|Topic||Pharm week 6 Yadira response|
|Type||Discussion Board Post|
|Sources / references||2|
|Description / paper instructions
Discussion board response instructions:
In your discussion question response, provide a substantive response that illustrates a well-reasoned and thoughtful response; is factually correct with relevant scholarly citations, references, and examples; demonstrates a clear connection to the readings In your participation responses to your peers, comments must demonstrate thorough analysis of postings and extend meaningful discussion by building on previous postings. Please use course text and 2 other resources to support the response.
Course Text: · Woo, T. & Robinson, M. (2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with Davis Plus eResourses, 4th ed. F.A. Davis Company. ISBN: 978080363827
Original Discussion Question:
Mike is a 46-year-old who presents with a complaint of “heartburn” for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit.
What would you prescribe initially?
How long would you prescribe these medications?
What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
How would the treatment vary if the patient has GERD instead?
What would you prescribe initially?
Since Mike has a positive serum H.Pylori test, I would initially prescribe antibiotics and a proton pump inhibitor. I would use a triple therapy option which is
usually the first line of treatment (Woo & Robinson, 2016). The medications
include, a proton pump inhibitor; such as omeprazole 20 mg BID, and two antibiotics; clarithromycin 500 mg BID and amoxicillin 1 g BID. If the patient presented with an allergy to penicillin, then I would change amoxicillin to metronidazole 500 mg BID.
2.How long would you prescribe these medications?
I would prescribe these medications for 10 to 14 days. I would then have the patient continue to use a PPI for 8 to 12 weeks until healing is complete. If the patient is low risk then I would stop ongoing therapy, if they are at high risk, such as a smoker, or they have history of COPD, CAD, or bleeding or perforated ulcers; then I would consider chronic PPI therapy (Woo & Robinson, 2016).
3.What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
One of the common side effects with taking antibiotics is diarrhea. For this reason, I would prescribe a probiotic such as Lactobacillus. A probiotic is useful in regulating the gastrointestinal flora (Yu, Zhang, Ni, Chen, & Duan, 2019). This may be necessary as the gut flora can be disturbed with the use of antibiotics (Woo & Robinson, 2016). According to Yu et al. (2016), Lactobacillus supplementation to the triple therapy of H.Pylori notably improved the eradication efficacy.
4. How would the treatment vary if the patient has GERD instead?
The treatment would vary if the patient had GERD instead because it would not require the use of antibiotics. Treatment would include lifestyle modification, such as avoiding foods that cause GERD such as spicy, acidic, tomato-based or fatty foods, chocolate, peppermint, onions, citrus and limiting intake of coffee, tea, alcohol, or carbonated beverages. For medications I would consider prescribing him a PPI or
H2RA to reduce the acid secretions. I would also educate and recommend that he avoid laying down within 3 hours after eating, avoid exercise or strenuous activity after eating, lose weight if necessary, to maintain an appropriate body weight, and avoid eating anything within 3 hours of going to bed (Woo & Robinson, 2016).
Woo, T. M., & Robinson, M. V. (2016). Pharmacotherapeutics for advance practice nurse prescribers (4th ed.). Philadelphia, PA: F.A. Davis Company.
Yu, M., Zhang, R., Ni, P., Chen, S., & Duan, G. (2019). Efficacy of Lactobacillus-supplemented triple therapy for H. pylori eradication: A meta-analysis of randomized controlled trials. PLoS ONE, 14(10), 1–16. https://doi-org.southuniversity.libproxy.edmc.edu/10.1371/journal.pone.0223309