NUR231 Drug Therapy

Question:

She is currently taking metoclopramide orally for her hyperemesis, but doesn’t feel that it is very effective. She is now considering whether to also use ondansetron wafers.
She has a medical history of severe viral hepatitis from when she spent 6 months travelling overseas for at the age of 22. This has resulted in her having permanent liver dysfunction.

1. Explain two main reasons why Kelly’s sciatica has increased during her pregnancy. Ensure that you include relevant pathophysiology in your answer.

2. Consider Kelly’s liver dysfunction – how might this impact on the pharmacokinetics of her paracetamol and metoclopramide. Ensure that you include an appropriate consideration of hepatic first pass metabolism in your answer.

3. Describe how her current anti-emetic medication can be effective in reducing nausea and vomiting.

4. Compare the mechanism of action of her current anti-emetic medication (metoclopramide) with an alternative medication that she is not taking, ondansetron.

5. Discuss one main reason why pregnancy can cause nausea and vomiting, ensuring that you focus on the mechanisms that directly affect the gastrointestinal system.

6. Kelly may be offered the use of pethidine for sciatica during this stage of her pregnancy, and during childbirth. Discuss one main adverse reaction that may occur as a result of pethidine administration, and how would this be managed.