Week 4 Pharmacotherapy Research

Pharmacotherapy in Gastrointestinal Disorders

According to Wurcel et al. (2015), persons who have been using illicit drugs are at risk of developing gastroenteritis syndrome which is non-infectious. The condition is caused by withdrawal from opiates as well as chronic use of cannabis. The latter causes what is referred to as hyperemesis syndrome. Given the drug use history of patient HL, therefore, the most likely diagnosis in this case would be Gastroenteritis and Hyperemesis Syndrome secondary to drug use (Wurcel et al., 2015). But the patient is also taking the hypothyroidism medication levothyroxine sodium (Synthroid), which is known to cause the side effects of nausea, vomiting, and diarrhea. For this reason, the differential diagnosis for patient HL would be Levothyroxine Toxicity (Rosenthal & Burchum, 2018; Katzung, 2018; Acosta, 2013).  Week 4 Pharmacotherapy Research

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            Patient HL should first stop using non-prescription drugs and substances. The drug therapy plan for him would therefore be:

  • Reduce the Synthroid dose to 88 mcg q.d.
  • Continue with nifedipine 30 mg q.d. and prednisone 10 mg q.d.
  • Add loperamide (Imodium) 4 mg STAT then 2 mg PRN
  • Add ondansetron (Zofran) 8 mg b.i.d (Rosenthal & Burchum, 2018; Katzung, 2018; Acosta, 2013).

The justification or rationale for the recommendation of the above treatment plan is as follows. Since Synthroid may be the one causing the gastrointestinal symptoms as a side effect, reducing the dose may lower its toxicity. Nifedipine and prednisone are left to be continued as their usefulness (controlling hypertension and reducing inflammation) outweighs their risks (causing diarrhea and vomiting). To reduce and stop diarrhea, loperamide or Imodium is added to be used until the diarrhea stops. It reduces GI motility by changing the pattern of electrolyte and water movement in the GI tract. Ondansetron (Zofran) is added to stop the vomiting. It blocks serotonin release in the GI tract and hence stops it from causing nausea and vomiting. For instance, it is chosen instead of metoclopramide (Reglan) as the latter may cause an increase in the blood pressure; which patient HL appears to be suffering from already as he is on nifedipine (Rosenthal & Burchum, 2018; Katzung, 2018; Acosta, 2013).    Week 4 Pharmacotherapy Research

References

Acosta, R. (2013). Pharmacology for health professionals, 2nd ed. Wolters Kluwer Health | Lippincott Williams & Wilkins

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.

Wurcel, A.G., Merchant, E.A., Clark, R.P., & Stone, D.R. (2015). Emerging and underrecognized complications of illicit drug use. Clinical Infectious Diseases, 61(12), 1840–1849. http://dx.doi.org/10.1093/cid/civ689

Week 4 Pharmacotherapy Research