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Case Study

Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain.  Onset of the symptom was about 4 days ago.  She reports thinking she is running a fever but has not taken her temperature.  She concerned that she is starting to feel weak. 

When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months.  In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.

She denies recent travel and reportedly has not been on any antibiotics in the past few weeks. 

In reviewing her record, you notice that her health history is positive for history of ulcerative colitis.  She has not been on any medications for this over the last few years as she had not been symptomatic.

Mrs. Z is on an oral contraceptive.  She takes slippery elm capsules and has for the last several years.  She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.

Objective data:

BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1

Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation

Otherwise her exam is unremarkable for pertinent positives or negatives.

Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3

· What pharmacologic therapy would you prescribe for Mrs. Z?

· How will you evaluate the effectiveness of this therapy?

· What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?

· Are there any pharmacogenetic considerations related to what you prescribed for the patient?

· Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?

· What, if any, lifestyle changes would you recommend?

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Case Summary:

· Mrs X, 34, F

· Chief complaint: (+) diarrhea, (+) abdominal pain, fatigue

· watery stools with streaks of blood

· (-) antibiotic use, (-) travel

· PMH: (+) ulcerative colitis, no maintenance meds

· Recent probiotic intake

· Abdominal examination: active bowel sounds all 4 quadrants, mild tenderness with palpation


· To consider ulcerative colitis flare – severe

· To consider intestinal amebiasis

What pha




Ulcerative colitis is an inflammatory bowel illness that causes the colon and rectum of the

patient to become inflamed and ulcerated for an extended period (Kamat et al., 2017). The

symptoms of ulcerative colitis are evident in Mrs. Z. Abdominal aches, exhaustion, and bloody

diarrhea is among these symptoms. Consequently, the pharmacological treatment for Mrs. Z will

be as follows: “Mesalamine 800mg TID for 6/52 weeks, Azathioprine 50mg TID for 2/5 weeks,

and Metronidazole 500mg TID for 5/7 days” (Kamat et al., 2017).

The goal of treatment is to reduce inflammation while also removing the source of it. As

an anti-inflammatory, Mesalamine is useful in treating inflammation in the gastrointestinal tract,

particularly in the colon and rectum. Because it inhibits the inflammatory immune responses

caused by the molecules in the colon’s lining, Azathioprine is classified as an immunosuppressive

medicine (Ryan et al., 2020). As a result, the inflammation will be reduced, and the patient will no

longer have discomfort in the abdomen. Finally, metronidazole is an antibiotic that aids in

eradicating colonic bacterial infection.

Qn 2.

A critical part of figuring out how medications affect Mrs. Z is evaluating how well they

work after giving them to her. The relief of the patient’s symptoms is one of the medication

therapy’s good benefits. Mrs. Z’s symptoms of discomfort, fever, and diarrhea should go away in

2 to 5 days if she takes her medication as prescribed. First, I’ll take her temperature, examine her

stool, and inquire about her stomach discomfort levels to see if the clinical signs and symptoms

have improved.


“The patient’s temperature will decreased from 100.1F to 36-37 degrees Celsius, her stool

will be solid” (Ryan,et al., 2017). the patient’s stomach pain will be at a minimal level if this

assessment demonstrates a positive outcome. Having a favorable result indicates that the

medication being given to Mrs. Z is working. This suggests that the indications and symptoms are

still present and that medication is ineffective at controlling them.

Second, I’ll look at the lab results to see if the meds are working. “It’s expected that the

white blood cell count will return to normal levels (4,000 to 11,000 WBCs per microliter) and that

the hemoglobin level will rise between 12 to 15.4 g/dl” (Ryan et a