The medication objectives for AJ. G’s will be; Getting rid of the discomfort
The medication objectives for AJ. G’s will be; Getting rid of the discomfort, making sure lesions are properly healing, avoiding returning condition, ensuring risks are avoided, and recommending J.G.’s medications.
Acid inhibitors will be the first line of treatment. Acid inhibitors reduce the amount of gastric acid that enters the gastrointestinal tract. Acid inhibitors improve symptoms and alleviate ulcer problems as a result. To help with proper diagnosis, drugs that lower gastric acid operates with proton pump inhibitors(PPIs). Acid release is inhibited by PPIs, which improve recovery. Gastric acid is lowered when the acid-secreting portion of the cell is blocked. Rabeprazole, omeprazole, as well as pantoprazole are acid inhibitors (Al-Gabri et at.,2022). Acid inhibitors reduce stomach acid production. J. G’s agony will be relieved once the gastrointestinal acid is controlled.
Patient learning is the process of modifying a patient’s condition by changing their perspectives, views, and capabilities to ensure better their well-being. In therapeutic communication, the caregiver discusses the patient’s involvement in their rehabilitation with them. The initial step in educating patients would be to go over the medications with a particular patient as per the recommended medication. The doctor should inform the patient why these medicines were recommended and how they should be used. The physician should then ask patients to read over the medication before taking it, and examining the directions guarantees that now the individual receives the proper doses (Chieng & Pan, 2022). Furthermore, teaching would emphasize the significance of taking medicines as prescribed. It is necessary to emphasize ethical oral consumption.
Acidity inhibitors could induce diarrhea. PPIs increase the risk of fractures, mainly in the forearm, thigh, and back.
Antibiotics are the next pharmacological treatment option for such patients. If ulcer-causing microorganisms are found in the gastrointestinal tract, antibiotics can effectively kill them. The drugs might also aid in treating J. G’s stomach ailment, which he developed earlier. Amoxil, tinidazole, and Flagyl are all antibiotics that can help with the problem and alleviate symptoms. Antibiotics would be administered based mainly on locality and antibiotic sensitivity. A person, for instance, had tried Zantac for approximately two weeks without success, indicating that they must be intolerant towards the medicine (Chamniansawat et al., 2021). Antibiotics and some other drugs will also be administered as a response. In addition to bismuth subsalicylate, antibiotics are given.
A patient’s initial dietary advice will limit caffeine if this makes the symptoms worse. Considering J.C usually takes approximately to 5 coffees each day, all decaffeinated or regular coffee should be eliminated. Caffeine must be omitted because it will likely upset the person’s gut. Furthermore, the patient should refrain from eating late into the evening and sleeping half an hour later. Acid accumulation inside the abdomen is aided by dining later than bedtime, almost after that. Another suggestion for such a person is to give up smoking. Cigarettes inhibit tissue repair and raise the chances of relapse. In addition, a patient must prevent or lower overall anxiety levels. Stress reduction promotes well-being and aids throughout the healing of ulcers in therapy. Finally, J.G can stay away from hot meals. Spiced meals provide nourishment that induces acidity in the belly. Instead, the person can begin eating a nutritious, balanced meal as soon as possible.
Al-Gabri, N., Elnagar, G. M., Saghir, S. A., El-Shaibany, A., Alnomasy, S. F., Althafar, Z. M., … & Yosri, M. (2022). Preliminary Study of Gastroprotective Effect of Aloe perryi and Date Palm Extracts on Pyloric Ligation-Induced Gastric Ulcer in Experimental Rats. BioMed Research International, 2022.
Chieng, J. Y., & Pan, Y. (2022). The Role of Probiotics, Prebiotics and Synbiotics in Adult Gastrointestinal Health. Gastroenterology & Hepatology Letters, 3(2).
Chamniansawat, S., Kampuang, N., Suksridechacin, N., & Thongon, N. (2021). Ultrastructural intestinal mucosa change after prolonged inhibition of gastric acid secretion by omeprazole in male rats. Anatomical Science International, 96(1), 142-156.
Week 10: Peptic Ulcer Disease Case Study
Make a list of specific treatment objectives for J.G.
The patient’s goal in peptic ulcer disease treatment is to alleviate symptoms, heal lesions, prevent recurrences, and avoid complications.
What kind of medication would you recommend for J.G.? Please explain your reasoning.
Because this treatment is for patients who cannot take amoxicillin due to a penicillin allergy, it is known as quadruple therapy. Penicillin and amoxicillin are antibiotics that are very similar. Patient J.G. is allergic to penicillin, according to the information provided. Furthermore, if the first treatment fails, doctors will prescribe quadruple therapy. Because the patient has had intermittent mid-epigastric pain for two months and has been taking over-the-counter antacids and histamine receptor antagonists for two weeks without relief, he requires a second round of treatment and may be given antibiotics other than those prescribed the first time (Kuna et al., 2019).
Discuss patient education that is specific to the prescribed therapy.
Standard Triple Therapy -when the preponderance of clarithromycin-insusceptible H. pylori strains exceeds 16% to 21%, this plan is not recommended. Metronidazole 500 mg twice daily replaces Amoxicillin with in an alternative triple drug plan (Sverdén et al., 2019). Additionally, adding probiotics to triple therapy, particularly Lactobacillus and Saccharomyces boulardii, has demonstrated to enhance reduce treatment side effects and eradication rates, particularly diarrhea.
List one or two side effects from the chosen agent that would cause you to change your treatment.
Standard Sequential Therapy and Triple Therapy can lead to nausea and other side effects like a changed sense of taste, a darkened tongue and darkened stools, among other things (Sverdén et al., 2019). Because of these side effects, your doctor may decide to prescribe another medication.
What would be your second-line therapy option?
Concomitant Therapy or Non-bismuth-based Quadruple Therapy Levofloxacin-Based Triple Therapy, and Bismuth-Based Quadruple Therapy are the second-line treatments. Based on the patient’s medical history, the Bismuth-Based Quadruple Therapy is the best option (Kuna et al., 2019).
What changes in J.G.’s lifestyle would you suggest?
• Giving up cigarette smoking and other tobacco products.
• Consuming a well-balanced diet that includes plenty of fruits, vegetables, and whole grains.
• Limiting the amount of alcohol and caffeine consumed.
Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic ulcer disease: a brief review of conventional therapy and herbal treatment options. Journal of clinical medicine, 8(2), 179.https://www.mdpi.com/2077-0383/8/2/179/pdf
Sverdén, E., Agréus, L., Dunn, J. M., & Lagergren, J. (2019). Peptic ulcer disease. Bmj, 367.
Luanda Gan Bedoya
The first goal for treatment for J.G. is to relieve the symptoms of peptic ulcer disease like midepigastric pain. The next treatment goal is to heal the infection in the patient’s stomach that can cause lesions. Other goals include preventing the reoccurrence of the disease and associated complications (Altwejry et al., 2020). The goals would help J.G. to save money he would use to buy over-the-counter medications. One drug I would recommend to the patient is oral route omeprazole. Omeprazole is classified under proton pump inhibitors, which work by decreasing the amount of acid produced in the stomach while promoting the healing of the stomach (Sun et al., 2020). Additionally, omeprazole significantly improves sleep, unlike other inhibitors that only heal the stomach. A specific patient education that J.G. would receive based on the prescribed drug is on the need to adhere to the prescribed dosage even if the symptoms improve quickly. Such education would be important since the drug may give quick relief to the patient before the full elimination of the disease. Therefore, failing to finish the dose can promote the disease’s reoccurrence. One of the adverse reactions of omeprazole that would prompt a change in the therapy is continuing sores in the mouth and sore throat (Sun et al., 2020). Sores in the mouth and throat caused by the drug may affect the patient’s feeding patterns, which could result in weight loss and fatigue. An alternative for the patient would be histamine (H-2) blockers like famotidine, which would be delivered orally. Famotidine works by decreasing the amount of acid produced by the stomach (Nguyen et al., 2022). I have chosen the drug since the patient is currently using Zantac 75, which has been ineffective. Some of the lifestyle changes I would recommend to J.G. include avoiding tobacco and increasing water intake. Furthermore, J.G. would need to eat easy-to-digest food regularly and avoid eating late at night as he currently does. Finally, I would advise the patient to be active for more time before he sleeps after eating and not go to bed after dinner as soon as he currently does.
Altwejry, A. S., Alsaiari, O. A., Saleem, E. R., Alshanbri, N. K., Alzahrani, A. A., Alamri, S. M., Al-Din Mahfouz, A. S., Alghamdi, T. A., Asiri, F. M., & Alzahrani, A. A. (2020). An overview on peptic ulcer disease, diagnosis and management approach. Pharmacophpore, 2020(2). https://pharmacophorejournal.com/article/an-overview-on-peptic-ulcer-disease-diagnosis-and-management-approach
Nguyen, K., Dersnah, G. D., & Ahlawat, R. (2022). Famotidine. StartPearls.
Sun, K., Ma, S., Hui, Y. Y., Wang, B., Yang, B., Zhu, L. P., Wang, S. Y., Li, S., Zhao, W., Jiang, K., Zhao, J. W., Wang, B. M., Chen, X., Zhang, G. L., Zhou, Z. H., Liu, Y. D., Ye, Q., Deng, Q. J., Liu, G. F., … Zhang, R. X. (2020). Efficacy of proton pump inhibitor on nighttime reflux symptoms and associated sleep disturbances in patients with gastroesophageal reflux disease: A real-world study in northern China. https://www.researchsquare.com/article/rs-33808/latest.pdf
Gioconda A. Orellana
Gastroesophageal Disease and Peptic Ulcer Diseases
Relief of pain and other symptoms, infection treatment and eradication, avoidance of acid production and complications, ulcer healing with mucosal support of stomach walls, and disease relapse prevention are all targets goals.
Proton pump inhibitors (PPI) (omeprazole 20mg, oral, BID 30 days) and antibiotics (azithromycin or clarithromycin 500 mg, oral, BID x 30 days) would be prescribed. If PPIs and antibiotics fail to control the symptoms, adjuvant therapy with antacids, sucralfate, and colloidal bismuth may be used. PPIs are the most effective first-line agents to treat the PUD support by EBP and RTCs (Hu et al., 2017).
Patient education includes detailed information about the disease, its prognosis, prevention, and complications. Likewise, the patient should be educated on medication dosage and schedules, the importance of taking medications as prescribed, the instructions to demonstrate full compliance and adherence, the importance of lifestyle changes, and drug-drug interactions.
PPIs are generally safe and well-tolerated. However, headache, diarrhea, and nausea are common adverse effects (Hu et al., 2017). Azithromycin or clarithromycin also cause the same side effects. Additionally, PPI, along with antibiotics treatment, is linked to a higher risk of osteoporotic fractures (Hu et al., 2017). Patients on long-term PPI therapy have a considerably higher risk of community-acquired and hospital-acquired pneumonia and a moderately increased risk of Clostridium difficile infection.
The patient’s response to the initial therapeutic decision influences the choice of second-line therapy. Lansoprazole and esomeprazole are more likely to produce headaches than other PPIs if the patient’s adverse reaction include headache. In this scenario, the doctor can substitute another PPI, such as rabeprazole (AcipHex) 20 mg, oral, BID for 30 days (Hu et al., 2017). If the reaction is more severe, the doctor may recommend using a combination of treatments. Famotidine (Pepcid Complete) 20 mg twice a day or cimetidine (Tagamet HB) 200 mg once or twice a day 30 minutes before meals, bismuth subsalicylate 300 mg QID, and metronidazole 500 mg QID.
Lifestyle changes concerning GERD and PUD include stopping smoking and drinking coffee since both increase acid production and damage the stomach mucosa. Moreover, it is recommended to exercise regularly, eat healthy and less spicy foods, avoid late-night eating and eat your last meal 3 hours before bedtime, and drink green tea or other herbal tea to aid digestion (Kim et al., 2017; Kulshreshtha et al., 2017).
Hu, Z. H., Shi, A. M., Hu, D. M., &, Bao, J. J. (2017). Efficacy of proton pump inhibitors for patients with duodenal ulcers: A pairwise and network meta-analysis of randomized controlled trials. Saudi Journal of Gastroenterology, 23(1), 11-19. https://doi.org/10.4103/1319-3767.199117
Kim, J., Kim, K., & Lee, B. (2017). Association of peptic ulcer disease with obesity, nutritional components, and blood parameters in the Korean population. PLOS ONE, 12(8), e0183777. https://doi.org/10.1371/journal.pone.0183777
Kulshreshtha, M., Srivastava, G., & Singh, M. (2017). Pathophysiological status and nutritional therapy of peptic ulcer: An update. Environmental Disease, 2(3), 76-86. https://doi.org/10.4103/ed.ed_11_17
Seth Lesperance Dupont Paurice.
Peptic Ulcer Disease- Case Study
This discussion is focused on J.G, a 42-year-old white man with a history of intermittent mid-epigastric pain suffering for a period of two months. J.G who has been diagnosed with peptic ulcer disease encountered an infection in his abdomen before six months. The severity of pain in J.G is so troublesome that it has even disrupted his normal sleep patterns. Peptic ulcer disease is generally described as a condition of painful sore or ulcer development on the lining of the oesophagus, abdomen, or on the small intestine. One in every ten individuals are known to be affected by peptic ulcers. The pathogenic organism that is responsible for the cause of this condition is Helicobacter pylori. These organisms affect the mucus wall that lines and protects the abdomen from gastric tissues with the development of inflammation (Kim, 2016). When the mucous layer protecting the stomach lining is affected, it results in the formation of open sores. Apart from this pathogenic organism, peptic ulcers are also caused due to the intake of pain relievers such as non-steroidal anti-inflammatory drugs, and certain medications such as aspirin, steroids, and anticoagulating agents. The common risk factors of this ulcer development are excessive intake of alcohol, smoking habits, family history, chronic disease conditions of liver, lungs, and kidney, untreated stress and anxiety associated conditions, excessive intake of spicy foods, and many more (Kuna et al., 2019).
The common symptoms that are associated with peptic ulcers include the development of a sense of burning pain on the stomach either before meals or during sleep, bloating, heartburn, nausea, intolerance to fatty acids, appetite changes, weight loss, dark stools, and vomiting. Peptic ulcers are diagnosed by using endoscopy, H.pylori laboratory tests, upper gastrointestinal series, and imaging tests. When peptic ulcers are not treated properly, it paves way for several complications such as internal bleeding, perforation, gastric cancer, and gastric outlet obstruction. Hence, proper treatment approaches are required to manage the development of these painful sores or ulcers. the pharmacological approaches that can be employed for treating peptic ulcers include proton pump inhibitors, histamine receptor blockers, antibiotics, and certain liquid bandages such as carafate. With the right treatment and management approaches, the condition can be treated within a few days to several weeks based on the intensity and severity of the symptoms. Peptic ulcers are prevented by avoiding the infections that are caused due to the causative agent and using the pain relievers with proper caution (Kavitt et al., 2019).
The specific goals for treatment for J.G are to reduce the intensity and severity of the pain exerted on the patient due to the symptoms of peptic ulcers. Another major goal is to administer the patient with the appropriate medications and lifestyle changes in order to prevent the condition from worsening and to inhibit the recurrence of ulcers (Yegen, 2018). As J.G is allergic to penicillin, the drug therapy that I would prescribe is the use of proton pump inhibitors and antibiotics such as clarithromycin and amoxicillin. A proton pump inhibitor is a common medication that inhibits the production of stomach acid and aids in healing of the inflammation. A combination of these antibiotics along with a proton pump inhibitor for almost a period of two weeks is found to be as an effective drug therapy for reducing the mid-epigastric pain that are caused due to peptic ulcers. This drug therapy also helps in inhibiting the growth of the pathogenic organism responsible for the development of ulcers in the stomach. Apart from these antibiotics, metronidazole, tinidazole, and tetracycline can also be administered for managing the symptoms caused due to peptic ulcers (Kuna et al., 2019).
Based on the prescribed therapy the patient education offered to J.G is primarily about the administration of proton pump inhibitors. Proton pump inhibitors are generally regarded as safe and effective for treating peptic ulcers. These inhibitors in certain cases lead to the development of after-effects such as headache, diarrhoea, nausea, and so on. In some cases, osteoporotic fractures may also develop when the therapy is not administered at the right dosage and intervals. Upon frequent exposure of the patient to the therapy with proton pump inhibitors, it is observed that the patient may be infected with various community acquired and nosocomial pneumonia like infections. Hence, care should be taken while administering proton pump inhibitors for managing peptic ulcers. Apart from this, J.G should also be educated on the need to cease from smoking habits in order to reduce the symptoms and recurrence of ulcers on the intestinal and abdominal linings (Xie et al., 2022).
The adverse reactions that would cause me to change the therapy for J.G includes the development of two important symptoms namely nausea, vomiting and diarrhoea which most frequently are associated with the intake of antibiotics. The choice for second-line therapy in this case is Pepto-Bismol. This drug that is rich in bismuth subsalicylate is primarily employed for nausea, gastric disturbances, acid reflux, and heart burn. It acts as an acid neutralizer and a soothing agent for the abdomen by protecting the lining of the stomach from being corroded with the formation of gastric juices (Abumunaser, 2021). The lifestyle changes recommended for J.G is the cessation from smoking habits. Smoking worsens the symptoms of ulcer formation and leads to several consequences. Hence, J.G should be advised to stop smoking. Based on the details provided, it is obser4ved that J.G drinks five cups of coffee each day. Drinking coffee triggers more production of stomach acids which in turn causes more inflammation, irritation and damage to the stomach linings and its adhering tissues. Hence, it is essential to advise J.G to reduce the intake of coffee every day. J.G should also be made to change the practice of having dinner at late nights in order to have a proper digestion and to get a good sleep. He should also be advised to refrain from foods that trigger acid reflux and should also be encouraged to adopt a healthy lifestyle with proper balanced diet and regular exercises (Kavitt et al., 2019).
Abumunaser, A. (2021). Peptic ulcer disease. Cases on Medical Nutrition Therapy for Gastrointestinal Disorders, 46–67. https://doi.org/10.4018/978-1-7998-3802-9.ch003
Kavitt, R. T., Lipowska, A. M., Anyane-Yeboa, A., & Gralnek, I. M. (2019). Diagnosis and treatment of peptic ulcer disease. The American Journal of Medicine, 132(4), 447–456. https://doi.org/10.1016/j.amjmed.2018.12.009
Kim, J. (2016). Peptic ulcer disease. Helicobacter Pylori, 509–513. https://doi.org/10.1007/978-981-287-706-2_51
Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic ulcer disease: A brief review of conventional therapy and herbal treatment options. Journal of Clinical Medicine, 8(2), 179. https://doi.org/10.3390/jcm8020179
Xie, X., Ren, K., Zhou, Z., Dang, C., & Zhang, H. (2022). The global, regional and national burden of peptic ulcer disease from 1990 to 2019: A population-based study. BMC Gastroenterology, 22(1). https://doi.org/10.1186/s12876-022-02130-2
Yegen, B. C. (2018). Lifestyle and peptic ulcer disease. Current Pharmaceutical Design, 24(18), 2034–2040. https://doi.org/10.2174/1381612824666180510092303
3/8/22, 11:36 PM
Peptic Ulcer Disease Case Study
Goals for Treatment
• Relieving the pain
• Healing lesions
• Prevention of recurrences
• Prevention of complications (Kuna etal., 2019)
Drug Therapy for J.G
The primary drug therapy would be acid blockers. According to Kuna et al. (2019), acid blockers lower the quantity of stomach acid released into the digestive system. As a result, acid blockers encourage healing and relieve ulcer pain. Medications that reduce acid production work together with proton pump inhibitors to assist in full treatment. Proton pump inhibitors block the production of acid and promote healing. Stomach acid gets reduced by the blockage of the part of the cell that secretes acid (Collins, 2017). Acid blockers include rabeprazole, omeprazole, and pantoprazole. Acid blockers lower the content of stomach acid. When the stomach acid gets reduced, the pain that J.C feels will get lowered.
Patient education refers to the influencing of patient behavior through altering their attitudes, beliefs, and skill for the maintenance and improvement of overall health (Bastable, 2016). During patient education, the caregiver speaks to the patient about their role in their recovery. Based on the prescribed therapy, the first patient education would involve reviewing the drugs with the patient. According to Collins (2017), the practitioner must explain to the patient why the specific drugs got prescribed and their uses. Next, the practitioner must ask the patient to review the medicine before taking them carefully. Reviewing the instructions ensures that the patient takes the right dosage. Additionally, the patient education would touch on the importance of timely intake of medication. An insistence on the rightful oral intake must also take place. Adverse Reactions
• Acid blockers can cause diarrhea
• Proton pump inhibitors increases therisk for wrist, hip, and spine fracture (Kuna et al., 2019)
Second-line Therapy Choice
The second drug therapy for the patient would be the use of antibiotics. Antibiotics help kill the bacteria that cause ulcers if they are in the digestive system (Kuna et al., 2019). Since J.G had an infection in his stomach six months ago, the antibiotics would also help deal with the problem. Amoxicillin, tinidazole, and Flagyl would assist in dealing with the issue and relieve the pain (Collins, 2017). The use of the antibiotics will get determined by the patient’s location and current resistance to antibiotics. For example, the patient had taken over-the-counter Zantac for two weeks without any relief, meaning that they are resistant to that drug. As a result, antibiotics other medicines will get prescribed. Antibiotics get administered alongside bismuth subsalicylate.
Lifestyle Change Recommendations
The first lifestyle recommendation for the patient would be avoiding coffee if it causes the pain to increase. Both decaffeinated and caffeinated coffee must get avoided since J.C currently consumes up to 5 cups a day. Since the coffee probably causes discomfort to the patient’s stomach, it should get avoided (Collins, 2017). Additionally, it would be recommended that the patient avoids eating late at night and going to sleep 30 minutes later. Eating late and going to sleep almost immediately enables acid concentration in the stomach. The other recommendation for the patient would be to avoid smoking. Kuna et al. (2019) argue that tobacco slows down ulcer healing and increases the likelihood of the recurrence of the ulcer. The patient should also avoid and reduce their stress levels. Better management of stress improves overall health, which assists in the recovery process during ulcer rehabilitation. Lastly, J.C should avoid spicy foods. Spicy food provides nutrients that cause acid to build in the stomach. Instead, the patient should eat a healthy and balanced diet early.
Bastable. (2016). Essentials of patient education. Jones & Bartlett Publishers.
Collins, H. (2017). Stomach ulcer – treatment, home remedies, recipes. CreateSpace Independent Publishing Platform.
Kuna, L., Jakab, J., Smolic, R., et al. (2019). Peptic ulcer disease: a brief review of conventional therapy and herbal treatment 0ptions. Journal of clinical medicine, 8(2), 179.