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.
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?
Instructions: Please prepare and submit a paper 3-4 pages [total] in length (not including APA format) answering the questions below. Please support your position with examples.
The patient’s subjective and objective data indicates she has inflammatory bowel disease (IBD). She presents with some IBD symptoms: diarrhea, abdominal pain, fever, fatigue, feeling weak, increased number of bowel movements and watery stool. Besides, the patient presents with IBD risk factors: health history of ulcerative colitis. She is currently on Benefiber prebiotic fiber, a significant risk factor for IBD. The lab tests indicate decreased sodium and potassium levels, caused by too much electrolytes’ loss due to diarrhea.
I would prescribe anti-inflammatory drugs to decrease the swelling in the colon. I would prescribe 400 mg delayed-release Mesalamine tablets to be taken four times a day. The patient will also require Azathioprine 3 mg/kg PO once daily. The Immune system suppressors will suppress the immune response that releases inflammation-inducing chemicals that damage the lining of the digestive tract (Pouillon et al., 2017). The patient will require an antibiotic prescription because the presence of fever presents an infection concern. She will need a twice-daily dose of Ciprofloxacin 100 mg to eradicate and prevent further infection (Chang & Hanauer, 2017).
Evaluation of Treatment Plan
The recommended pharmacologic therapy will be considered effective if it attains the intended treatment goals. The patient will be evaluated for the gradual elimination of diarrhea, abdominal pain, and fever and body weakness. The body’s sodium levels are expected to go back to between 135 and 145 milliequivalents per liter and the Potassium level 3.6 to 5.2 millimoles per liter. These are the normal levels in healthy adults.
The patient should be advised to take all the prescribed drugs as directed by the care provider. The drugs should be taken at the same time every day for better outcomes. The patient should be advised not to exceed the prescribed dose, dose frequency, and prescription duration ordered by the care provider. She should not stop any of the prescribed medicine without checking first with the care provider, even if symptoms improve. In case a dose is missed, it should be taken as soon as possible unless it is almost time for the next dose. In that case, she should skip the missed dose and resume the regular dosing schedule to o avoid double dosing.
The delayed-release Mesalamine tablets should be taken orally, with food, four times a day. The tablets should not be crushed or chewed because doing so reduces their efficiency and increase the risk of side effects. The patient should increase fluid intake to improve renal excretion of the drug and avoid toxicity.
The most common side effects of Mesalamine that the patient should watch out for include stomach upset, nausea, vomiting, constipation, headache, joint, and muscle pain. These side effects often go away after a few days without any clinical intervention. Some severe side effects that the patient should immediately report to the care provider include the presence of whole or partial tablets in the stool, indicating impaired absorption. The patient may also experience increased abdominal pain, bloody diarrhea, fever, change in the amount of urine, dark urine, yellowing eyes or skin, chest pain and shortness of breath, and allergic reactions.
Regarding the Azathioprine prescription, the drug should be taken with food to reduce the risk of gastrointestinal side effects. The common side effects that the patient should watch out for include fever, swollen glands, body aches, night sweats, easy bruising or bleeding, cold hands and feet, and shortness of breath, and increased frequency of infection (Broekman et al., 2017). These side effects can be fatal; therefore, the patient should contact the care provider if they become bothersome. Besides, these drugs are contraindicated in pregnant women as they can harm the unborn baby; therefore, the patient should use contraceptives efficiently to avoid pregnancy while on this prescription.
Regarding the ciprofloxacin prescription, the medication should be taken twice daily, at least 2 hours before or 6 hours after taking supplements and vitamins, because they impair its absorption and decrease its effectiveness. Besides, Calcium-rich foods, such as dairy products calcium-fortified juice, can also reduce the effect of this medication; therefore should not be co-administered. The patient should watch out for drug side effects such as nausea, diarrhea,
dizziness, lightheadedness, headache, or trouble sleeping (Wang & Hamlyn, 2020). These side effects are often mild and disappear without any intervention. The patient should contact the care provider if serious side effects such as unusual bleeding, persistent fever, persistent sore throat, fainting, change in urine, and color are experienced.
An individual’s genetic makeup impacts drug absorption, metabolism levels, and clearance. All the current prescriptions are excreted through renal system. The patient should be tested for gene mutations that impact renal structure and functioning. The individual should also be tested for Glutathione S-transferases (GSTs). High GST levels could make the body sensitive to azathioprine and potentially more prone to adverse effects during treatment with azathioprine, thus requiring a reduced dose.