NSG 6005 Week 2 Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee
NSG 6005 Week 2 Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee
Week 2 Case Study
What are your concerns about this drug regimen?
The patient is on Amitriptyline, which is a trigger for irritable bowel syndrome (IBS). Amitriptyline is possibly worsening the patient’s IBS symptoms of abdominal cramps and diarrhea (Hadjivasilis et al., 2019). Besides, the patient complains of insomnia, yet she is on Zolpidem, a sedative-hypnotic used to treat insomnia. The patient also complains of urinary retention, which is associated with medications with anticholinergic activity like antipsychotics, antidepressants, anticholinergic respiratory agents, opioids, alpha-adrenoceptor agonists, NSAIDs, and benzodiazepines (Serlin et al., 2018). The patient is on antipsychotics like Amitriptyline and anticholinergic agents like dicyclomine, which could be contributing to urinary retention.
What recommendations do you have for this patient?
The patient has diarrhea-predominant IBS (IBS-D) since she reports frequent diarrhea. Thus I would recommend treatment with antidiarrheal agents, like loperamide and psyllium, a bulk-forming agent (Farmer et al., 2020). In addition, I would recommend the intake of dietary fiber and bulk to produce bulky, soft stools and promote regular bowel habits. The patient will be recommended to have 30-40 g of dietary fiber daily. Furthermore, I will recommend regular meals, drinking 8-10 cups of liquid daily, and chewing food slowly to promote normal bowel function. I will also advise the patient to keep a symptom diary where she records potential IBS triggers and bowel habits for some time (Farmer et al., 2020). This will help her to identify food triggers for IBS symptoms. These foods can include alcohol, caffeine, wheat products, eggs, or beverages containing sorbitol or fructose. Besides, I will recommend stopping or lowering the dosage of medications that trigger IBS, like Amitriptyline.
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NSG 6005 Week 2 Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee References
Farmer, A. D., Wood, E., & Ruffle, J. K. (2020). An approach to the care of patients with irritable bowel syndrome. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 192(11), E275–E282. https://doi.org/10.1503/cmaj.190716
Hadjivasilis, A., Tsioutis, C., Michalinos, A., Ntourakis, D., Christodoulou, D. K., & Agouridis, A. P. (2019). New insights into irritable bowel syndrome: from pathophysiology to treatment. Annals of gastroenterology, 32(6), 554–564. https://doi.org/10.20524/aog.2019.0428
Serlin, D. C., Heidelbaugh, J. J., & Stoffel, J. T. (2018). Urinary Retention in Adults: Evaluation and Initial Management. American family physician, 98(8), 496–503.
Aubre R. presents as a new patient to your practice having recently relocated from rural Tennessee. She is 68 years old and complains of irritable bowel syndrome (IBS) with abdominal cramping and frequent diarrhea with occasional constipation. She has a history of domestic violence with resultant anxiety requiring inpatient hospitalization 8 years ago. She is also complaining of urinary retention, insomnia, and hip pain since a hip fracture 4 years ago. Her drugs include zolpidem 10 mg hs, bethanechol 25 mg tid, metoclopramide 10 mg tid, amitriptyline 100 mg hs, alprazolam 0.25 mg tid, hydrocodone/APAP 5/500 tid, and dicyclomine 20 mg four times daily.
What are your concerns about this drug regimen?
What recommendations do you have for this patient?
Submission Details:
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