Introduction Gastrointestinal (GI) and hepatobiliary disorders are common and can significantly impact the structure and function of the GI tract. These disorders often present with similar symptoms, making it challenging to identify the underlying cause. Advanced practice nurses play a crucial role in evaluating patients and prescribing appropriate pharmacotherapy to target the cause of these disorders rather than just managing the symptoms. This assignment focuses on designing an appropriate drug therapy plan for a patient presenting with symptoms of a possible GI/hepatobiliary disorder.
Case Study-D.C. is a 46-year-old female who presents with a 24-hour history of pain in the right upper quadrant (RUQ) of the abdomen. She reports that the pain started about an hour after a large dinner she had with her family. Additionally, she has experienced nausea and one episode of vomiting prior to presentation. D.C. has a past medical history (PMH) of hypertension, type II diabetes mellitus (DM), gout, deep vein thrombosis (DVT) caused by oral contraceptive pills (BCPs), and is currently taking multiple medications.
The initial assessment of the patient includes vital signs, which reveal a blood pressure of 136/82 mmHg, heart rate of 82 beats per minute, and a temperature of 98.8°F. D.C. has a body weight of 202 lbs and a height of 5’8″. Her notable laboratory results include a white blood cell count (WBC) of 13,000/mm3, total bilirubin level of 0.8 mg/dL, direct bilirubin level of 0.6 mg/dL, alkaline phosphatase (Alk Phos) level of 100 U/L, aspartate transaminase (AST) level of 45 U/L, and alanine transaminase (ALT) level of 30 U/L. She has documented allergies to latex, codeine, and amoxicillin. The physical examination reveals normal findings in the eyes, ears, nose, and throat (HENT), non-distended abdomen with minimal tenderness, warm and dry skin, and an alert and oriented neurological status with appropriate mood.
Drug Therapy Plan Based on the information provided in the case study, it is crucial to develop a drug therapy plan that targets the possible underlying cause of D.C.’s symptoms. The symptoms of RUQ pain, nausea, and vomiting suggest a possible hepatobiliary disorder, such as cholecystitis or cholelithiasis. However, further diagnostic tests are needed to confirm the diagnosis and guide treatment decisions.
D.C.’s PMH of hypertension and type II DM should be taken into consideration when selecting appropriate drug therapy options. It is essential to avoid medications that may worsen these chronic conditions or interact with her current medications. Additionally, her history of DVT related to oral contraceptive use should be considered when prescribing medications that may increase the risk of thromboembolic events.
Considering all these factors, the drug therapy plan for D.C. should include the following components:
1. Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain management in hepatobiliary disorders. However, NSAIDs should be used with caution in patients with hypertension and DM due to their potential adverse effects on blood pressure control and glycemic control. Therefore, an alternative analgesic, such as acetaminophen, may be a safer option for D.C. to manage her RUQ pain.
2. Nausea and vomiting: Antiemetic medications can help alleviate D.C.’s symptoms of nausea and vomiting. However, medication selection should be guided by her medical history. Antidopaminergic agents, such as metoclopramide, may be effective in relieving these symptoms and can be considered as a first-line treatment option. If D.C. has a history of extrapyramidal symptoms or is at risk of drug-drug interactions, alternative antiemetics such as ondansetron or promethazine can be considered.
3. Diagnostic workup: To confirm the diagnosis of a hepatobiliary disorder, further diagnostic tests should be performed. These may include laboratory tests, such as liver function tests (LFTs) and imaging studies, such as an abdominal ultrasound or computed tomography scan. Once the underlying cause is identified, appropriate targeted drug therapy can be initiated.
Conclusion In conclusion, the management of gastrointestinal and hepatobiliary disorders requires a careful evaluation of the patient’s symptoms, medical history, and individual factors. Advanced practice nurses play a crucial role in designing appropriate drug therapy plans that target the cause of these disorders. In the case of D.C., further diagnostic workup is needed to confirm the diagnosis, and medications should be selected with caution considering her comorbidities and medication history.