Diagnosis and Rationale
In accordance with the symptoms, the patient can probably be diagnosed with Opiate withdrawal. In addition, HL has hepatitis C. The reasoning for the opiate withdrawal syndrome diagnosis stems from a variety of factors. Firstly, the symptoms identified in the subject are listed among ones found in opioid addicts undergoing a withdrawal stage. Nausea, vomiting, abdominal pain, and diarrhea are common in such patients (Stotts, Dodrill, & Kosten, 2009). Secondly, the patient has a history of addiction to drugs, which is one of the primary factors to consider when diagnosing a patient. Dependence is highly difficult to treat completely, especially in cases of prolonged abuse. Arcangelo, Peterson, Wilbur, and Reinhold (2017) also list drug withdrawal as the common etiology of nausea and vomiting. Chemoreceptor trigger zones such as opiate receptors not being stimulated by the drug can cause contractions of abdominal muscles and, therefore, bowel movement (Arcangelo et al., 2017). Another rationale for opiate withdrawal as a diagnosis can be the prescription of Nifedipine. The medication is commonly prescribed to reduce chest pain and relieve hypertension that is also a side effect of opiate withdrawal (Stotts et al., 2009; Arcangelo et al., 2017).
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Hepatitis C is typical comorbidity in patients that use or have a history of using drugs. Environmental factors such as drug sharing or passing needles for injections are a common cause of developing hepatitis C. Given the patient’s history of drug abuse, it is highly probable that such practices were used. The symptoms also became the indicator that led to such a diagnosis. Despite the fact that many patients with hepatitis C experience no symptoms, certain adversities such as nausea and stomach pain can still be observed (Pastore et al., 2016). In addition to that, the patient has been prescribed Synthroid. The drug has a generic name of levothyroxine that is often used to treat thyroid issues and immune system disorders (Arcangelo et al., 2017). Hepatitis C is commonly known to reduce the body’s ability to defend against viruses and infections by inflicting damage to the thyroid (Pastore et al., 2016). The named symptoms manifested in the patient can also be attributed to the side effects of the medication he or she is currently prescribed. For instance, Nifedipine is documented to produce nausea and vomiting in more than 10 percent of cases (“Nifedipine side effects,” 2015).
Appropriate Drug Therapy
The goals of the drug therapy are to relieve the patient from the feeling of nausea, prevent vomiting and decrease the number and volume of bowel movements while hardening their consistency. The second goal is to tailor medications to the patient’s diagnosed conditions and disorders so as to minimize adverse side effects and ensure the absence of adverse drug interaction. As a first-line treatment against the above-mentioned symptoms, phenothiazines can be used (Arcangelo et al., 2017). This option is considered viable for long-term treatment of the named symptoms and has no known interactions with prescribed medications. In particular, Fluphenazine can be considered. As an additional factor that can influence the prescription decision one can notice its relative inexpensiveness (Arcangelo et al., 2017). Given the amount and cost of other drugs, Fluphenazine could be a viable option. Fluphenazine is taken orally or administered intramuscularly as symptoms emerge. Second and further admissions should be made within 4-6 hours if needed. The dosage is 0.5–5 milligrams daily.
It is noteworthy to mention that Fluphenazine is used as a monotherapy, which means that no other drugs of the same action are necessary. As for contraindications, the aforementioned drug is advised against provided the patient has Parkinson’s or takes sedatives. Therefore, the patient must be consulted and any other drugs he or she uses need to be examined. Alcohol intake is also not advised while undergoing treatment with Fluphenazine.
Antihistamine– anticholinergic drugs can be used as a second-line treatment option. Dimenhydrinate is a relatively accessible and valid choice within this group of drugs. Despite the fact that they are often used as agents to cure motion sickness, their mechanism of action that interrupts visceral afferent pathways is reported to be rather effective against both mild and severe cases of nausea and vomiting. The drug’s daily dosage is 50-100 milligrams (Arcangelo et al., 2017). It is administered orally at the first arrival of symptoms and retaken if needed in 4 to 6 hours. A dosage of 200 milligrams could inflict serious damage to the body.
As for diarrhea management, a typical solution for a variety of causes is loperamide. The patient’s case of diarrhea is likely to be withdrawal syndrome-induced. Given that, infectious diarrhea that is known to be exacerbated by antimotility agents is highly unlikely. Other than that, the drug does not have any known interactions with the Synthroid, Nifedipine, and prednisone. It can also be used in conjunction with Fluphenazine (“Fluphenazine drug interactions,” 2015). Loperamide is administered orally in dosages no more than 2.5-5 milligrams as dictated by the onset of symptoms (Arcangelo et al., 2017).
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
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Pastore, F., Martocchia, A., Stefanelli, M., Prunas, P., Giordano, S., Toussan, L.,… Falaschi, P. (2016). Hepatitis C virus infection and thyroid autoimmune disorders: A model of interactions between the host and the environment. World Journal of Hepatology, 8(2), 83.
Stotts, A., Dodrill, C., & Kosten, T. (2009). Opioid dependence treatment: Options in pharmacotherapy. Expert Opinion on Pharmacotherapy, 10(11), 1727-1740. Web.