Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed

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

This is a case study you do in a Grand Rounds (advanced clinician level brainstorming) style with the ‘Pharmacological Plan’ as the major part of your discussion.

Instructor/Facilitator help/suggestions:

1. Include three differential diagnoses. Do not just say “Symptoms are vague, no diagnoses possible, I will just do further assessment.” Subjective & Objective information are intentionally provided vague (as a clinical case) so that you can develop a couple of pharmacological cases & discuss.

3 DIAGNOSIS- GASTRITIS, DRUG WITHDRAWAL, ALCOHOL WITHDRAWAL,

2. Briefly address how you will pharmacologically treat the three diagnoses you listed (Pharmacological Plan).

-loperamide to arrest the diarrhea.

-phenothiazines such as promethazine. Promethazine can be given in 12.5- 25mgs every four to six hours as needed

-ZOFRAN

-compazine

-ATIVAN if he is having these symptoms due to alcohol withdrawal

0.9% NS fluids

synthroid should be monitored for adverse effects and dose adjusted accordingly to avoid further liver insult.

For example, antacid, H2 blocker, or proton pump inhibitor all three are an

acid reduction with proton pump inhibitor being the most potent one. For this patient, I

would recommend taking an antacid because the is no side effects of diarrhea. H2 receptor

antagonists and proton pump inhibitor both have side effects of diarrhea and HL is already

experiencing diarrhea. For HL nausea and vomiting will prescribe Compazine 5mg every 4-

6hrs. alternatively, Phenergan 12.5 mg very 4-6hrs.

3. Include why patient is on Synthroid, Nifedipine, a peripheral calcium channel blocker & prednisone an anti-inflammatory immunosuppressive agent (pharmacological information needed) and why patient was on these drugs, discussion based on your objective & assessment. Briefly state the mechanism of action of these agents.

4. Long discussions/stories of no relevance to advanced practice pharmacology will carry no value with this project.

5. Include NEWER AGENTS of cure for hepatitis C infection. Spell out the drug names. Discuss how these NEWER hepatitis C drugs of CURE work. 

• Elbasvir/Grazoprevir (Zepatier)

• Glecaprevir/Pibrentasvir (Mavyret)

• Sofosbuvir/Ledipasvir (Harvoni)

• Sofosbuvir/Velpatasvir (Epclusa)

6. Include peer reviewed, scholarly articles of past 4 years as reference. 

7. Make it a Point you have Clinician Level Pharmacology in focus.

Best, Dr. P

 Explain your diagnosis for the patient, including your rationale for the diagnosis.

• Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

• Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Please make you writing short and sweet- to the point. It is not to be lengthy. I do not want a starting paragraph restating the focus of the paper is to… that is not master’s degree work. 

EXAMPLES OF RESPONSES- example only. This example is not pharmacology focused

DIAGNOSIS WILL BE GASTROENTERITITS

There are many causes of nausea and vomiting, most commonly these symptoms are caused by ingestion of substances or drugs, gastrointestinal disorders or metabolic disorders (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In this particular case study it is important to take into consideration the factors that could be contributing to the nausea, vomiting and diarrhea in patient HL. The patient has a history of drug abuse. With that being said, drug withdraw can be a factor in the cause of nausea, vomiting and diarrhea. Treatment for this type of cause would be dependent on what type of drug that patient was withdrawing from. The next factor would be medications the patient is currently taking. All three of these medications have nausea and vomiting as potential side effects. If this is the cause of the patient’s chief complaint, changing the medications could be an appropriate response. The last consideration would be the patient’s diagnosis of possible Hepatitis C. The most common symptoms of Hepatitis C include nausea, vomiting, and diarrhea (Franciscus, 2015). It would be hard to diagnosis the cause of this episode of nausea vomiting without other information such as aggravating and relieving factors, how long these symptoms have been occurring and if any other symptoms are associated with these. First line treatment of nausea and vomiting include phenothiazines such as promethazine. Promethazine can be given in 12.5- 25mgs every four to six hours as needed. Contraindications include hypersensitivity, seizure disorders and Parkinson’s disease. Adverse effects include sedation, agitation, dry mouth and blurred vision (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Second line therapy would be to add an antihistamine or anticholinergic such as diphenhydramine. This medication is dosed from 25-50mg every six to eight hours as needed. Adverse effects include drowsiness, confusion and dry mouth. Contraindications include asthma, hypersensitivity and narrow-angle glaucoma (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). If this persists the patient needs to reevaluate for other causes. 

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