Roger, a 55year-old male is evaluated for a 4-month history of frequent and urgent defecation with loose and bloody stool, mild abdominal cramping and fatigue. He has up to eight bowel mov

Roger, a 55year-old male is evaluated for a 4-month history of…
Roger, a 55year-old male is evaluated for a 4-month history of frequent and urgent defecation with
loose and bloody stool, mild abdominal cramping and fatigue. He has up to eight bowel
movements a day and often wakes at night with symptoms. Prior to onset, he had one bowel
movement a day with well-formed stool. He does not have fever, nausea or vomiting, but has lost
3kg (7lb). He has mild joint pain in his knees and ankles that also began 4 months ago, which is
worse in the morning and resolves somewhat during the day. The patient is a former cigarette
smoker but quit smoking 2 years ago. His medical history includes hypertension and his only
medication is hydrochlorothiazide.
On physical examination, vital signs are normal. There is mild lower abdominal tenderness
without rebound or guarding. There are no palpable abdominal masses. Examination of the rectum
shows gross blood. Lab studies: Hgb 12.3 g/dL, Hct 32%, RBC 3.4 million, MCV 76 fL, MCHC
28 g/dL, RDW 17%. Fecal leukocytes are present, but stool analysis is negative for infection.
Colonoscopy shows continuous erythema, friability, and loss of vascular pattern from the rectum
to the splenic flexure. The rest of the colon and terminal ileum is normal. Histology shows
cryptitis, crypt abscesses and crypt architecture distortion.

1. Using the resource Feuerstein, J.D., Isaacs, K.L., Schneider, Y., Siddique, S.M., Falck-Ytter, Y., & Singh, S. (2020). AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastrotenterology, 158,1450-1461. https://doi.org/10.1053/j.gastro.2020.01.006 , what non-pharmacologic and pharmacologic
interventions will you use for your treatment plan? How does each intervention treat the
pathophysiology of the diagnosis(es)? What is the priority for each intervention (which
interventions are first versus later)?

2- What are the important prescribing considerations for the pharmacologic interventions (medications are Infliximab and Sulfasalazine?

3- What outcomes would you anticipate – therapeutic effects and adverse effects of Infliximab and Sulfasalazine? How will you evaluate for these outcomes?

4 What patient education and follow up is required for the medications prescribed?