Mrs. Agarwalis 35 years old and is complaining of bloody diarrhea
Mrs. Agarwalis 35 years old and is complaining of bloody diarrhea. She claims that she was in good health “except for the last three months when this condition started.” In the past three months, Mrs. Agarwal has had four instances of bloody diarrhea, where it would last for a few days and resolve. Her husband claims that her appetite is “just not what it used to be” while he tells you she has been “feeling more tired than usual.” She says she has a very stressful job and has been experiencing frequent tension headaches, for which she takes one 200 mg Advil daily. Her husband adds that she “smokes one pack of cigarettes a day” to relieve her stress. Mrs. Agarwal reports abdominal tenderness upon palpation. The physician suspects that Mrs. Agarwal has inflammatory bowel disease. From your pharmacology class, you know that some of the treatments Mrs. Agarwal may receive include anti-diarrheal medications, immunosuppressive agents, and corticosteroids.
Questions
With a diagnosis of inflammatory bowel disease, what could be discussed with Mrs. Agarwal regarding changes to her diet and lifestyle? How would you present this information to her and her husband?
Agarwal receives an oral prescription for the corticosteroid, prednisone (Winipred), for seven days. How would you educate Mrs. Agarwal regarding the mechanism of action of this medication? What side effects could she expect?
Agarwal is worried about the potentially dangerous side effects of taking an immunosuppressive agent, such as azathioprine (Imuran). She states, “…I read on the Internet that you can get cancer or something even worse, from taking immunosuppressive agents…” What is your initial response to Mrs. Agarwal’s concern regarding the potential serious side effects?
Agarwal returns after 4-weeks with a severe flare-up for which she has been prescribed a corticosteroid suppository. Mrs. Agarwal wonders why she got a different medication that is administered rectally. What should you tell her about why this route of administration was chosen? How would you instruct her on how to administer it?
Agarwal is experiencing severe diarrhea with this current flare-up, having to go to the toilet 12-14 times per day. She has been taking the anti-diarrheal, loperamide (Imodium), for 48 hours to help relieve her diarrhea. Mrs. Agarwal has complaints of dry mouth, lethargy, tachycardia and voiding once every 24 hours and states she is concerned about these side effects. List 3 questions and the rationale for asking the questions, being very specific, that you would like to ask Mrs. Agarwal based on the information in this question.
Answer preview Mrs. Agarwalis 35 years old and is complaining of bloody diarrhea
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