Week 7 Discussion Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders This week’s discussion involves a case study of patient HL that presents with the following symptoms of nausea, vomiting, and diarrhea. He has a past 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 The purpose of the discussion is to provide a diagnosis including the rationale and create a drug therapy plan appropriate for the patient’s history, diagnosis, and the current drug prescribed. Diagnosis: Acute Hepatitis C Hepatitis C is a blood-borne viral illness that affects approximately 2.4 million people in the United States alone (Centers for Disease Control and Prevention [CDC], n.d.). Individuals with who are injection drug users or have a history injection drug use are at a higher risk of acquiring HCV. Exposure through sexual transmission of an infected person, sharing contaminated items such as razors or toothbrushes, and unregulated tattooing, although infrequent can occur (CDC, n.d.). Although Hepatitis C may be eradicated without treatment, 75-85% of patients with the disease will develop chronic HCV infections that may develop cirrhosis, hepatocellular carcinoma, and hepatic decompensation (CDC, n.d.). Many times, individuals who have HCV will be asymptomatic, which causes the patient to go untreated leading to chronic HCV (Feld, Bisceglie, & Bloom, 2017). Signs and symptoms that can occur with acute HCV are fever, headache, malaise, anorexia, nausea, vomiting, diarrhea, and abdominal pain (CDC, n.d.). With the patient’s history of past drug abuse and possible HCV
diagnosis, along with the current symptoms HL is displaying, the diagnosis of acute hepatitis C is made. Drug Therapy Plan HL is currently taking Synthroid, nifedipine, and prednisone. Nifedipine and prednisone are both metabolized by the liver and should be used with caution in patients with liver disease due to enhanced drug effects (Drugs.com, 2018). Nifedipine (Procardia) is a calcium channel blocker that is used to treat hypertension and also has gastrointestinal side effects which can exacerbate the patient’s current symptoms (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Along with the potential for significant drug accumulation due to nifedipine being metabolized in the liver and the possible liver impairment of the patient, it will be removed from the current drug therapy and be replaced with lisinopril, an angiotensin-converting enzyme inhibitor (ACE).
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- Summer '15
- Arcangelo, Hepatitis C, nifedipine