Week 2 Case Study IBS Case Study

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School

South University *

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NSG 6005 A

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Chemistry

Date

Feb 20, 2024

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docx

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Uploaded by bcruz75 on coursehero.com

1 Week 2 Case Study FNP Student South University NSG 6005 Advanced Pharmacology Professor December 25, 2023

2 Week 2 Case Study In this case study, Aubre R., a 68-year-old patient who recently relocated from rural Tennessee, presents a complex medical profile. She is grappling with irritable bowel syndrome (IBS) characterized by abdominal cramping and alternating episodes of frequent diarrhea and occasional constipation. Aubre R. has a history of domestic violence, leading to anxiety that necessitated inpatient hospitalization eight years ago. Furthermore, she is experiencing urinary retention, insomnia, and hip pain following a hip fracture four years ago. She is prescribed the following medications: zolpidem 10 mg at bedtime, bethanechol 25 mg three times a day, metoclopramide 10 mg three times a day, amitriptyline 100 mg at bedtime, alprazolam 0.25 mg three times a day, hydrocodone/APAP 5/500 three times a day, and dicyclomine 20 mg four times daily. This paper undertakes a detailed analysis of the case study featuring Aubre, aiming to address two key inquiries: first, elucidating concerns arising from the current drug regimen, and second, formulating recommendations to optimize care for this patient. Through the analysis of these factors, my goal is to offer practical insights and considerations relevant to medication management in clinical settings. 1. What are your concerns about this drug regimen? Aubre is experiencing polypharmacy, the use of multiple medications for various health issues, which is common in older individuals with multiple health problems. This can lead to adverse outcomes, including increased mortality, falls, longer hospital stays, and higher chances of readmission. The risk of harm rises with the number of medications, especially in older patients due to age-related factors (Masnoon et al., 2017). Certain medications among older

3 individuals may counteract each other, potentially causing increased or aggravated issues due to heightened drug sensitivity. I am concerned about the negative impact of Aubre's current medication regimen on her Irritable Bowel Syndrome (IBS) and related symptoms. Bethanechol, used to enhance bladder muscle tone, may worsen her IBS symptoms, including cramping, due to side effects such as gastrointestinal stimulation. Methclopramide for motility is causing diarrhea, and dicyclomine and hydrocodone are linked to intermittent constipation episodes. Amitriptyline, with its anticholinergic effects, poses a risk of hypotension and works against the intended effects of her IBS medications, especially in older patients (Rosenthal & Burchum, 2021, Chapter 27). Considering Aubre's advanced age, there are potential challenges with opioid metabolism and benzodiazepine use. These factors, along with her elevated risk of falls due to pain, polypharmacy, and urgent bathroom visits, emphasize the critical importance of addressing her physical safety concerns arising from her current medication profile. 2. What recommendations do you have for this patient ? One of the initial modifications I propose for the patient's treatment plan involves a strategic reduction in the number of prescribed medications to mitigate potential risks associated with polypharmacy. Specifically, I recommend discontinuing the administration of dicyclomine and substituting it with peppermint oil, recognized as a first-line treatment for Irritable Bowel Syndrome (IBS) (Alammar et al., 2019).

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