Drug Therapy and Rationale

Specific Treatment Goals

Considering J.G.’s presenting symptoms, the most likely condition is Peptic Ulcer Disease (PUD), predominantly duodenal ulcer. The specific treatment goal for his treatment would be to eliminate H. pylori, heal ulcers, prevent complications and relapse, and reduce or eradicate symptoms(Narayanan et al., 2018). These goals can be accomplished through a combination of drug therapy and lifestyle modification

Drug Therapy and Rationale

The treatment regimens for J.G. would be a combination of proton pump inhibitors (PPI) and antimicrobial therapy.Because J.G is allergic to penicillin, his triple-drug regimen will include clarithromycin 500mg and metronidazole 500mgas antimicrobial agents and esomeprazole 20 mg as a PPI (all drugs bid for 14 days and taken orally). This is the recommended first-line therapy for PUD, particularly for H. pylori eradication (Puig et al., 2016). The triple treatment regimen will suppress the acid, which is critical in eradicating ulcer-related symptoms and the healing of gastric mucosal inflammation. Besides, the PPI improves the antimicrobial agent efficacy against H. pylori within the mucosal surface.

Patient Education Based On the Prescribed Therapy

The patient would be advised to adhere to the drug prescription until the dose is over. Any missed dose must be taken immediately, he remembers, with the only exemption being if it is almost time for the subsequent dosage. The patient will also be advised against doubling up the doses. Further, all the prescribed drugs must be taken before meals and can safely be taken together with antacids. The patient will also be educated on the adverse reactions of the drugs and advised to seek the assistance of a healthcare provider in case of diarrhea, black tarry stool, and persistent headache or abdominal pain.

Adverse Reactions and Choice of Second-Line Therapy

Adverse drug reactions that may prompt therapy discontinuation include a black-tarry stool, an indication of GI bleeding. Others include diarrhea, persistent headache or abdominal pain, rash, sore throat, and hallucinations. Should J.G. experience these adverse drug reactions, the second-linerecommended therapy would be Lansoprazole 30 mg bid, metronidazole 250mg qid, tetracycline 500mg qid, andbismuth subsalicylate 525mg qid for 14 days, all taken orally (Lanas & Chan, 2017).

Recommended lifestyle changes

The patient will be advised to strictly cease smoking while on this treatment because it will increase the duodenal ulcers and delay his healing. Secondly, a recommendation will be made to him to be taking his meals at least 3 hours before going to sleep to allow the stomach to digest the food. Finally, he will be advised to reduce caffeine intake, although it may not have any impact on the healing process.

References

Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet390(10094), 613-624.

Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic ulcer disease and Helicobacter pylori infection. Missouri medicine115(3), 219.

Puig, I., Baylina, M., Sanchez-Delgado, J., Lopez-Gongora, S., Suarez, D., Garcia-Iglesias, P., … & Calvet, X. (2016). Systematic review and meta-analysis: triple therapy combining a proton-pump inhibitor, amoxicillin, and metronidazole for Helicobacter pylori first-line treatment. Journal of Antimicrobial Chemotherapy71(10), 2740-2753.

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Lucia Reyes

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Week 10 Discussion

List specific goals for treatment for J.G.

Epigastric pain alludes to a pain that normally occurs in the middle of the upper abdomen. The diagnosis shows that J.G is suffering and pain is from peptic ulcer disease. The main goal of the treatment of the peptic ulcers will be to relieve the current symptoms and prevent recurrence. 

What drug therapy would you prescribe for J.G.? Why?

Drug therapy will help in managing J.G. peptic ulcer problem. One of the therapies will be combination of the metronidazole and clarithromycin (Auesomwang et al., 2018: Long et al., 2018). These are antibiotics will target killing of the Helicobacter pylori which is the bacterial that causes peptic ulcers. Secondly, the drug therapy will involve proton pump inhibitor. These help in reduction of acids which lead to healing of the ulcers. 

Discuss specific patient education based on the prescribed therapy.

Majorly, the patient will be educated on the importance of strict adherence to the prescribed antibiotics. This is to protect the bacteria from developing resistance which will make the treatment difficult. Additionally, the patient will be educated on the side-effects of the drugs and when to report to the physician. 

List one or two adverse reactions for the selected agent that would cause you to change therapy.

The major side effect that will call for the change of the selected therapy is serious nervous system problem. This will require the patient to inform the physician for the changes. 

What would be the choice for second-line therapy?

The most recommendable second line therapy will be Bismuth-based quadruple therapy. This will involve Bismuth subsalicylate 525 mg or subcitrate 300 mg, metronidazole 250 mg, and tetracycline 500 mg, four times daily; and PPI twice daily (Fashner & Gitu, 2016). This should be allowed to continue for 14 days (Seyyedmajidi et al., 2019). 

What lifestyle changes would you recommend to J.G.?

JG needs to stop smoking. This is one of the habits that is escalating his problems. Additionally, he should also avoid taking his meals at late night which may also acerbate his epigastric pain. 

References

Auesomwang, C., Maneerattanaporn, M., Chey, W. D., Kiratisin, P., Leelakusolwong, S., & Tanwandee, T. (2018). Ten‐day high‐dose proton pump inhibitor triple therapy versus sequential therapy for Helicobacter pylori eradication. Journal of gastroenterology and hepatology33(11), 1822-1828.

Fashner, J., & Gitu, A. C. (2016). Diagnosis and treatment of peptic ulcer disease and H. pylori infection. American family physician91(4), 236-242.

Long, X., Chen, Q., Yu, L., Liang, X., Liu, W., & Lu, H. (2018). Bismuth improves efficacy of proton‐pump inhibitor clarithromycin, metronidazole triple Helicobacter pylori therapy despite a high prevalence of antimicrobial resistance. Helicobacter23(3), e12485.

Seyyedmajidi, M., Abbasi, L., Seyedmajidi, S., Hosseini, S. A., Ahmadi, A., Hajiebrahimi, S., & Vafaeimanesh, J. (2019). Levofloxacin-containing triple therapy versus bismuth-based quadruple therapy as regimens for second line anti- Helicobacter pylori. Caspian journal of internal medicine10(2), 211–216. https://doi.org/10.22088/cjim.10.2.211

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