CASE PRESENTATION

Presented By :
ON ULCERATIVE Shivam Sharma
COLITIS
PATIENT INITIAL ASSESSMENT
AND RECONCILIATION
Patient Name : Rampal Yadav Age : 44 Sex : M
IP NO. IP20109002001 Date Of Admission : 14 / 8 / 21
Ward : Gastroenterology
Allergies ( drug/food) : Not specified
Chief Complaints : Abdominal Pain , frequent bowel movement , bloody stools with
diarrhea , fever , blurred vision and bleeding rectum
Personal History : Water intake is 3 to 4 litters per day , no history of smoking and
alcoholism , appetite is decreased and bowel movement is frequent
Past medical history : Taking Amlodipine from 2 years for hypertension
history of surgery and family history not specified
CONT.
M I C R O S C O P I C A L E VA L U AT I O N A N D O T H E R D I A G N O S T I C S T U D I E S

Microbiological Investigation :
No any particular microorganism is detected so the bid is due to immunogenic
causes
Stool with blood and mucus
Colonoscopy
Colonoscopy reveals Erythema with erosions in rectum with loss of vascular pattern
Multiple polyploid lesions in sigmoid colon throughout the procedure
Recto Sigmoid Biopsy
Ulceration , Crypt abscess and lamina propria infiltration

USG Abdomen is normal

ASSESSMENT
The diagnosis made on the basis of above Lab findings and diagnosis is
IBD ( Ulcerative colitis )
PLAN
STANDARD TREATMENT
APPROACH
MEDICATION CHART
SNO Brand name Salt ROUTE dosage frequency Start date

1 INJ CeftSb Ceftriaxone IV 375 mg BD 14-8-21

+sulbactam
2 Tab Mesacol mesalamine oral 1.25mg BD 14-8-21
3 INJ Pantop pantaprazole IV 40mg BD 14-8-21

4 Tab Dolo paracetamol oral 650mg SOS 14-8-21

5 Tab propanoloL oral 40mg OD 14-8-21

Propanolol
(generic)
6 Tab Folvit Folic acid oral 5.0 mg OD 14-8-21
7 TabSulphasala sulphasalazine oral 50mg TDS 14-8-21
zine(generic)

8 Tab Eldoper Loperamide oral 2mg SOS 14-8-21

9 Tab Millipred Prednisolone oral 40mg OD 14-8-21
PHARMACIST INTERVENTION

Mesalamine drug should be given IV than oral by giving drug IV the drug
doesnot interacts with the pantaprazole and causes severe drug interaction.

Their should be proper time durtion between the prednisolone , mesalamine
and folic acid to avoid their interation.

Patient should avoid cosumption of caffeine

Patient is seen with the common symptoms of the meslamine such as
headache and constipation.

Patient can be given with polyethlene glycol if constipation continues.

If mesalamine cannot be given IV then we have to give alternate drug such as
budesonide 9mg.
DRUG REATED PROBLEM

POSSIBLE DRUG INTERACTIONS:- 3 INTERACTIONS :-

1 SERIOUS AND 2 MINOR

Pantoprazole + Mesalamine:-(SERIOUS) pantoprazole decreass the effects of
mesalamine by increasing gastric ph. Applies only to oral form of both agents.

Mesalamine + folic acid :- (MINOR) mesalamine decreases levels of folic acid
by inhibition of GI absorption. Applies only to oral form of both the agents.

Prednisolone + mesalamine :- (MINOR) prednisolone decreases levels of
mesalamine by increasing renal clearance.
 DRUG RELATED PROBLEM

Patient is seen with the side effects such as constipation
and headache.

Patient cosumed caffeine leads to food drug interaction
with propanolol caffeine decreases the effectiveness of the
drug.

No unneccessary indications

Mesalamine route shouldnot be oral
PATIENT COUNSELLING
Source of History : Self
Suggestions Given To : Patient
Accepted : YES
Medication Related Recommendation patient is advised on the medications
whether they should be taken with or without food , at bed time or in morning with water
juice or milk

Informed regarding specific side effects of medicines

DISEASE RELATED RECOMMENDATIONS patient is informed regarding

chronic nature of the disease and proctocolectomy if medications fail

Information regarding nutrition rich diet and to avoid orc druids and to
inform in case of worsening of symptoms

DRUG RELATED COUNSELLING :

Patient
SNO Brand name Salt Before/after Time to take Possible side
meal effects
1 . INJ CeftSb Ceftriaxone After Morning and Black stools
+sulbactam evening
2 Tab Mesacol mesalamine after night pain
3 INJ Pantop pantaprazole before Early morning Rash hives
4 Tab Dolo paracetamol sos sos Rare
hepatotoxicity

5 Tab Propanolol propanolol Anytime afternoon Cold hands or

(generic) feet

6 Tab Folvit Folic acid after afternoon Rare headache

7 TabSulphasalazin sulphasalazine 1 hour after night Rash/sores

e(generic)

8 Tab Eldoper Loperamide sos sos Stomach fullness

 SPECIFIC RECOMMENDATIONS

Eating a nutrient diet that help in reducing fatigue and
disease.

Avoid medication which causes any symptom and directly
contact you doctor and report the side effects to the
doctor.
THANKYOU