Posted: May 15th, 2023

Mrs. Z is a 34-year-old female with a history of ulcerative colitis

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.

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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:

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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.

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

Instructions:

Please prepare and submit a paper 3-4 pages [total] in length (not including APA formatted title and references pages) answering the questions below. Please support your position with examples.

What pharmacologic therapy would you prescribe for Mrs. Z?

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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?

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What, if any, lifestyle changes would you recommend?

______________________
Based on the provided information, Mrs. Z is a 34-year-old female with a history of ulcerative colitis who presents with diarrhea, abdominal pain, and weakness. Her recent symptoms include 10 small volume watery stools with varying amounts of blood daily. The objective data shows mild tenderness on abdominal palpation and a temperature of 100.1°F. Her labs reveal an elevated white blood cell count (WBC) of 14,000, decreased hemoglobin (Hgb) of 11.9, and decreased potassium (K) of 3.3.

Pharmacologic therapy:
Considering Mrs. Z's history of ulcerative colitis, her current symptoms, and the presence of blood in her stools, the most appropriate pharmacologic therapy would be to initiate treatment for an acute flare of ulcerative colitis. The recommended initial therapy typically involves a combination of corticosteroids and aminosalicylates. In this case, oral prednisone and mesalamine can be considered.
Prednisone: Prednisone is a systemic corticosteroid that helps reduce inflammation. It can be initiated at a dose of 40-60 mg daily and gradually tapered over several weeks as symptoms improve.
Mesalamine: Mesalamine is an aminosalicylate agent that acts topically in the gastrointestinal tract to reduce inflammation. It can be administered orally as a delayed-release formulation or as a rectal suppository or enema, depending on the extent of colonic involvement. The dosage will depend on the specific product prescribed.
Evaluation of therapy effectiveness:
The effectiveness of the pharmacologic therapy can be evaluated based on the resolution of symptoms and improvement in objective measures. Mrs. Z's symptoms, such as diarrhea, abdominal pain, and blood in stools, should gradually improve with treatment. Additionally, monitoring the inflammatory markers (such as C-reactive protein or fecal calprotectin) can help assess the reduction in inflammation. Follow-up visits and repeat laboratory tests can be scheduled to evaluate her progress.

Patient education:
Mrs. Z should be provided with comprehensive patient education regarding the prescribed medications, potential side effects, and the importance of adherence to the treatment plan. Key points to cover include:

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Explanation of the purpose and mechanism of action of the medications.
Instructions on how to take each medication, including dosage, frequency, and duration.
Potential side effects and when to contact the healthcare provider.
Importance of completing the full course of treatment and not stopping the medications abruptly.
Lifestyle modifications and self-care strategies, such as stress reduction techniques, adequate hydration, and maintaining a healthy diet.
Pharmacogenetic considerations:
Pharmacogenetic testing may not be immediately necessary for the medications prescribed in this scenario. However, certain genetic variations can affect drug metabolism and response. If available, genetic testing can be considered to identify any relevant pharmacogenetic considerations that may impact drug selection or dosage adjustments.

Alternative therapies or over-the-counter agents:
While the primary treatment for ulcerative colitis involves prescription medications, there are some over-the-counter agents and alternative therapies that may provide additional support:

Probiotics: Probiotic supplements or foods containing beneficial bacteria may help promote a healthy gut microbiome. However, the specific strains and dosages should be discussed with the healthcare provider.
Anti-diarrheal agents: Over-the-counter antidiarrheal medications like loperamide can provide temporary relief from diarrhea. However, their use should be limited and under the guidance of a healthcare professional.
Slippery elm and fiber supplements: Slippery elm and fiber supplements like Benefiber, which Mrs. Z is already taking, can help add bulk to stools and alleviate symptoms of diarrhea. However, their efficacy should be monitored, and adjustments

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