23 Mar Apply pharmacology concepts to the gastrointestinal and hepatobiliary systems

Symptoms of various gastrointestinal (GI) and hepatobiliary disorders often overlap, making diagnosis and treatment challenging. For example, symptoms such as nausea, vomiting, constipation, and diarrhea are non-specific and could also be the result of underlying medical history or current prescription drug use. As an advanced practice nurse, you could be potentially responsible for providing care to a patient who may present with non-specific symptoms related to the gastrointestinal and hepatobiliary systems.

When selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (ie diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

Learning Resources: Please plan accordingly throughout the week to review all learning resources that include but not limited to the lecturio resources and all required reading. There is much information provided but all is relevant that you will need not only for the successful completion of this course but also as you begin your practice as a Nurse Practitioner. As well, there are many required media videos for you to view this week and they are very informative.

Week 4 Assignment: Please use the following Case Studies to complete your Assignment for this week that is Due by Day 7.

To Prepare:

· Review the following case studies and answer ALL questions.

· When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.

· Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.

· Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

· Review the information provided and answer questions posed in the case study

· When recommending a medication, write out a complete prescription for the medication

· Whenever possible, use clinical practice guidelines in developing your answers when possible

· Include at least three references to support your answer and cite them in APA format.

Required resources to look into:

· Rosenthal, L. D., & Burchum, J. R. (2025) . Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (3rd ed.). Elsevier.

· Chapter 66, “Drugs for Peptic Ulcer Disease” (pp. 584–593)

· Chapter 67, “Laxatives” (pp. 593–600)

· Chapter 68, “Other Gastrointestinal Drugs” (pp. 600–610)

· Chapter 70, “Drugs for Obesity” (pp. 620–628)

SCENARIO 1

What are the errors in the following prescriptions (1 per prescription)? Rewrite each prescription correctly. What is each medication’s classification and mechanism of action (MOA)?

· levothyroxine 88 mg PO daily #30 1 RF

· montelukast 10 mg chewable tablet PO qHS #90 0 RF

· memantine/donepezil (Sinemet) 28/10 mg PO once daily #30 1 RF

· tiotropium (Spiriva) 2.5 mcg PO once daily #60 3 RF

· Qulipta 60 mg PO PRN for migraine #30 1 RF

SCENARIO 2

FT, a 35-year-old male, is at a follow up visit with normal blood work but blood pressure readings of 143/89 and 144/94. He is on propranolol 40 mg po BID; budesonide-formoterol (Symbicort) 160/4.5 mcg per inhalation, 1 inhalation as needed for symptoms; semaglutide 0.5 mg SC once weekly; and herbal supplement yohimbine. How would you treat this patient? Include a complete medication order. How would you improve his medication therapy plan and what education would you provide? What is goal blood pressure for FT?

SCENARIO 3

AY is a 14-year-old female (weight 46 kg) who experiences brief staring episodes lasting 10-12 seconds, occurring multiple times per day. Current medication includes budesonide-formoterol (Symbicort) 160/4.5 mcg per inhalation 1 inhalation BID for maintenance plus 1 inhalation PRN. She has been diagnosed with moderate persistent asthma that is well controlled with no recent exacerbations and typical absence seizures. As her provider, your task is to initiate pharmacologic therapy.

Which of the following would you prescribe? WHY? Briefly explain why the other options are less appropriate.

· albuterol MDI 2 puffs every 4-6 hours PRN

· budesonide-formoterol 160/4.5 mcg, 2 inhalations BID

· carbamazepine 200 mg PO BID

· ethosuximide 500 mg PO daily

· gabapentin 300 mg PO TID

· lamotrigine 25 mg PO daily

· levetiracetam 250 mg PO BID

· valproic acid 250 mg PO BID

What is the classification and MOA of the drug you selected? What education would you provide and how would you monitor the effectiveness of the treatment plan?

SCENARIO 4

GC is a 68-year-old male with poorly controlled type 2 diabetes and exhibits challenges with adherence. Current medications include donepezil 5 mg po qhs and losartan 50 mg po daily. His lab work today includes: BG 320 mg/dL, A1C 10.5%, K⁺ 4.3, Cr 1.8, eGRF 27, BP 126/78.

Which of the following would you prescribe? WHY? Briefly explain why the other options are less appropriate.

· acarbose 25 mg PO TID with meals

· empagliflozin (Jardiance) 10 mg PO daily

· exenatide (Byetta) 5 mcg SC twice daily

· glyburide 2.5 mg PO daily

· insulin glargine (Lantus) 10 units SC nightly

· metformin 500 mg PO daily

· semaglutide (Ozempic) 0.25 mg SC once weekly

· sitagliptin (Januvia) 50 mg PO daily

What is the classification and MOA of the drug you selected? What education would you provide and how would you monitor the effectiveness of the treatment plan? What is his goal A1C, BG and BP?