Week 4 Assignment: Pharmacology 

Week 4 Assignment: Pharmacology 

Week 4 Assignment: Pharmacology 

The case portrays a 46-year-old woman with complaints of RUQ pain for 24 hours. The RUQ pain began about an hour postprandial, and she also experienced nausea and one episode of vomiting before coming to the clinic. She has a medical history of Type 2DM, gout, HTN, and DVT secondary to oral BCPs. Abnormal lab results include a high WBC count and Direct bilirubin levels. GI findings include a non-distended abdomen with minimal tenderness. This paper aims to describe the diagnosis and propose a treatment plan.

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Diagnosis

Acute Cholecystitis is the likely diagnosis for this case. It is a GI condition characterized by gallbladder inflammation caused by gallstones that cause chemical irritation and inflammation. The gallstones mostly obstruct the cystic duct as well as the neck of the gallbladder and the common bile duct. Persons at high risk for gallstones are referred to with 4 Fs: Female, Forty, Fat, and Fertile (Giles et al., 2020). Gallstones are prevalent in obese persons due to impaired fat metabolism and increased cholesterol. The patient, in this case, is a female in her forties and is obese. Clinical manifestations include RUQ pain or discomfort elicited by a high-fat or high-volume meal, anorexia, nausea, vomiting, indigestion, flatulence, abdominal fullness, rebound tenderness, fever, and jaundice. The patient’s RUQ pain was triggered by a large meal, and he had nausea and vomiting. Patients with Cholecystitis have an elevated WBC count due to inflammation, similar to this client (Gallaher & Charles, 2022). Direct and indirect serum bilirubin levels are also increased, as in the client’s case.

Drug Therapy

Drug therapy will include IV antibiotics, analgesics, and antiemetics. Antibiotic therapy will include Imipenem/Cilastatin (Primaxin) 500 mg IV every 6 hours (Mou et al., 2019). I would also recommend Ketorolac IV 30 mg single dose, then 10 mg QID orally for pain relief. The antiemetic of choice will be IV Promethazine 12.5 mg every 6 hours to alleviate nausea and vomiting.

Conclusion

The likely diagnosis is Acute Cholecystitis, an inflammation of the gallbladder caused mostly by gallstones. Clinical manifestations that align with Acute Cholecystitis include RUQ pain elicited by a large meal, nausea, vomiting, high WBC count, and elevated Bilirubin levels. Treatment will comprise IV Imipenem/Cilastatin, IV Ketorolac, and IV Promethazine for antibiotic coverage, pain relief, and control of nausea and vomiting.

References

Gallaher, J. R., & Charles, A. (2022). Acute Cholecystitis: A Review. JAMA, 327(10), 965–975. https://doi.org/10.1001/jama.2022.2350

Giles, A. E., Godzisz, S., Nenshi, R., Forbes, S., Farrokhyar, F., Lee, J., & Eskicioglu, C. (2020). Diagnosis and management of acute cholecystitis: a single-centre audit of guideline adherence and patient outcomes. Canadian journal of surgery. Journal canadien de chirurgie, 63(3), E241–E249. https://doi.org/10.1503/cjs.002719

Mou, D., Tesfasilassie, T., Hirji, S., & Ashley, S. W. (2019). Advances in the management of acute cholecystitis. Annals of gastroenterological surgery, 3(3), 247–253. https://doi.org/10.1002/ags3.12240