HL has a history of drug abuse and possible Hepatitis C. Hepatitis C would be a likely diagnosis considering that today, most people become infected with HCV by sharing needles or other equipment to inject drugs (American Liver Foundation, 2017). Hepatitis C is a viral infection spread by contact with contaminated blood. The virus attacks the liver causing inflammation and in some cases, serious liver damage. Many individuals have no symptoms and do not know they are infected. Symptoms include fatigue, anorexia, malaise, nausea, vomiting, headaches, hyperalgia, cough, abdominal pain, jaundice, and low grade fever (Huether & McCance, 2017). After 20 to 30 years of hepatitis C infection, cirrhosis may occur (Mayo Clinic, n.d.). A blood test screening for Hepatitis C would need to be ordered. If the initial test is positive, additional tests would need to be conducted to determine the viral load and genotype. Treatment includes the use of direct-acting antiviral (DAA) agents, that work against specific targets of the HCV replication cycle to achieve 2 goals: block virus replication and induce progressive clearance of the virus through cellular death of infected cells (Horsley-Silva & Vargas, 2017). According to Horsley-Silva & Vargas (2017), once HCV infection is identified, appropriate treatment can be selected based upon genotype, clinical situation, contraindication, and drug-drug interactions. HL’s current medications include Synthroid 100mcg, Nifedipine 30mg daily, and prednisone 10mg daily. Nifedipine is a calcium channel blocker whose adverse effects include headaches, flushing, palpitations, mood changes, and gastrointestinal complaints. In patients with hepatic impairment (liver cirrhosis) nifedipine has a longer elimination half-life and higher bioavailability than in healthy volunteers (Adalat, 2010). If HL does have Hepatitis C or liver cirrhosis, dosage adjustments or an alternative therapy should be considered to avoid side effects of this medication. Prednisone is an oral corticosteroids which are ideal if being treated for illnesses requiring the medication to be administered at lose doses or for long term use. This medication can cause GI irritation and GI side effects. There is significant risk of GI toxicity. Taking this medication with food may reduce GI side effects. Synthroid is used for treating hypothyroidism. In addition to tremor, weight loss, head ache and insomnia, other side effects include nausea, vomiting, and diarrhea. The patient should have TSH levels drawn to evaluate whether or not dosage of Synthroid needs adjusted.
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- Summer '15
- Gastroenterology, Week 7 Discussion, Prednisone, Hepatology, Hepatitis C