Case Study: Inflammatory Bowel Disease Essay

Case Study: Inflammatory Bowel Disease Essay

Case Study

Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain. Onset of the symptom was about 4 days ago. She reports thinking she is running a fever but has not taken her temperature. She concerned that she is starting to feel weak.

When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months. In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.

She denies recent travel and reportedly has not been on any antibiotics in the past few weeks.

In reviewing her record, you notice that her health history is positive for history of ulcerative colitis. She has not been on any medications for this over the last few years as she had not been symptomatic.

Mrs. Z is on an oral contraceptive. She takes slippery elm capsules and has for the last several years. She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.

Objective data:

BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1

Abdomen: active bowel sounds all 4 quadrants, mild tenderness with palpation

Otherwise her exam is unremarkable for pertinent positives or negatives.

Labs:  WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3

 

• What pharmacologic therapy would you prescribe for Mrs. Z?
• How will you evaluate the effectiveness of this therapy?
• What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?
• Are there any pharmacogenetic considerations related to what you prescribed for the patient?
• Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?
• What, if any, lifestyle changes would you recommend?

 

Background

The case study is about Mrs. Z who is a 34yo female. She visits the clinic with a chief complaint of diarrhea and abdominal pain. The client reports that these symptoms started 4 days ago. She further reports a suspected fever but denies taking a temperature. The client also reports feeling weak. The client reports an increase in the number of bowels in the last few months.

She reports having an average of about 10 small-volume watery stools. Her daily stool contains varying amounts of blood. The client denies recent use of antibiotics or travel. Her medical history is positive for ulcerative colitis. The client denies being under any medications for the last few years. Mrs. Z has also not been symptomatic in the recent past. She reports being on an oral contraceptive. The client takes slippery elm capsules for some years. In the last few days, the client has been taking Benefiber prebiotic fiber, 2 to 3 doses. The client’s blood pressure was 116/70 and 100/66 while sitting and standing. Her oxygenation saturation was 92 and her temperature was 100.1. Her physical examination results indicated active bowel sounds in all 4 quadrants of her abdomen. Mild tenderness was also noted with palpation. The client’s lab results indicated a WBC of 14,000; Hct 35.7; Hgb 11.9; 133 sodium, and 3.3 potassium. This paper focuses on pharmacological therapy that would be recommended for Mrs. Z; strategies for evaluating the effectiveness of the prescribed therapy; recommended patient education related to the prescribed pharmacologic agent; pharmacogenetic to be considered regarding prescribed pharmacology agents; helpful alternative therapies or over-the-counter agents; and recommended lifestyle changes.

Pharmacological Therapy that would be recommended for Mrs. Z

Inflammatory bowel disease (IBD) is a common diagnosis in various patient populations worldwide. IBD is categorized into two major forms, including ulcerative colitis and Crohn’s disease. Individuals diagnosed with this condition mainly report chronic inflammation of the gastrointestinal (GI) tract. The client has a positive history of ulcerative colitis, which is characterized by various symptoms, including diarrhea often accompanied by pus or blood, rectal bleeding, abdominal cramping, and pain, the urgency to defecate, rectal pain, inability to defecate, weight loss, and fatigue or weakness (Sehgal et al., 2018). The client reports diarrhea and abdominal pain during the clinical interview. The client reports an increase in the number of bowels in the last few months with an average of about 10 small-volume watery stools. Her daily stool contains varying amounts of blood and reports feeling weak, qualifying for an ulcerative colitis diagnosis. Additionally, ulcerative colitis is attributed to some physical exams findings such as skin rashes, abdominal tenderness without mass, joint swelling and pain, and abdominal pain (Buck et al., 2020). The client’s physical examination indicated mild tenderness with palpation and evidence of abdominal pain. Therefore, the client qualifies for ulcerative colitis diagnosis.

The client would be prescribed Dipentum 500 mg twice daily. This drug is preferred since it’s an aminosalicylate with anti-inflammatory action. According to Le Berre et al. (2020), aminosalicylates are recommended as the first-line treatment and maintenance therapy in adults with ulcerative colitis. These drugs are recommended due to their efficacy in inducing and maintaining remission in individuals diagnosed with mild to moderate ulcerative colitis. Thus, Dipentum 500 mg twice daily would effectively manage presented symptoms, including diarrhea and abdominal pain, and prevent remission.

Strategies for Evaluating the Effectiveness of the Prescribed Medication

A healthcare provider evaluates a treatment regimen to determine its efficacy in treating an individual patient. In this case, the client’s drug therapy will be evaluated after two weeks based on clinical manifestations reported during the initial visit. A decline in the number of bowel movements, the volume of watery stool, and blood in the stool will indicate the efficacy of the prescribed medication, Dipentum 500 mg twice daily as treatment and maintenance therapy. Additionally, the decline in abdominal pain after taking the medication for two weeks will indicate its effectiveness in managing the client’s condition. The client will be advised to continue with the current drug and dosage and return to the clinic after two weeks for review. On the contrary, the current medication and dosage will be considered ineffective if the client does not report improvement in initial clinical manifestations after taking the medication for two weeks. In this case, the client’s dosage should be titrated upwards to Dipentum 2 g/day. According to Murray et al. (2020), the effectiveness of Oral 5‐aminosalicylic acid in treating adults with ulcerative colitis increases with dosage. Thus, increasing the current dosage of Dipentum from 500 mg twice daily to 2 g/day would enhance its efficacy in remitting presented symptoms.

Recommended Patient Education related to prescribed pharmacological Agent

Patient education enhances outcomes in patients treated with pharmacological agents. In this case, the client should be educated on the significance of taking an adequate amount of fluids while taking the prescribed medication. This drug is more effective when the patient is well-hydrated during treatment. Additionally, being hydrated prevents severe intoxication that may cause an imbalance in blood pH and electrolytes and imbalance, which might damage the kidney or liver. Furthermore, the client should be educated about Dipentum’s potential side effects, including headache, nausea and vomiting, heartburn, stomach discomfort, reduced appetite, skin rash, itching, and muscle pain (Mizuno et al., 2020). The client will adhere to the prescribed drug and dosage once potential side effects are known, achieving positive health outcomes.

Pharmacokinetics to be considered regarding Prescribed Medication

Dipentum causes potential drug-drug interactions when used with some medications. The client is on an oral contraceptive, increasing the risk of drug-to-drug interaction when taken with Dipentum (Chowdhury, 2019). This drug has a microsomal enzyme-inducing activity, which is likely to affect contraceptive activity negatively. For this reason, the client should abstain or use barrier methods while taking this medication to reduce the risk of unwanted pregnancy.

Over-the-Counter Agents

Over-the-counter medications are recommended to this client to enhance the efficacy of the prescribed pharmacological agents. Specifically, the client can use over-the-counter medications for managing abdominal pain such as loperamide. This drug is recommended due to its efficacy in relieving cramping from diarrhea.

Recommended Lifestyle Changes

The client would be advised to adjust her lifestyle, including taking a healthy diet and engaging in physical activities. Briguglio et al. (2020) reported that a healthy diet and increased physical activities effectively prevent lifestyle diseases. Thus, the client will be at a lower risk of developing lifestyle diseases such as hypertension, obesity, and diabetes type 2 Mellitus following lifestyle changes. Additionally, the client should practice sleep hygiene to reduce the likelihood of developing mental health disorders (Briguglio et al., 2020).

Overall, the client’s current diagnosis is ulcerative colitis, which is characterized by diarrhea, abdominal pain, blood in the stool, and feeling weak. This condition can be managed using Dipentum 500mg, which has an anti-inflammatory effect. Additionally, the client can use loperamide, which is an effective over-the-counter medication for managing abdominal pain accompanied by diarrhea.

References

Briguglio, M., Vitale, J. A., Galentino, R., Banfi, G., Zanaboni Dina, C., Bona, A., … & Glick, I. D. (2020). Healthy eating, physical activity, and sleep hygiene (HEPAS) as the winning triad for sustaining physical and mental health in patients at risk for or with neuropsychiatric disorders: considerations for clinical practice. Neuropsychiatric Disease and Treatment, 55-70.

Buck, M., Dumic, I., McDermott, W., Nordstrom, C., Dawan, S., Virata, A., … & Nordin, T. (2020). Leukocytoclastic vasculitis as a rare dermatologic manifestation of Crohn’s disease mimicking cellulitis: a case report. BMC gastroenterology, 20(1), 1-7.

Chowdhury, L. (2019). Handbook of Pharmacology for the Anaesthesiologist. Jaypee Brothers Medical Publishers.

Le Berre, C., Roda, G., Nedeljkovic Protic, M., Danese, S., & Peyrin-Biroulet, L. (2020). Modern use of 5-aminosalicylic acid compounds for ulcerative colitis. Expert Opinion on Biological Therapy, 20(4), 363-378.

Mizuno, S., Ono, K., Mikami, Y., Naganuma, M., Fukuda, T., Minami, K., … & Kanai, T. (2020). 5-Aminosalicylic acid intolerance is associated with a risk of adverse clinical outcomes and dysbiosis in patients with ulcerative colitis. Intestinal research, 18(1), 69.

Murray, A., Nguyen, T. M., Parker, C. E., Feagan, B. G., & MacDonald, J. K. (2020). Oral 5‐aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database of Systematic Reviews, (8).

Sehgal, P., Colombel, J. F., Aboubakr, A., & Narula, N. (2018). Systematic review: safety of mesalazine in ulcerative colitis. Alimentary pharmacology & therapeutics, 47(12), 1597-1609.