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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify the common signs and symptoms of ulcerative colitis.

  • Evaluate treatment options for an acute episode of ulcerative colitis and recommend a specific treatment plan that includes the medication, dosing regimen, potential side effects, and monitoring parameters.

  • Develop a pharmacotherapeutic plan for an ulcerative colitis patient whose disease is in remission.

  • Discuss recent advances in the pharmacotherapy of ulcerative colitis.

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PATIENT PRESENTATION

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Chief Complaint

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“I can’t take the pain and diarrhea anymore. I thought I could make it until I got home to see my doctor but today I realized I needed to see someone.”

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HPI

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Bonnie Smith is a 32-year-old woman who presents to the ED with the chief complaint of a 1.5 week history of abdominal pain associated with cramping, bloody diarrhea, and mucus that she states is typical of her ulcerative colitis flares. She states that she has been having about four to five bloody bowel movements a day for most of the time that she has been in our city on vacation, but today she was dizzy when she stood up; she did not have any symptoms while sitting or lying down. She has been here on vacation for almost 2 weeks and is scheduled to return home in 3 days. She has not traveled outside the country, been hospitalized, or received antibiotics recently. She was diagnosed with UC approximately 3 years ago and has had approximately one exacerbation a year that her physician has treated with Pentasa capsules four times a day during each exacerbation. Each time her symptoms have resolved with 4–6 weeks of therapy. She has refused maintenance therapy because she does not want to take a medication four times a day; it is not conducive to her work and social life and she has refused rectal medications for the same reason. Her last exacerbation was approximately 10 months ago.

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PMH

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  • Ulcerative colitis, diagnosed 3 years ago

  • Type 1 DM

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FH

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Mother has a history of CAD and lung CA; father has a history of ulcerative colitis, S/P colectomy 18 years ago.

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SH

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Works as an office manager; lives with her fiancée; no children; denies tobacco use; drinks one to two glasses of wine every few weeks; acknowledges marijuana use from 2002 to 2005 but states none in the past 10 years

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Meds

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  • NPH insulin 22 units in the morning and evening; insulin aspart 6 units for blood glucose >300 mg/dL.

  • Vaccination history is unavailable.

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All

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NKDA

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ROS

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Negative for chest pain, SOB, dysuria, fever, chills, N/V, myalgias, arthralgias, polyuria, or recent ...

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