Case Study: Inflammatory Bowel Disease
It is important to note that Mrs. Z suffers from inflammatory bowel disease, or IBD, which causes her small watery stools and diarrhea. The most appropriate pharmacological therapy should focus on prescribing anti-inflammatory medication to reduce inflammation’s effect on the body. In addition, the therapy can include immune suppressors in order to reduce inflammation symptoms even further. Therefore, since the patient is most likely suffering from ulcerative colitis due to her positive history, corticosteroids and aminosalicylates should be used as the core medications.
When it comes to inflammatory bowel disease, a wide range of medications can be used to reduce the impact of inflammation on bodily function. It is stated that “medications, including 5-aminosalicylates, corticosteroids, immunomodulators (thiopurines [azathioprine and mercaptopurine] and methotrexate), and biological agents (anti-tumor necrosis factor [TNF; infliximab, adalimumab, and certolizumab pegol], and anti-adhesion molecules [vedolizumab]), are the cornerstone of treatment of IBD” (Chan et al., 2017, p. 434). In other words, aminosalicylates and corticosteroids should be utilized in order to reduce inflammation and ensure that the disease does not progress further. The next line of medications that can be used includes immune suppressors, such as methotrexate or azathioprine. It is stated that “under combination therapy, AZA dose reduction, but not withdrawal, appears to be as effective as a continuation of AZA at full dose” (Roblin et al., 2017, p. 142). In other words, the immune suppressant can be used in combination with anti-inflammatory drugs, but a reduced dose will be needed. The selected drug, mesalamine, a 5-aminosalicylic acid, is effective against ulcerative colitis.
Moreover, the process of evaluating the effectiveness in regard to pharmacological therapy is critical. It is important to evaluate on the basis of symptom reduction. Firstly, the patient needs to be asked about diarrhea and watery stools, which means that stools’ overall frequency and typology will be the first evaluative measure. Secondly, the patient’s WBC can also be an indicator of the effectiveness of the therapy. The presence of low anemia levels of key vitamins and minerals in the blood might indicate that the intestine is not absorbing nutrients properly (NYU Langone Hospitals, 2022). Lab measurements are necessary to ensure that there are no renal alterations, liver enzyme changes, and drug toxicity. Lastly, endoscopic procedures can also be used to evaluate the effectiveness of the treatment by observing abnormalities visually.
The results of endoscopic studies play an important role in the diagnosis of inflammatory bowel disease. Characteristic radiological signs in this disease are segmentation and discontinuity of lesions, the presence of ulcers of various sizes and shapes, areas of narrowing of the intestine, and fistulas (Arcangelo et al., 2021). With the help of the most valuable diagnostic endoscopic studies, segmentation and asymmetry of the inflammatory process, focal hyperemia, and edema are revealed.
Since mesalamine is prescribed as an agent to treat the symptoms of the disease, education on consumption needs to be delivered. The patient will be informed on how the pills work, where swallowing the entire pill as a whole is critical to its effectiveness (Arcangelo et al., 2021). Mrs. Z will be told that the mesalamine pill’s protective coating needs to dissolve near the inflamed area in order for the drug to work on the problematic regions of the intestinal lining. In the case of pharmacogenetic considerations, it is important to note that the drug works by activating γ-form peroxisome proliferator-activated receptors (PPAR-γ) (Yamamoto-Furusho, 2017).
IBD UC patients tend to have low expression of PPAR-γ, which results in inflammation. Researchers “observed an increase of PPAR alpha expression in patients with UC who were treated with 5-aminosalicylates compared with those who received any other combined therapy” (Yamamoto-Furusho, 2017, p. 198). The patient should also know that she might become sensitive to sunlight, which is why she should consider this factor when taking the pill.
Alternatively, Mrs. Z can also take antibiotics, vitamins and supplements, and anti-diarrheal medications. The latter will help to alleviate the watery stools, and the former might be useful for combatting infections if present. Vitamins and supplements might be needed in order to ensure that her body gets a sufficient amount of vitamins and minerals, which might be lacking due to lower absorption of the intestinal lining. For lifestyle changes, diet is important in order to assist the digestive system. The recommendations include low-fat products, lean proteins source, high fiber carbohydrates, omega-3 fatty acids, and proper hydration.
In conclusion, Mrs. Z has an ulcerative colitis type of inflammatory bowel disease. The prescribed medication is a 5-aminosalicylic acid or mesalamine, which is an anti-inflammatory drug. Reducing inflammation is critical in order to restore her health and well-being. The evaluative measures include lab tests, stool tests, and blood work. The patient should also be properly educated on how to swallow the pills in order to ensure more precision-based targeting of the inflamed region. In addition, antibiotics, vitamins and supplements, and anti-diarrheal medications can be used. In the case of lifestyle adjustments, the diet should involve a lower amount of fats, lean proteins, and high-fiber carbohydrates.
Arcangelo, V. P., Peterson, A., Wilbur, V., & Reinhold, J. A. (2021). Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer Health.
Chan, W., Chen, A., Tiao, D., Selinger, C., & Leong, R. (2017). Medication adherence in inflammatory bowel disease. Intestinal Research, 15(4), 434–445. Web.
NYU Langone Hospitals. (2022). Diagnosing inflammatory bowel disease in adults. Web.
Roblin, X., Boschetti, G., Williet, N., Nancey, S., Marotte, H., Berger, A., Phelip, J. M., Peyrin-Biroulet, L., Colombel, J. F., Tedesco, E. D., Paul, S., & Flourie, B. (2017). Azathioprine dose reduction in inflammatory bowel disease patients on combination therapy: An open-label, prospective and randomized clinical trial. Alimentary Pharmacology & Therapeutics, 46(2), 142–149. Web.
Yamamoto-Furusho J. K. (2017). Pharmacogenetics in inflammatory bowel disease: Understanding treatment response and personalized therapeutic strategies. Pharmacogenomics and Personalized Medicine, 10, 197–204. Web.