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Effective Management of Gastroesophageal Reflux Disease (GERD) in a Patient with Persistent Symptoms

SCENARIO 4
Jenny is a 63-year-old woman with complaints of heartburn 4 to 5 times a week over the past 3 months. Her symptoms are worse at night after going to bed. Her heartburn is worse, and she coughs a lot at night. She has tried OTC Prevacid 24 hour once daily for the past 2 weeks. This has helped the symptoms some, but she is still bothered by them. Current medications include Diltiazem CD 120 mg PO once daily, Hydrochlorothiazide 25 mg PO once daily, Metformin 500 mg PO twice daily, Aspirin 81 mg PO daily, Fluticasone/salmeterol DPI 100 mcg/50 mcg one inhalation twice daily. Your working diagnosis for this patient is GERD. What treatment plan would you implement for Jenny? What medications would you prescribe and how would you monitor them? What education would you provide regarding her treatment plan?
To Prepare:
Review the case studies above and answer ALL questions.
When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patients current medications.
Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.

Sample Answer

Essay

Effective Management of Gastroesophageal Reflux Disease (GERD) in a Patient with Persistent Symptoms

Thesis Statement: Managing GERD in a patient with persistent symptoms like Jenny requires a comprehensive treatment plan that includes optimizing medication therapy, lifestyle modifications, and patient education to achieve symptom relief and improve quality of life.

Treatment Plan:

For Jenny’s GERD symptoms that are not adequately controlled with OTC Prevacid, a step-up approach involving prescription-strength medications is warranted. Lifestyle modifications should also be emphasized to complement pharmacological therapy.

Medication Recommendations:

1. Proton Pump Inhibitor (PPI): Switching to a prescription-strength PPI like Esomeprazole is recommended for improved acid suppression and symptom relief.

Prescription:

– Drug: Esomeprazole
– Dose: 40 mg
– Route: Oral
– Frequency: Once daily in the morning before breakfast
– Special Instructions: Take at least 30 minutes before meals
– Dispensed: 30 tablets (30 days supply)

– Refills: 1

2. Medication Review:

– Prevacid: Discontinue OTC Prevacid as Jenny will be transitioning to a prescription PPI.
– Diltiazem CD and Hydrochlorothiazide: Monitor for potential drug interactions between PPIs and these medications that may require dose adjustments.
– Metformin, Aspirin, Fluticasone/Salmeterol: No changes needed for these medications in relation to GERD treatment.

Monitoring:

1. Symptom Relief: Follow up with Jenny in 4 weeks to assess her response to Esomeprazole and evaluate the improvement in her GERD symptoms.

2. Adverse Effects: Monitor for any adverse effects related to PPI therapy, such as gastrointestinal disturbances or nutrient malabsorption.

Education Regarding Treatment Plan:

1. Lifestyle Modifications: Educate Jenny on dietary and lifestyle changes that can help alleviate GERD symptoms, such as avoiding trigger foods, elevating the head of the bed, and refraining from eating close to bedtime.

2. Medication Adherence: Stress the importance of taking Esomeprazole consistently and at the prescribed time to maximize its effectiveness in controlling acid reflux.

References:

1. Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 108(3), 308-328.

2. Moayyedi, P., & Talley, N. J. (2006). Gastro-oesophageal reflux disease. The Lancet, 367(9528), 2086-2100.

3. Vakil, N., van Zanten, S. V., Kahrilas, P., Dent, J., Jones, R., & Global Consensus Group. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. American Journal of Gastroenterology, 101(8), 1900-1920.

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