Case Study: 42-Year-Old Female with Bloating, Fullness and Acid Reflux

HM is a 42-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night

SCENARIO 4

HM is a 42 year-year-old female seeking evaluation for feelings of fullness, bloating and acid reflux with symptoms worse at night. HM eats fast food once a day and consumes 2 cups of coffee a day. She drinks alcohol socially on weekends. PMH includes asthma, diabetes and hypertension. Her blood pressure today is 142/85. Current medications include prn famotidine, prn albuterol, Pulmicort Flexhaler 90 mcg 2 inhalations twice daily, cetirizine 10 mg daily, bisoprolol 5 mg po daily and metformin 1000 mg po daily with food. How would you improve her drug therapy plan? What changes would you make (include complete medication orders)? What information would you provide to the patient at her visit? Can a patient take a H2 blocker and PPI at the same time? NURS 6521 Week 4 Assignment pharmacology concepts to the gastrointestinal and hepatobiliary systems

SCENARIO 4

HM has signs consistent with a serious condition known as gastroesophageal reflux disease (GERD). To obtain the best treatment outcomes, going from H2 blockers to PPI is possible because the latter includes more effective acid inhibition agents (Scarpignato et al., 2020). Change in behavior is also important; this also reveals another aspect that is important in the management of the symptoms.

For medication changes, medication includes Pantoprazole 40 mg for a daily dose in case of a GERD treatment plan. The current use of famotidine will be stopped so that unnecessary combination of drugs is not encouraged (Scarpignato et al., 2020). Pantoprazole has been recommended in a pack of 30 tablets to be taken orally, one tablet daily before breakfast, with three refill packs.

Patient education emphasizes that, for the best effect, pantoprazole must be taken 30 min before meals. It is therefore important that diets taken should be Governments, and ADDS should advise that the consumption of caffeine, alcohol, and fast foods be minimized. Lifestyle measures include weight loss and head-of-the-bed elevation during sleep (Savarino et al., 2021).

Evaluation of monitored aspects includes evaluating symptom relief after 4 to 6 weeks of therapy. Also, evaluating the risks related to PPIs for long-term usage include osteoporosis (Mukhtar et al., 2022). Patients who continue having their symptoms or experience certain alert signs like weight loss or difficulty swallowing may require endoscopy.

Owing to the fact that H2 blockers and PPIs have similar methods of action, there is usually no need for the two medications to be used at the same time. PPIs have a better efficacy profile in terms of symptom relief and mucosal healing (Mukhtar et al., 2022)

References

Mukhtar, M., Alzubaidee, M. J., Dwarampudi, R. S., Mathew, S., Bichenapally, S., Khachatryan, V., … & Khan, S. (2022). Role of non-pharmacological interventions and weight loss in the management of gastroesophageal reflux disease in obese individuals: a systematic review. Cureus , 14 (8).

Savarino, V., Marabotto, E., Zentilin, P., Demarzo, M. G., de Bortoli, N., & Savarino, E. (2021). Pharmacological management of gastro-esophageal reflux disease: an update of the state-of-the-art. Drug design, development and therapy , 1609-1621.

Scarpignato, C., Sloan, J. A., Wang, D. H., & Hunt, R. H. (2020). Gastrointestinal pharmacology: practical tips for the esophagologist. Annals of the New York Academy of Sciences , 1481 (1), 90-107.