Drug Study

on Mesalamine
Mercaptopurine
Presented by:
Lamia Habib Alshammri 201900555
Latifa saud Alshammari 201900969
Sarah Sahan Alshammari 201900182
Presented to: Dr. Vivian (Pharmacology 1 Instructor)
2nd Semester AY 2020-2021
 Patient Information and History:
● Name of Patient: A.M
● Age: 46 years old
● Gender: Female
● Medical Condition: Crohn's Disease
● Patient History of Medical Condition: A.M is a 47-year-old with Crohn's Disease, DM, and HTN who presented to the ED after
two days of severe abdominal pain, nausea, vomiting, and diarrhea. She stated that on Wednesday evening after being in her
usual state of health she began to experience sharp lower abdominal pain that radiated throughout all four quadrants. The pain
waxed and waned and was about a 4/10 and more intense than the chronic abdominal pain episodes she experiences
periodically from her Crohn’s disease. The pain was sudden, and she did not take any medications to alleviate the discomfort.
The abdominal pain was quickly followed by two episodes of partial diarrhea and soft stool that was tan in color with no signs
of blood. Her abdominal pain continued, and she developed nausea and then vomited six times that evening before going to
sleep. Overnight her abdominal pain worsened, and she stayed in bed for most of the day on Thursday. She had nausea again
all day but had no other episodes of diarrhea or vomiting that day and did not eat anything for fear of vomiting. She was able to
drink water and keep it down. By late Thursday night, her pain had intensified to a 10/10 and she called 911 and was brought to
the ER by ambulance from her home in Burlington.
● Ms.A.M was last hospitalized at UNC for Crohn's disease exacerbation in March 2007. She has been compliant with taking her
medications for Crohn's and has been stable on her mesalamine, mercaptopurine, and omega -3-acid supplement.

● Upon arrival to the ED, Ms.A.M was put on IV fluids, given fentanyl 50 mcg IVP, phenegran 12.5 mg diluted with 10 mL NS IVP,
and Mg sulfate IVP.
Drug Name/Generic Name
Dosage/Picture
Brand name:
1- Asacol HD, Pentasa, Delzicol, Lialda, Apriso
2- Mercaptopurine
3- Lovaza, Vascazen, Omtryg, and Omega
Generic name:
1- mesalamine
2- Purinethol or Purixan
3- omegas
Dosage:
1-500 mg QID
2- 50 mg tablets , Oral Suspension: 20 MG/1 ML
3-900 mg .po. per day
 Classification

1
5-Aminosalicylic Acid
Derivatives
3
antilipemic or lipid-regulating agents.

2
Antineoplastic; Antimetabolite,
Purine Antagonist;
Immunosuppressant
 Action - Indication - Contraindication

Action:

● work by blocking the activity of cyclooxygenase and lipoxygenase, thereby, reducing the production of
prostaglandins.
● Antimetabolite and purine antagonist. Inhibits purine metabolism by unclear mechanism. Blocks conversion
of inosinic acid to adenine and xanthine ribotides within sensitive tumor cells. Also inhibits adenine-
containing coenzymes, suggesting an influence over multiple cellular reactions.
● polyunsaturated fatty acids (PUFAs) and their metabolites are natural ligands for peroxisome proliferator-
activated receptor (PPAR) gamma that regulates inflammatory gene expression and NFκB activation.
 Action - Indication - Contraindication

Indication:

● used to treat inflammatory bowel disease.

● Drug: Allopurinol may inhibit metabolism and thus increase toxicity of mercaptopurine; may potentiate
or antagonize anticoagulant effects of warfarin.
● help reduce the risk of heart disease. They have been used along with diet and exercise to help lower
levels of a certain blood fat (triglyceride) and to raise levels of "good" cholesterol (HDL).
 Action - Indication - Contraindication

Contraindication
PRO

● hypersensitivity to mesalamine or salicylates .Breastfeeding .Rectal suspension: Hypersensitivity to salicylates,

amino salicylates or to any ingredients in the suppository vehicle.
● .Children with chickenpox or flulike symptoms.
● Prior resistance to mercaptopurine; first trimester of pregnancy (category D); lactation; infections.
● appendicitis.
● inflammatory bowel disease.
● paralysis of the intestines.
● blockage of the stomach or intestine.
Side Effects - Adverse Reactions

● work by blocking the activity of cyclooxygenase and lipoxygenase, thereby,

reducing the production of prostaglandins.
● Antimetabolite and purine antagonist. Inhibits purine metabolism by
unclear mechanism. Blocks conversion of inosinic acid to adenine and
xanthine ribotides within sensitive tumor cells. Also inhibits adenine-
containing coenzymes, suggesting an influence over multiple cellular
reactions.
● bad breath, bad-smelling sweat, headache, and gastrointestinal symptoms
such as heartburn, nausea, and diarrhea.
 Side Effects - Adverse Reactions

● fever, headache, rash with pruritus, nausea, vomiting, and

dyspepsia.
● GI: Stomatitis, esophagitis, anorexia, nausea, vomiting, diarrhea,
intestinal ulcerations, impaired liver function, hepatic necrosis.
Hematologic: Leukopenia, anemia, eosinophilia, pancytopenia,
thrombocytopenia, abnormal bleeding, bone marrow hypoplasia.
Urogenital: Hyperuricemia, oliguria, renal impairment. Skin: Rash.
Body as a Whole: Drug fever.

● Fishy breath.
● Stomach upset.
● Loose stools.
● Nausea
 Nursing Responsibilities

• Provide patient with copy of mesalamine administration instructions. Monitor lab test,
Assess for S&S of allergic-type reactions, Expect response to therapy within 3–21 d.
Assessment & Drug Effects :
• Lab tests: Monitor CBC with differential, platelet count, Hgb, Hct, and liver functions closely.
• Monitor for S&S of liver damage. Hepatic toxicity occurs most often when dose exceeds 2.5 mg/kg/d.
Jaundice signals onset of hepatic toxicity and may necessitate terminating use.
• Withhold drug and notify physician at the first sign of an abnormally large or rapid fall in platelet and
leukocyte counts.
• Record baseline data related to I&O ratio and pattern and body weight.
• Check vital signs daily. Report febrile states promptly.
• Protect patient from exposure to trauma, infections, or other stresses (restrict visitors and personnel
who have colds) during periods of leukopenia.
• Report nausea, vomiting, or diarrhea. These may signal excessive dosage, especially in adults.
• Watch for signs of abnormal bleeding (ecchymoses, petechiae, melena, bleeding gums) if
thrombocytopenia develops; report immediately.
 cont.

• Patient & Family Education

• Report any signs of bleeding (e.g., hematuria, bruising, bleeding gums).
• Report signs of hepatic toxicity (see Appendix F).
• Increase hydration (10–12 glasses of fluid daily) to reduce risk of
hyperuricemia. Consult physician about desirable volume.
• Notify physician of onset of chills, nausea, vomiting, flank or joint pain,
swelling of legs or feet, or symptoms of anemia.
• Do not breast feed while using this drug.
Nursing Responsibilities

• Monitoring S&S
• Monitoring adverse reaction
 Reference:

• https://www.rxlist.com/consumer_mesalamine_asacol_pentasa/drugs-condition.htm#what_other_drugs_interact_with_mesalamine

• http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=M032.html

• https://www.rxlist.com/consumer_mesalamine_asacol_pentasa/drugs-condition.htm#what_other_drugs_interact_with_mesalamine
 THANKS
YOU!!

CREDITS: This presentation template was created by Slidesgo, including icons by

Flaticon, and infographics & images by Freepik