Crohn’s disease
THE BRIEF/INSTRUCTIONS
LO2: Assess, appraise and critique current and future treatments and make informed judgements on the appropriateness of treatment and care to specific patient contexts
LO4: Undertake medication reviews with patients with complex needs to identify and communicate the most appropriate course of action
Rosie Harper
DoB 12.04.2007
Rosie is a 14-year-old girl, who lives at home with her dad and younger sister.
Height 165cm
Weight 49kg
White British
Allergies: NKDA
Current medication:
Asacol MR® 400mg tablets 2 BD
Abidec® multivitamin drops – 0.6mL OD
Ferrous fumarate 140mg/5mL oral solution – 10mL OD
Loperamide 2mg capsules – 1 TDS as needed
Omeprazole 10mg capsules – 1 OD
Prednisolone 5mg dispersible tablets – 1 OD
Rosie was diagnosed at the age of 13 with Crohn’s disease, as she wasn’t growing and was losing weight. She is managed under a shared care arrangement between her GP and the local children’s hospital. Her Crohn’s is currently in remission, and she is getting ready to study for her GCSEs.
Crohn’s disease is a chronic inflammatory bowel condition which presents most commonly in adolescence or early adulthood; research differential diagnoses for the initial symptoms of Crohn’s and describe how they would be confirmed or discounted include examples of histology where appropriate. (10%)
Rosie’s dad has heard about the use of enteral nutrition to induce remission of Crohn’s in children and young people as he is concerned about the long term effects of steroid use by Rosie – critically appraise the evidence to support the use of enteral nutrition in this way. (20%)
Asacol® is a modified release preparation, designed to release the drug when it reaches the ileum critically discuss factors to be considered when formulating modified release preparations of mesalazine. (15%)
Asacol® is unlicensed in the paediatric population and your pre-registration technician is cautious about its use – construct a response to them about the use of medications outside their product licence. (10%)
Rosie experiences a flare up of her Crohn’s and it is decided to trial her on a biologic therapy.
Critically evaluate the following paper on infliximab, and discuss the appropriate use of infliximab in Rosie’s care. (20%)
Hyams, J., Crandall, W., Kugathasan, S., Griffiths, A., Olson, A., Johanns, J., Liu, G., Travers, S., Heuschkel, R., Markowitz, J., Cohen, S., Winter, H., Veereman–Wauters, G., Ferry, G. and Baldassano, R., 2007. Induction and Maintenance Infliximab Therapy for the Treatment of Moderate-to-Severe Crohn’s Disease in Children. Gastroenterology, 132(3), pp.863-873.
Unfortunately, Rosie’s disease was worse than had been suspected, and following an emergency MRI scan it was decided to operate to give Rosie a temporary ileostomy.
Rosie’s post-surgery medication regimen:
Abidec® multivitamin drops – 0.6mL OD
Codeine phosphate 30mg tablets – 1 or 2 up to QDS to manage stoma output
Ferrous fumarate 140mg/5mL oral solution – 10mL OD
Loperamide 2mg capsules – up to 8 daily as needed
Omeprazole 10mg capsules – 1 OD
Following Rosie’s surgery, she has some difficulties managing her stoma output, leading to the skin around her stoma site becoming macerated and developing a staphylococcal infection.
Rosie needs systemic antibiotics to treat her skin infection, decide on an appropriate drug and regimen. Comment on formulations that could be used for a patient like Rosie. (10%)
Rosie is now 16 and has been managing her ileostomy successfully with her post-surgery medication regimen. She has worked hard at school and her dad wants to reward her for her excellent GSCE results with a family trip to Dubai.
Research what plans Rosie and her dad will need to make in order for her to have a safe trip to Dubai with her medication. (15%)
