Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders The patient mentioned in this week's case study has H.L., and the primary symptoms are nausea, vomiting, and diarrhea. The patient's prior medical history incorporates drug usage as well as a suspected Hepatitis C infection. H.L.'s present medication prescription consists of Nifedipine 30 mg twice daily, Synthroid 100 mcg every day, and Prednisone 10 mg twice daily. Patient Diagnosis and Rationale Definitive diagnosis is a difficult procedure, which must be carefully considered. Besides the patient's indicated prior medical record, among the current drugs H.L. is using, what worries me the most is the Prednisone 10 mg daily dose. Questions arise, such as why he is on prednisone. One other issue would be how long H.L. was on prednisone. Is the individual a cigarette or alcohol user? Corticosteroids have been studied in hepatitis patients. Corticosteroids have been used in various liver disorders, most often in autoimmune hepatitis. According to the National Institute of Diabetes and Digestive and Kidney Diseases (2014), they have been demonstrated to enhance results and preservation. The patient in the given scenario is more prone to have Hepatitis C since illegal drug addicts are deemed high risk (New York State Department of Health, 2011). According to Schellenberg et al. (2007), oral corticosteroids have more impacts on numerous cell types than inflammatory cells." While its wide impact is useful in reducing inflammation, it can also negatively impact other cells. According to Schellenberg et al. (2007), one of the side effects of oral corticosteroid treatment is immunosuppression, which allows viral diseases to thrive. A higher incidence of gastrointestinal bleeding and peptic ulcers is also reported by Schellenberg et al. While further data is required to confirm the diagnosis, the patient could have gastroenteritis. Based on the available data, the patient may have Helicobacter pylori
3 (H. pylori). Although one cannot tell how long H.L. has been on prednisone, the patient is in danger of immunosuppression. Percival and Suleman (2014) categorized Helicobacter pylori as an invasive bacterium, which plays a prominent part in the etiology of peptic ulcer disease. According to Perry et al. (2006), 50% of the world is estimated to be infected with H. pylori, and gastroenteritis is a prevalent domestic infection in the U. S. It has been found in vomitus and feces in fast gastrointestinal transit, according to Perry et al. (2006). These data suggest that gastroenteritis bouts allow H. pylori infection. Appropriate Drug Therapy Plan and Rationale Drug interactions must be monitored as an aspect of the therapy procedure. The American College of Gastroenterology advises a cocktail of up to three antibiotics plus an antisecretory drug (Proton Pump Inhibitor or Histamine 2 receptor antagonist) for eliminating Helicobacter pylori, according to Rosenthal and Burchum (2020). Clarithromycin with amoxicillin or nitroimidazole offers excellent and reliable eradication levels. Since the patient is taking nifedipine, an alternate therapy is required. Clarithromycin combines with nifedipine by inhibiting its metabolic route, isoenzyme CYP3A4, causing shock or cardiac blockage. They found that "azithromycin may be employed in H.P. elimination strategy, which has equal effectiveness to clarithromycin but is cheaper and has less adverse effects" (Khoshnood, 2014). In this situation, I will use the following therapy advice from Khoshnood, Hakimi, Salman-Roghani, and Reza Mirjalili (2014): Azithromycin 250 mg, one pill every day for ten days. Amoxicillin 1 g, two times a day for ten days. Omeprazole 20 mg, twice daily for ten days
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