Ulcerative colitis – Advanced Pharmacology week 7 response 2
Type of document Essay
1 Page
Subject area Pharmacology
Academic Level Master
Style APA
Number of references 4
Order description:
Please respond to Loris post in one of the following ways Provide alternative recommendations for drug treatments.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research and make sure to offer drug alternatives use the readings and resources as references or i dont get credit
Loris post
1 day ago Lori Woolley
Main Post Ulcerative colitis
COLLAPSE
Main Question Post Week 7 Pharmacology
Case Study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
My first thought for this patient would be a simple stomach flu or drug withdrawal. The patient has a history of drug abuse and withdrawal fits the symptoms displayed. After I rule the flu and drug withdrawal out, I would look at why the patient is prescribed Prednisone. This would lead me to think about an inflammatory bowel disease such as Crohn’s disease or Ulcerative colitis.
Ulcerative Colitis
Ulcerative colitis (UC) is one of two inflammatory conditions of the gastrointestinal tract. Inflammatory bowel diseases are a term used for a chronic inflammatory condition like UC or Crohn’s disease (Arcangelo, Peterson, Wilbur & Reinhold, 2016). UC causes inflammation to the lining of the colon and rectum. This develops over time with most people. Patient with UC present with diarrhea, abdominal pain and cramping, rectal bleeding, weight loss and fatigue. Symptoms vary depending on where the inflammation occurs in the large intestine (MayoClinic, 2018). The cause of UC is unknown but is common in the US, England, and northern Europe (Schoenfeld & WU, 2018).
I believe I would explore why the patient is on Prednisone and at a low dose. My first thought would be a maintenance dose for inflammation. The patient has a drug abuse problem, and possible Hepatitis C so one would think possible Cirrhosis of the liver, but that would be a later diagnosis, and patient is not showing any jaundice or other symptoms so far. The patient is taking Synthroid to treat hypothyroidism or possible prevention of a goiter, the case study does not elaborate on that. The patient is also on Nifedipine which is a calcium channel blocker which relaxes the blood vessels, and muscle of the heart. This is used to treat hypertension, and angina (Drugs.com, 2018). The patient is also taking Prednisone which is a corticosteroid that is and anti-inflammatory, and an immunosuppressant medication that is often used to treat UC.
As a practitioner I would take a stool specimen and CBC to look for an elevation of white blood cell count for a reflection of ongoing inflammation associated with any infections including UC. I would also take kidney and liver function tests, and check for iron deficiency as well. A colonoscope would also be needed to look at the large intestine and determine the extent of the damage. A biopsy can be taken to determine severity (Schoenfeld & WU, 2018). I would also pay attention to vital signs, any weight loss and a thorough abdominal exam. To begin a drug therapy depends on the severity of the disease thus far. The goal of treatment is to focus on the symptoms and try to treat effectively to maintain a productive quality of life (Arcangelo, Peterson, Wilbur & Reinhold, 2016). Schoenfeld & Wu (2018) posits that the goal of treatment “with medication are too induce remission, maintain remission, minimize side effects of treatment, improve quality of life and minimize risk of cancer” (p.5). The medication treatment includes Aminosalicylates, Corticosteroids, Immunosuppressive, Antibiotics, tumor necrosis factor inhibits and selective adhesion molecule inhibitors (Arcangelo, Peterson, Wilbur & Reinhold, 2016). I would prescribe an increased dose of corticosteroid such as Prednisone to reduce inflammation, an anti-diarrheal medication such as Imodium and a possible iron supplement if labs show an iron deficiency. Based on the limited information, I would start the patient out slow and increase medications as I receive results from labs and diagnostics. Patient does not present with a fever so I would not likely prescribe an antibiotic.
Prednisone 40 mg daily
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Phenergan 12.5 mg Q6 hrs PO PRN
Immodium 4 mg PRN PO (two capsules) followed by 2 mg (one capsule) after each unformed stool until diarrhea is controlled. Not to exceed 3 times in 24 hrs.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Drugs.com. (2018, March). Nifedipine. Retrieved from https://www.drugs.com/nifedipine.html
Mayo Clinic. (2018, March). Ulcerative colitis. Retrieved from https://www.mayoclinic.org/diseases-conditions/ulcerative-colitis/symptoms-causes
Schoenfeld, A., Wu, G. Y. (2018). Ulcerative colitis. Retrieved from https://www.medicinenet.com/ulcerative_colitis/article.htm
Resources to use and readings
Learning Resources
This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.
Required Readings
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 28, “Nausea and Vomiting” (pp. 429-446)
This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.
Chapter 29, “Gastroesophageal Reflux Disease and Peptic Ulcer Disease” (pp. 447-462)
his chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations.
Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp.465-494)
This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.
Chapter 31, “Inflammatory Bowel Disease” (pp. 497-515)
This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.
Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359.
Note: Retrieved from the Walden Library databases.
This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.
Drugs.com. (2012). Retrieved from http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Required Media
Laureate Education, Inc. (Executive Producer). (2012). Pharmacology for the gastrointestinal system. Baltimore, MD: Author.
This media presentation outlines drug treatment options for disorders of the gastrointestinal system.
Note: The approximate length of this media piece is 2 minutes.
