Continued abdominal pain and diarrhea for 2 months
History of Present Illness
SM is a 31-year-old woman with a history of mild-moderately severe extensive ulcerative colitis. She has been receiving oral budesonide for 9 months but continues to have worsening intermittent abdominal pain and diarrhea with occasional blood over the last 2 months.
Drug Therapy Problems
Care Plan (by Problem)
What signs and symptoms are associated with mild to moderate versus moderate to severe UC?
Hint: See Clinical Presentation and Diagnosis in PPP
What are the main differences between prednisone and budesonide when treating UC?
Hint: See Table 20-2 in PPP
What major cytokines do the biologic agents used for treatment of UC target?
Hint: See Table 20-3 and Treatment in PPP
How does the disease process for UC differ from Crohn’s Disease?
Hint: See Figure 20-2 in PPP
What are the main sites of action for the oral aminosalicylates?
Hint: See Table 20-1 in PPP
What is the role of azathioprine in the treatment of UC?
Hint: See Treatment in PPP
The disease process for UC is chronic and often progresses in severity over time. As initial therapies such as aminosalicylates and corticosteroids lose efficacy, there are now multiple agents that may be initiated to induce and maintain remission. Given many of these agents, particularly the biologic agents and the immunomodulators, have the potential for serious adverse effects, high costs, and drug interactions, the pharmacist plays an essential role in assisting the healthcare team in making the most effective and affordable drug regimen. This requires use of the most recent evidence-based treatment guidelines to direct therapy choices and patient education on how to appropriately use and optimize their medications.
FS. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology. 2021;161(3):1043–1051.e4. doi: 10.1053/j.gastro.2021.05.063
RD. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary. Gastroenterology. 2020;159(1):350–357. doi: 10.1053/j.gastro.2020.04.012