doc_clotaire
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A 25-year-old woman with Crohn's disease presents to your office with
recurrent abdominal pain and diarrhea. She has been taking mesalamine
4 grams per day for the last year. Last fall, after developing
diarrhea and pain, she was placed on prednisone 60 mg daily. She had a
complete remission and, after a 3-month tapering of the prednisone,
suffered a relapse. Prednisone was restarted 2 months ago at 60 mg
daily, and now as the dose has decreased to 20 mg per day, the
diarrhea has recurred. She is having 6 to 8 water stools per day,
crampy pain, and some weight loss. What would be the best next step?
(A) Restart the prednisone and plan to maintain the dose at 40-60 mg
indefinitely
(B) Restart the prednisone with 6-mercaptopurine and plan on
prednisone taper in 2 months
(C) Stop the prednisone and add cyclosporine
(D) Admit to the hospital and give high-dose intravenous steroids to
induce remission
(E) Stop the mesalamine and add methotrexate
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| sprint123
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I think B-Due to steroid sparing effect of mercaptopurine
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| Justice
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(E)
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| docnikki
Forum Guru
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B.
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| doc_clotaire
Forum Guru
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Answer:
(B) Restart the prednisone with 6-mercaptopurine and plan on
prednisone taper in 2 months
Explanation:
Prednisone is effective in treating active Crohn's disease for short
durations (3-6 months). Long-term use for maintenance is not
indicated. 6-Mercaptopurine and azathioprine are steroid-sparing
medications used to limit the need for prednisone. Prednisone, like
other corticosteroids, has numerous side effects and should only be
used for treating active flares of disease, not maintenance of
remission. Cyclosporine and methotrexate have limited roles in the
management of Crohn's disease.
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The elevator to succes is broke ,you must take the stairs
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| mdwannabe
Forum Guru
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Posts: 1,133
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Think in simple terms...
!. Need something to stop the current smx... Prednisone NOW... but gotta think about the future as well, she failed prednisone taper twice...next drug in line is 6-MP...so Add that to regimen and strat tapering prednisone again, after resolution of smx.
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