Sample Answer for NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Included After Question
Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.
For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
- Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
- Select one type of diabetes to focus on for this Discussion.
- Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
- Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.
BY DAY 3 OF WEEK 5
Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.
BY DAY 6 OF WEEK 5
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
A Sample Answer For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The World Health Organization defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces (American Diabetes Association, 2022 ). Insulin is a hormone that regulates blood glucose. The number of people being diagnosed with diabetes continues to raise as the Centers for Disease Control report released in 2018 showed that 7.3 million Americans, or 11.3% of the population. There are several types of diabetes with the most common including type 1 diabetes, type 2 diabetes, juvenile, and gestational diabetes. These types differ from each other significantly hence this makes it easy for physicians to make correct diagnoses.
Type 1 diabetes
Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in your pancreas that produce insulin. The damage is permanent. According to the ICD-10, Type 1 diabetes diagnostic criteria include unexplained weight loss, excessive production of urine, experiencing excess thirst, increased appetite, tiredness, and blurry vision as well as mood changes. If the condition is left untreated, it can lead to heart damage, kidney damage, eye damage, foot damage, nerve damage, and oral infections. According to American Diabetes Association, the American diagnostic criteria for type 1 diabetes includes a 2-hour plasma glucose level ≥200 mg/dL (11.1 mmol/L) or during a 75 oral glucose tolerance test (OGTT).
Type 2 diabetes
Type 2 diabetes starts out as insulin resistance. This means your body cannot use insulin efficiently, which causes your pancreas to produce more insulin until it cannot keep up with demand. Insulin production then decreases, which causes high blood sugar. The body is impaired in how it regulates insulin and in the long term, there is a higher presence of sugar in the bloodstream. The symptoms of type 2 diabetes are increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, unexplained weight loss, numbness or tingling in the hands, and areas of darkened skin, usually in the armpits and neck. If not treated it can lead to kidney damage, eye damage, hearing impairment, sleep apnea, and dementia (DeFronzo et al., 2015). Type 1 diabetes is characterized by the inability of the body to produce enough insulin, the type 2 diabetes is characterized by the inability of the body to utilize insulin hence having high sugar in the blood.
Gestational diabetes
This type of diabetes occurs during pregnancy when insulin-blocking hormones are produced. Gestational diabetes occurs only in people who have preexisting diabetes or have family members who have been diagnosed with the condition. It affects how cells utilize insulin leading to high levels of blood sugar. Pregnancy influences the body significantly and these changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin. Gestational diabetes can go unnoticed as it has limited symptoms only frequent urination and increased thirst. Lack of early intervention can lead to stillbirth, obesity, early term, excessive birth weight, and difficulties breathing.
These three types of diabetes differ significantly in that while type 1 diabetes is characterized by the inability of the body to produce enough insulin, type 2 diabetes is characterized by the inability of the body to utilize insulin hence having high sugar in the blood. The gestational occurs only in pregnant women unlike the other which can occur in anybody.
Selected: Type 2 diabetes treatment
Metformin is the most common type of drug administered to people with type 2 diabetes. The drug works by lowering the glucose level in the liver and improves the body’s sensitivity to insulin so that the body uses insulin more effectively (Foretz et al., 2019). This drug can come comes as a tablet, liquid, and an extended-release tablet which is prepared by obtaining a solution of metformin hydrochloride in water. The tablet is taken with a glass of water before meals. those taking the solution, have to prepare it by adding the extended tablet, they prepare it by measuring the oral liquid with a marked spoon oral syringe, or medicine cup and adding water to make a solution. The liquid is usually taken with meals one or two times a day and the regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. The drug is taken orally.
People diagnosed with type 2 diabetes and prescribed metformin, have to consider some diet patterns. When taking metformin, avoid alcohol since it affects the drug’s effectiveness. Avoid too many refined carbs, especially white bread, white rice, white pasta, candy, soda, desserts, and snacks like chips or crackers (Ley et al., 2014). There are some foods that a patient taking metformin can consider and they include healthy fats, fiber, lean proteins, vegetables, and complex carbs such as brown rice, whole-grain oats, and whole-grain
Short-term and Long effects of type 2 diabetes and metformin
The short-term effects of diabetes type 2 involve developing the complications of hypoglycemia which are low blood sugar and this is linked to some medications such as insulin or a sulfonylurea drug. Other complications involve hyperglycemia which is having too much glucose in the body. Besides, the long-term effects of diabetes include increased risk of developing heart disease, stroke, high blood pressure, narrowing of blood vessels (atherosclerosis), and nerve damage (neuropathy) in limbs.
Taking metformin for a long time can cause vitamin b12 deficiency, lactic acidosis, lower back pain, decreased appetite, difficulty sleeping, and diarrhea.
References
American Diabetes Association. (2022). Statistics About Diabetes. https://diabetes.org/about-us/statistics/about-diabetes
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., … & Weiss, R. (2015). Type 2 diabetes mellitus. Nature reviews Disease primers, 1(1), 1-22.
Foretz, M., Guigas, B., & Viollet, B. (2019). Understanding the glucoregulatory mechanisms of metformin in type 2 diabetes mellitus. Nature Reviews Endocrinology, 15(10), 569-589.
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007.
A Sample Answer 2 For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The scenario depicts patient HL presenting with nausea, vomiting, and diarrhea. HL has a history of drug abuse and possible Hepatitis C. The patient is currently on Synthroid 100 mcg, Nifedipine 30 mg, and Prednisone 10 mg. Therefore, this paper seeks to discuss the diagnosis and drug therapy for this patient.
Diagnosis
Hepatitis C Virus (HCV) infection is a likely diagnosis for this patient. Clinical manifestations include fatigue, fever, night sweats, chills, joint pain, muscle pain, pruritus, lymphadenopathy, and spider nevi (Moosavy et al., 2017). GI symptoms include appetite changes, nausea, abdominal pain, diarrhea, jaundice, and indigestion (Moosavy et al., 2017). Pertinent positive findings consistent with HCV infection include nausea, vomiting, and diarrhea. HCV infection can be attributed to the patient’s history of drug abuse and Hepatitis C (Hojati et al., 2018). However, the symptoms can be associated with the side effects of the medications. Nausea is a side effect of Nifedipine and Prednisone, while diarrhea is a side effect of Synthroid.
Drug Therapy
Drug therapy should eradicate HCV and prevent the progress of HCV infection to cirrhosis, hepatocellular carcinoma, or liver failure (Nardelli et al., 2017). The drug therapy for the HCV infection diagnosis is Sofosbuvir/Peginterferon/Ribavirin combination for 12 weeks (Chung et al., 2018). The combination has a high treatment response and is recommended for drug abusers because it decreases the risk of self-injection (Hojati et al., 2018). I would recommend the therapy since it has few side effects, which will promote compliance. In addition, I would reduce the dose of current medications, Nifedipine to 10 mg and Prednisone to 5 mg, to minimize the side effects.
Conclusion
The patient has a likely diagnosis of HCV infection based on symptoms of nausea, vomiting, and diarrhea and a history of drug abuse and Hepatitis C. Sofosbuvir/Peginterferon/Ribavirin combination for 12 weeks would be appropriate since it has a high response for drug abusers and has few side effects.
References
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A.I., Bhattacharya, D., Broder, T., Falade-Nwulia, O.O.,& Fontana, R. J. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases.
Hojati, S. A., Maserat, E., Ghorbani, M., Safarpour, A., & Fattehi, M. R. (2018). Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective? Medical archives (Sarajevo, Bosnia and Herzegovina), 72(5), 325–329. doi:10.5455/medarh.2018.72.325-329
Moosavy, S. H., Davoodian, P., Nazarnezhad, M. A., Nejatizaheh, A., Eftekhar, E., & Mahboobi, H. (2017). Epidemiology, transmission, diagnosis, and outcome of Hepatitis C virus infection. Electronic physician, 9(10), 5646–5656. https://doi.org/10.19082/5646
Nardelli, S., Riggio, O., Rosati, D., Gioia, S., Farcomeni, A., &Ridola, L. (2019). Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms. World Journal of Gastroenterology, 25(48), 6928.
A Sample Answer 3 For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The scenario depicts patient HL presenting with nausea, vomiting, and diarrhea. HL has a history of drug abuse and possible Hepatitis C. The patient is currently on Synthroid 100 mcg, Nifedipine 30 mg, and Prednisone 10 mg. Therefore, this paper seeks to discuss the diagnosis and drug therapy for this patient.
Diagnosis
Hepatitis C Virus (HCV) infection is a likely diagnosis for this patient. Clinical manifestations include fatigue, fever, night sweats, chills, joint pain, muscle pain, pruritus, lymphadenopathy, and spider nevi (Moosavy et al., 2017). GI symptoms include appetite changes, nausea, abdominal pain, diarrhea, jaundice, and indigestion (Moosavy et al., 2017). Pertinent positive findings consistent with HCV infection include nausea, vomiting, and diarrhea. HCV infection can be attributed to the patient’s history of drug abuse and Hepatitis C (Hojati et al., 2018). However, the symptoms can be associated with the side effects of the medications. Nausea is a side effect of Nifedipine and Prednisone, while diarrhea is a side effect of Synthroid.
Drug Therapy
Drug therapy should eradicate HCV and prevent the progress of HCV infection to cirrhosis, hepatocellular carcinoma, or liver failure (Nardelli et al., 2017). The drug therapy for the HCV infection diagnosis is Sofosbuvir/Peginterferon/Ribavirin combination for 12 weeks (Chung et al., 2018). The combination has a high treatment response and is recommended for drug abusers because it decreases the risk of self-injection (Hojati et al., 2018). I would recommend the therapy since it has few side effects, which will promote compliance. In addition, I would reduce the dose of current medications, Nifedipine to 10 mg and Prednisone to 5 mg, to minimize the side effects.
Conclusion
The patient has a likely diagnosis of HCV infection based on symptoms of nausea, vomiting, and diarrhea and a history of drug abuse and Hepatitis C. Sofosbuvir/Peginterferon/Ribavirin combination for 12 weeks would be appropriate since it has a high response for drug abusers and has few side effects.
References
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A.I., Bhattacharya, D., Broder, T., Falade-Nwulia, O.O.,& Fontana, R. J. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases.
Hojati, S. A., Maserat, E., Ghorbani, M., Safarpour, A., & Fattehi, M. R. (2018). Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective? Medical archives (Sarajevo, Bosnia and Herzegovina), 72(5), 325–329. doi:10.5455/medarh.2018.72.325-329
Moosavy, S. H., Davoodian, P., Nazarnezhad, M. A., Nejatizaheh, A., Eftekhar, E., & Mahboobi, H. (2017). Epidemiology, transmission, diagnosis, and outcome of Hepatitis C virus infection. Electronic physician, 9(10), 5646–5656. https://doi.org/10.19082/5646
Nardelli, S., Riggio, O., Rosati, D., Gioia, S., Farcomeni, A., &Ridola, L. (2019). Hepatitis C virus eradication with directly acting antivirals improves health-related quality of life and psychological symptoms. World Journal of Gastroenterology, 25(48), 6928.
A Sample Answer 5 For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
A brief explanation of types of Diabetes:
Type 1 DM is when insulin-producing cells (Pancreatic B cells) are destroyed thus eliminating insulin production. This can occur abruptly. Type 2 DM is insulin resistance and gradual insulin deficiency. Gestational DM is when the placenta produces hormones that antagonize insulin actions, and the production of cortisol increases threefold during pregnancy. Juvenile DM was once known as Type 1 DM, where the pancreas makes little or no insulin, occurs abruptly, in childhood or adolescence, and can occur in adults. In children ages 4-7 and 10-14 years. Rosenthal & Burchum (2021)
My interest is Type 2 DM:
I chose Biguanide, Metformin ER by mouth 500mg, 750mg, or 1000mg available doses. The action is the medication is it decreases glucose production by the liver and increases tissue response to insulin. Side effects are decreased appetite, n/v, diarrhea, and rare lactic acidosis. Metformin is suited for patients who skip meals. It does not lower blood glucose any lower if the patient is not eating. Will consider adding other agents if needed. Start with an initial dosage of ER 500mg one by mouth at bedtime. Rosenthal & Burchum (2021) Metformin monotherapy should be started at diagnosis of type 2 diabetes unless there are contraindications. Metformin is effective and safe, is inexpensive, and may reduce the risk of cardiovascular events and death. Compared with sulfonylureas, metformin as first-line therapy has beneficial effects on A1C, weight, and cardiovascular mortality. Metformin may be safely used in patients with an estimated glomerular filtration rate (eGFR) as low as 30 mL/min/1.73 m2, and the FDA recently revised the label for metformin to reflect its safety in patients with eGFR ≥30 mL/min/1.73 m2. Patients should be advised to stop the medication in cases of nausea, vomiting, or dehydration. American Diabetes Association (2018)
Dietary considerations:
Metformin is associated with vitamin B12 deficiency, with a recent report from the Diabetes Prevention Program Outcomes Study (DPPOS) suggesting that periodic testing of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. American Diabetes Association (2018) Lifestyle changes with moderate exercise, plus weight loss will reduce the risk of type 2 DM. Avoid alcohol, simple and refined carbs, saturated fats, trans fats, and sodium. Eat high protein, low carb, and fat foods. Rosenthal & Burchum (2021)
The long-term impact of Type 2 DM:
The most prevalent diabetic complications are hypertension, peripheral sensory neuropathy, coronary artery disease, retinopathy, and peripheral vascular disease. Lloyd & Hopkinson (2001)
References
American Diabetes Association (2018). Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes Diabetes Care, 73–85 Retrieved on 12/28/2022 from https://diabetesjournals.org/care/article/41/Supplement_1/S73/29735/8-Pharmacologic-Approaches-to-Glycemic-Treatment
Links to an external site. https://doi.org/10.2337/dc18-S008
Lloyd, A., Sawyer, W., & Hopkinson, P. (2001). Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research, 4(5), 392–400.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.)
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