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 week’s patient has some rather non-specific GI complaints. One potential intervention is the prescription or recommendation of an agent to treat diarrhea. While many anti-diarrheal agents are available over-the-counter, it does not mean that they can be used indiscriminately. If anti-motility agents are used in patients with bloody diarrhea, complications may result. Additionally, in 2016, the FDA issued an alert regarding cardiac arrest and syncope associated with the commonly used anti-motility agent, loperamide. Interestingly, these events were most commonly noted in patients who were abusing loperamide, sometimes to self-treat for opioid withdrawal (FDA, 2016). So, while loperamide is an effective antidiarrhealagent, it must be taken according to directions.
FDA. (2016). FDA warns about serious heart problems with high doses of the antidiarrheal medicine loperamide (Imodium), including from abuse and misuse. Retrieved fromhttps://www.fda.gov/downloads/Drugs/DrugSafety/UCM505108.pdf
The patient in this case has a history of drug abuse and possible hepatitis C.The treatment of hepatitis C has advanced significantly over the past decade and it is now considered a curable condition for many patients.With that said,there are many considerations and barriers to therapy.
1.A definitive diagnosis withgenotypingmust be completed. The type of therapy will varybased on the viral genotype that is identified.
2. The level of liver fibrosis, compensation, and other patient specific factors must be assessed.
3. Many hepatitisC therapies cost $60,000-115,000 per course of therapy. While medical assistance programs do exist, this cost can still be a significantburden that requires discussion and careful planning.
The reference below contains additional details explaining some of the costs and considerations with newer hepatitis C therapies.
Kish, T.,Aziz, A., &Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies.P & T : a peer-reviewed journal forformularymanagement,42(5), 316–329.
Write a 1-page paper that addresses the following:
- 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.
Expert Solution Preview
Patient HL presents with symptoms of nausea, vomiting, and diarrhea. The patient has a history of drug abuse and potential Hepatitis C, and is currently taking Synthroid, Nifedipine, and Prednisone. A thorough diagnosis and appropriate drug therapy plan will be proposed for this patient.
Based on the patient’s symptoms and medical history, the most probable diagnosis is acute gastroenteritis. The patient exhibits classic symptoms of gastroenteritis, including nausea, vomiting, and diarrhea. In addition, the patient’s history of drug abuse and potential Hepatitis C can cause gastrointestinal symptoms. A laboratory test for gastroenteritis can help confirm the diagnosis.
Drug Therapy Plan:
The appropriate drug therapy plan for the patient is the use of oral rehydration therapy and symptomatic treatment. Anti-motility agents such as loperamide should be avoided as the patient has potential Hepatitis C and drug abuse history. The use of anti-motility agents in patients with bloody diarrhea can lead to complications. Furthermore, loperamide has been associated with cardiac arrest and syncope, especially in patients who misuse or abuse the drug. Therefore, the patient should use oral rehydration therapy to replace fluids and electrolytes lost through diarrhea and vomiting.
Oral rehydration therapy is recommended because it is a safe and effective way of treating gastroenteritis. It is also known to be useful in treating dehydration associated with diarrhea and vomiting. In patients with drug abuse and potential Hepatitis C, selecting a safe treatment option is crucial. Therefore, avoiding anti-motility agents like loperamide is vital as it can cause life-threatening complications. Symptomatic treatment can help relieve nausea, vomiting, and diarrhea symptoms. Thus, a comprehensive drug therapy plan that includes oral rehydration therapy and symptomatic treatment is justified for this patient.
In conclusion, Patient HL has symptoms that suggest acute gastroenteritis. An appropriate drug therapy plan for this patient is oral rehydration therapy and symptomatic treatment. Oral rehydration therapy is safe, well-tolerated, and effective in treating dehydration associated with diarrhea and vomiting. Symptomatic treatment can help relieve the symptoms of nausea, vomiting, and diarrhea. This treatment plan is justified as it is safe and effective for the patient, considering their history of drug abuse and potential Hepatitis C.
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