms of the patient does not support hypothyroidism. Nausea and vomiting can be a sign of high blood pressure, but the patient's BP is 136/82mmhg which is within normal range. So, the nausea, vomiting and diarrhea might be cause by Gastroenteritis. The patient's symptoms are most likely due to a gastrointestinal infection, possibly viral, and the prednisone is exacerbating the symptoms. The patient's history of drug abuse and possible hepatitis C are also risk factors for GI infections.

The labs that I would order would include a CBC, CMP, stool culture, and stool ova and parasites. I would also order a viral panel, including tests for norovirus, rotavirus, and adenovirus. A liver panel and an antibody test for hepatitis C would be the diagnostic tests that would be ordered to confirm this diagnosis in the laboratory. If the results of these tests came back positive, the patient would be given antiviral medicine in order to treat the condition.  A complete blood count (CBC) would be ordered to evaluate for anemia, which can be a complication of GI bleeding. A comprehensive metabolic panel (CMP) would be ordered to assess for electrolyte abnormalities, which can occur with vomiting and diarrhea. A stool culture would be ordered to identify the causative organism of the infection. Stool ova and parasites would be ordered to rule out parasitic infections, which are common in developing countries but can also occur in developed countries. The viral panel would be ordered to identify the specific virus causing the infection. The norovirus is a common cause of viral gastroenteritis and is often responsible for outbreaks of vomiting and diarrhea. The rotavirus is the most common cause of severe diarrhea in young children and can also cause vomiting. The adenovirus is another virus that can cause gastroenteritis, although it is less common than the norovirus and rotavirus.

 

Appropriate Drug Therapy

The patient's current medication regimen does not appear to be related to the symptoms. The patient is taking Synthroid for hypothyroidism, Nifedipine for hypertension, Prednisone for an unknown reason, Flagyl for an unknown reason, and Metronidazole for an unknown reason. I would recommend discontinuing the Flagyl and Metronidazole, as they are not likely to be helpful for the current symptoms. I would also recommend discontinuing the Prednisone, as it is likely exacerbating the symptoms. The patient should continue taking the Synthroid and Nifedipine.  For the current symptoms, I would recommend a trial of an antiemetic such as ondansetron (Zofran) and loperamide (Imodium) for diarrhea. If the symptoms improve with this regimen, no further treatment may be necessary. If the symptoms do not improve, or if the patient develops a fever, I would recommend admission to the hospital for IV fluids and further testing. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool.  

Recommend Drug Therapy

I would recommend this drug therapy plan for the patient because it is likely to help with the symptoms of nausea, vomiting, and diarrhea. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool.

The patient is likely experiencing these symptoms due to their history of drug abuse and possible Hepatitis C. The medication that they are currently taking, Flagyl and Metronidazole, are antibiotic that is used to treat bacterial infections. However, it can also cause nausea, vomiting, and diarrhea as side effects. The other medications that the patient is taking, such as Synthroid, nifedipine, and prednisone, are not likely to be the cause of the symptoms. However, they may be contributing to the severity of the symptoms.

The recommended drug therapy plan is likely to help the patient with their symptoms. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. However, it can also be effective in treating nausea and vomiting caused by other conditions, such as drug abuse. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool. This can help to reduce the severity of diarrhea.

References

Egerton-Warburton, D., Meek, R., Mee, M. J., & Braitberg, G. (2014). Antiemetic use for nausea and vomiting in adult emergency department patients: randomized controlled trial comparing ondansetron, metoclopramide, and placebo.  Annals of emergency medicine,  64(5), 526-532.

De, A., Rajagopalan, M., Sarda, A., Das, S., & Biswas, P. (2018). Drug reaction with eosinophilia and systemic symptoms: an update and review of recent literature.  Indian journal of dermatology,  63(1), 30.

Andreyev, H. J. N., Davidson, S. E., Gillespie, C., Allum, W. H., & Swarbrick, E. (2012). Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer.  Gut,  61(2), 179-192.

Leung, A. K., Leung, A. A., Wong, A. H., & Hon, K. L. (2019). Travelers' diarrhea: a clinical review.  Recent patents on inflammation & allergy drug discovery,  13(1), 38-48.