Case 018: Ulcerative Colitis

PATIENT PRESENTATION

Chief Complaint

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.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms are associated with mild to moderate versus moderate to severe UC?

   Hint: See Clinical Presentation and Diagnosis in PPP

2. What are the main differences between prednisone and budesonide when treating UC?

   Hint: See Table 20-2 in PPP

3. What major cytokines do the biologic agents used for treatment of UC target?

   Hint: See Table 20-3 and Treatment in PPP

4. How does the disease process for UC differ from Crohn’s Disease?

   Hint: See Figure 20-2 in PPP

5. What are the main sites of action for the oral aminosalicylates?

   Hint: See Table 20-1 in PPP

FOLLOW-UP

What is the role of azathioprine in the treatment of UC?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

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.

Key References