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LEARNING OBJECTIVES

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

  • Identify the common signs and symptoms of ulcerative colitis (UC).

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

  • Develop a pharmacotherapeutic plan for a patient with UC whose disease is in remission.

  • Discuss recent advances in the pharmacotherapy of UC.

PATIENT PRESENTATION

Chief Complaint

“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.”

HPI

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 UC flares. She states that she has been having about four 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.

PMH

UC, diagnosed 3 years ago

Type 1 DM

FH

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

SH

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 2005 to 2008 but states none in the past 10 years

Meds

Insulin aspart via insulin pump; settings per endocrinology.

Vaccination history is unavailable.

All

NKDA

ROS

Negative ...

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