The female 63-year-old patient reports chronic mid-epigastric pain that worsens after eating. Sometimes, the color of her stool is very dark that can indicate the presence of blood in the stool. The patient denies excessive gas, regurgitation of food, and nausea or vomiting. She suffers from morbid obesity, type II diabetes, dyslipidemia, and hypertension. Differential diagnoses for this case are chronic gastritis and peptic ulcer disease.
Additional History to Discuss
It is important to learn whether the patient has a history of taking non-steroidal anti-inflammatory drugs (NSAID) during a long period of time. It is also necessary to learn whether she has a history of consuming alcohol or smoking. In order to prescribe the treatment for the condition, it is necessary to take tests on determining an H. pylori bacteria infection. This test will indicate whether the patient needs to take antibiotics.
Depending on the results of the test on H. pylori bacteria, it is possible to propose taking only Aciphex (rabeprazole) 20 mg orally once a day for four weeks if the results are negative. If there are H. pylori, it is necessary to propose the combination therapy with antibiotics. The patient should take Aciphex 20 mg in addition to Amoxil (amoxicillin) 500 mg and Flagyl (metronidazole) 500 mg two times per day for 14 days. Aciphex is a proton pump inhibitor to decrease acid levels in the stomach, and alternatives include omeprazole, lansoprazole, esomeprazole, but they cannot be used in this case because of major interactions with atorvastatin.
The only possible alternative is the use of generic rabeprazole instead of Aciphex (Onyekwere et al., 2014). Thus, Aciphex (rabeprazole) is selected to relieve symptoms and treat the disease with a focus on fewer side effects. H2 inhibitors cannot be used in this case because of their interactions with other drugs taken by the patient to address dyslipidemia and hypertension. Antibiotics are also selected depending on possible interactions.
The choice of medications depends on such risk factors as the patient’s obesity, type II diabetes, hypertension, and dyslipidemia. Taking the prescribed medications, it is necessary to control changes in the patient’s blood pressure and the function of the liver and kidneys (Kasiri, Khoshdel, Karimi, Sedehi, & Kasiri, 2017). It is necessary to guarantee that the patient will avoid the use of NSAIDs and alcohol in order to prevent the development of side effects.
Drug Interactions and Side Effects
There are moderate interactions between Aciphex and lisinopril and no interactions between Aciphex and atorvastatin, Premarin, and metformin. Interactions between Flagyl and atorvastatin are moderate, and there are no interactions between Amoxil and other medications taken by the patient. Possible side effects of these medications may include headaches, nausea, diarrhea, and stomach pain (Onyekwere et al., 2014). To reduce adverse effects, it is necessary to manage the dosage of medications.
Patient Education and Other Interventions
While taking Aciphex, the patient should not increase the dose of lisinopril and immediately report any side effects to a physician. When using the combination therapy, the daily dosage of atorvastatin should be reduced to 20 mg to prevent any possible side effects. Overdosing of all taken medications is prohibited (Kasiri et al., 2017). In addition to drug therapy, it is also necessary to recommend sticking to a diet without spicy, fried, and fatty foods. The consumption of fresh vegetables and fruit with high levels of acid should also be avoided, but the patient can continue using antacids like Tums.
The paper has provided the description of a possible drug regimen for the female patient with obesity who suffers from the symptoms typical of gastritis and peptic ulcers. The proposed combination of medications is recommended with reference to the results of the test on H. pylori bacteria. Furthermore, one should note that the medical decisions and propositions are also supported by the recent studies on the problem.
Kasiri, K. A., Khoshdel, A., Karimi, A., Sedehi, M., & Kasiri, N. (2017). Comparison of amoxicillin and metronidazole effect on the three-drug regimen for the treatment of Helicobacter pylori infection in children. Journal of Advanced Pharmaceutical Technology & Research, 8(2), 63-74.
Onyekwere, C. A., Odiagah, J. N., Igetei, R., Emanuel, A. O. D., Ekere, F., & Smith, S. (2014). Rabeprazole, clarithromycin, and amoxicillin Helicobacter pylori eradication therapy: Report of an efficacy study. World Journal of Gastroenterology, 20(13), 3615-3622.