THIS IS A PHARMACOLOGY CLASS. PLEASE PRESCRIBE THE MEDS

Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.

Overview: Gastrointestinal Case Study
Joshua George is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (H2Ras) for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20 pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin.

Diagnosis: Peptic Ulcer Disease

List specific goals for treatment for J.G.
What drug therapy would you prescribe for J.G.? Please provide your rationales.
What are the parameters for monitoring success of the therapy?
Discuss specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause you to change therapy.
What would be the choice for second-line therapy?
What over-the-counter and/or alternative medications would be appropriate for J.G.?
What lifestyle changes would you recommend to J.G.?
Describe one or two drug–drug or drug–food interaction for the selected agent.

She had a UTI years ago and it was like this, except for the incontinence. She has been more tired for the past several months. She relates she stopped getting her period about 8-12 months ago and relates her menopause was easy. She relates no medical or surgical history. She has no known drug allergies and takes no medications. Social history is negative for alcohol, tobacco, and recreational drugs. Her last exam was several years ago.

Vital signs: temperature 99.1, BP 140/ 82, pulse 88, respirations 12. Height is 5’ and weight 235 lbs. (BMI 45.89). Clean catch urine was obtained, and the urine dipstick showed SG 1.010, trace blood, neg nitrates, neg leukocytes, negative glucose, 3 protein. She thinks that maybe she had some vaginal spotting several days ago, but nothing since.

Pt relates that she has had some constipation, and increased gas for the past several months. She was using NFP for contraception prior to her stopping her period. No other urinary symptoms were reported.

Update:

Limited physical exam shows well developed, well-nourished obese Hispanic female in no apparent distress.
Breasts: pendulous, bilateral white/yellow nipple discharge noted
Abd: obese, ? mass in Abd but difficult to assess due to body habitus, otherwise soft and non-tender. Fungal dermatitis under pannus.
CVA: No cva tenderness.
VVBSU: WNL, some watery d/c noted, nitrazine positive. Vagina with pink with rugae present. Good pelvic support, no cystocele or rectocele noted.
Cervix: soft, smooth without CMT, os parous, slightly open
Uterus: difficult to assess due to body habitus however feels enlarged by bi manual exam.
Adnexa: not palpated

QUESTIONS:
What testing are you considering?
What is your differential diagnosis?