Week 4 Discussion: Gastrointestinal and Hepatobiliary System

Discussion Topic: Week 4 – Gastrointestinal and Hepatobiliary SystemWelcome to Week 4 – Gastrointestinal and Hepatobiliary System

This week we will 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.

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.

SCENARIO 1

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

Ubrelvy 200 mg PO at onset of migraine #30 0 RF
memantine/donepezil (Sinemet) 7/10 mg po once daily #30 1 RF
Stalevo 200 mg po TID #90 2 RF
levothyroxine 137 mg PO daily #30 3 RF
omeprazole (Protonix) 40 mg PO daily before breakfast #30 3 RF

SCENARIO 2

AL a 46-year-old female presents to clinic with chief complaint, “I get short of breath and wheeze almost every night. I also have a cough that wakes me up 2-3 times a week.” Her symptoms have been present almost 3 months. She has no prior hospitalizations or ED visits; no smoking history and no significant occupational exposures. She takes cetirizine for seasonal allergic rhinitis. NKDA. CBC normal, BP 114/68, HR 88, RR 18, SpO₂: 97%, spirometry: FEV₁ 70% predicted, FEV₁/FVC 0.65, reversibility testing: FEV₁ improves by 15% after albuterol inhalation, Peak Expiratory Flow (PEF): 65% of personal best. What is your diagnosis and treatment plan? How would you monitor treatment and what patient education would you provide?

SCENARIO 3

LV is a 9-year-old female that experiences brief staring episodes lasting ~10 seconds, occurring multiple times per day. Otherwise healthy, NKDA. Normal CBC, CMP, LFTs. She has been diagnosed with typical absence seizures. As her provider, your task is to initiate pharmacologic therapy. Write a complete medication order for LV, include monitoring parameters and patient/caregiver education points relevant to the medication and seizure management.

SCENARIO 4

TY is a 65-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 190 mg/dL, A1C 8.5%, K⁺ 4.1, Cr 1.9, eGRF 26, BP 125/76.

Which of the following would you prescribe:

canagliflozin (Invokana) 100 mg PO daily
exenatide (Byetta) 5 mcg SC twice daily
glimepiride 1 mg PO daily
glyburide 2.5 mg PO daily
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 and blood pressure?

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Tutor’s Step-by-Step Guide for This Discussion

Step 1: Identify the System and Disorder

GI, hepatobiliary, endocrine, or neurologic
Match symptoms with diagnostic criteria

Step 2: Use Clinical Guidelines

GINA (Asthma)
ADA (Diabetes)
AAN (Seizures)

Step 3: Write COMPLETE Prescriptions

Always include:

Drug name
Dose
Route
Frequency
Dispense amount
Refills
Instructions

Step 4: Justify Drug Selection

Renal/hepatic function
Age
Adherence
Safety

Step 5: Include Monitoring and Education

Faculty expect:

Labs
Follow-up timelines
Patient teaching

References (APA 7)

Global Initiative for Asthma. (2023). GINA asthma management guidelines.
American Diabetes Association. (2024). Standards of care in diabetes.
Lexicomp Online. (2024). Drug monographs.
Epilepsy Foundation. (2023). Absence seizure management.
Medscape. (2024). Pharmacology database.

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