Gastrointestinal and hepatobiliary disorders usually are related in their signs and manifestations in the human body, mainly due to their proximity and anatomical functions in absorption of lipids, biliary secretion, metabolism and excretion of wastes (Rosenthal. & Burchum, 2018). Any dysfunction in one system could adversely affect the other. Viral Hepatitis is the most common liver disease, affecting millions of Americans, it is estimated that 3.9 million Americans are infected with hepatitis C (Rosenthal. & Burchum, 2018) NURS 6521 Week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders. Health care professionals especially advanced practice Nurse Practitioners are expected to be proficient in treatment and management of these group of disorders.
A male patient presenting with nausea, vomiting and diarrhea with a medical history of drug abuse and hepatitis C, points to a possible diagnosis of viral gastroenteritis. Patient HL appears to have other chronic medical conditions, based on his medication list—Nifedipine 30mg orally daily is used for hypertension, Synthroid 100mg orally daily is used for hypothyroidism and prednisone 10mg orally daily for possible treatment of hepatitis C (Drugs.com, 2017). Hepatitis C is a chronic infection that may slowly progress causing liver damage, cancer and death. It is said to be the leading cause for most liver transplants (Rosenthal. & Burchum, 2018), mostly associated with alcoholics and drug users.
Diagnosis, Treatment and Rationale
The initial treatment of choice here, is to treat and control current signs and symptoms of nausea, vomiting and diarrhea. Complete history obtained, laboratory tests done—Complete blood count (CBC), Basic metabolic panel (BMP), and Thyroid-stimulating hormone (TSH). Stool culture to identify offending microbes. Blood cultures, urinalysis, urine culture and drug screen. Liver and kidney function tests are equally indicated for patients with history of drug abuse. Use of antiemetics medications—Serotonin antagonists like Ondansetron (Zofran) 4mg orally every 4 hours as needed for Nausea and vomiting. Use of Glucocorticoids (Dexamethasone) 10mg-20mg intravenously, then 4-8mg daily maintenance doses (Drugs.com, 2017., Rosenthal. & Burchum, 2018). Broad-spectrum antibiotics, fluid and electrolytes replacement. Health education on proper hand and food hygiene, health dangers of illicit drug use especially Hepatitis C and human immune deficiency disease (HIV). Treatment of hypertension with Nifedipine in addition with prednisone could be changed, as drug interaction exists with the two. Prednisone causes fluid retention and edema (Drugs.com, 2017).
Broad-spectrum antibiotics of choice for acute gastroenteritis is Metronidazole (Flagyl), usually 500mg intravenously twice daily, ciprofloxacin with infliximab is known to be effective too (Drugs.com, 2017). Loperamide (Imodium) 2-4mg is used to suppress bowel motility and fluid secretion into the intestinal lumen, hence less diarrhea. The use of Ledipasvir 90mg/Sofosbuvir 400mg daily for 6 weeks, for patients with acute hepatitis C virus of genotype 1 mono-infection (Martinello, Hajarizadeh, Grebely, Dore & Matthews, 2018).
Treatment Plan Reasons
The rationale behind the collection of stool, blood and urine sample before initiation of broad-spectrum antibiotics, is to identify and isolate the causative bacteria/viruses for therapeutic management. The use of Ondansetron (Zofran) for Nausea and vomiting is well tolerated by most patients, unlike promethazine (Phenergan), which is known to depress respiration and could cause local tissue injury if given intravenously (Rosenthal. & Burchum, 2018). Metoclopramide (Reglan) is another drug of choice for gastrointestinal discomfort (Drugs.com, 2017). Prednisone may reduce the effects of calcium-channel blocker- Nifedipine, by lowering the blood pressure further. In this case study, Nifedipine could be alternated with a betablocker like Metoprolol, as nifedipine will increase the effect of prednisone by altering the hepatic/intestinal enzyme—CYP3A4 metabolism. Prednisone use must be monitored for possible suppression of immune response. Ordering hepatis C RNA test and antibody test for HCV is to determine and isolate cause of intestinal symptoms.
Summary
Patients like HL, with history of hepatitis C needs health education on prevention of acute viral infections, healthy nutrition, to avoid drug abuse especially hepatotoxic medications like acetaminophen, limit alcohol and risky behaviors to limit spread of virus. NURS 6521 Week 4 Assignment: Pharmacotherapy for Gastroin
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