T.B. is 65 year-old man who is presented to the hospital with worsening diarrhoea, abdominal  pain and blood in stool. The patient has a medical history of hypertension, back pain, gastro-oesophageal reflux disease and Crohn’s Disease diagnosed six months ago. Colonoscopy on admission reveals lesions and disease throughout the colon, ileum and duodenum. A diagnosis of acute flare up of Crohn’s Disease has been made.

Medications on admission:

    Amlodipine 10mg po daily

    Pantoprazole 40mg daily

    Mesalamine (Pentasa) 1g po QID

    Prednisolone 40mg po daily (started by GP one week ago)

    Ibuprofen 200mg po QID PRN for knee pain

    Hyoscine 10mg po TDS PRN for stomach cramping

a)  What are your recommendations in managing T.B.’s acute Crohn’s Disease flare up?  Provide details of therapies you would recommend and rationale of your recommendations.  (3 marks)

b) Based  on your recommendation from question (a), are there any monitoring or tests you would like to order for T.B.? (4 marks)

c) After the initial flare up, what would you recommend to maintain remission of T.B.’s Crohn’s  Disease? (2 marks)

d)  Upon reviewing T.B.’s regular medications, identify THREE additional drug related problems from his regimen and make appropriate recommendations accordingly. (6 marks)