Outcome Evaluation

• Monitor for improvement of symptoms in patients with active IBD, such as reduction in the number of daily stools, abdominal pain, fever, and heart rate.

• For patients in remission, assure that proper maintenance doses of medications are used and educate the patient to seek medical attention ifsymptoms recur or worsen.

• Evaluate patients receiving systemic corticosteroid therapy for improvement in symptoms and opportunities to taper or discontinue corticosteroid therapy. For patients using more than 5 mg daily of prednisone for more than 2 months or for steroid-dependent patients consider the following:

• Central bone mineral density testing to evaluate the need for preventive or therapeutic bisphosphonate therapy;

• Periodic monitoring of blood glucose, lipids, and blood pressure;

• Evaluation for evidence of cushingoid features or signs or symptoms of infection.

• When considering treatment with azathioprine or 6-MP, obtain baseline CBC, liver function tests, and TPMT activity. These tests should be monitored closely (every 2-4 weeks) at the start of therapy and then approximately every 3 months during maintenance therapy.

• With azathioprine and 6-MP, monitor for hypersensitivity reactions, including severe skin rashes and pancreatitis. Educate the patient regarding signs and symptoms of pancreatitis (nausea, vomiting, and abdominal pain).

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Anxiety and Depression 101

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