3. IBD Flashcards
1
Q
What are some key features of IBD?
A
- abnormal activation of the immune system
- chronic inflammation
- lifelong disease
2
Q
What are the racial risk factors for IBD?
A
white > African American > Hispanic and Asian
3
Q
What are some theoretical causes of IBD?
A
- infectious
- genetic
- immunologic
- environmental
- psychological
4
Q
First degree relatives of people with IBD have ___x risk themselves.
A
20
5
Q
Smoking is _______ for UC and _________ for CD
A
protective
increases
6
Q
UC is confined to the ______ and _______.
A
rectum
colon
7
Q
UC presents with continuous, _______, _________ inflammation.
A
diffuse
surface
8
Q
CD can present in _________ of GI.
A
any part
9
Q
What is the most common site of CD?
A
terminal ileum
10
Q
What characterizes mild UC?
A
> 4 stools per day
+/- blood
No systemic disturbances
Normal ESR
11
Q
What is ESR?
A
Erythrocyte Sedimentation Rate
12
Q
What characterizes moderate UC?
A
- > 4 stools/day
- minimal systemic disturbance
13
Q
What characterizes severe UC?
A
- > 6 stools/day
- blood +
- evident systemic disturbance
- ESR > 30
14
Q
What is UC: distal disease?
A
- aka left-sided disease
- limited to areas below the splenic fixture
15
Q
What is UC: extensive disease?
A
pancolitis - involves the entire colon
16
Q
What is UC: proctitis?
A
- most common form
- inflammation confined to the rectal area
17
Q
What is UC: prostosigmoiditis?
A
inflammation of the rectum and sigmoid colon
18
Q
What characterizes mild/moderate CD?
A
- NO dehydration, systemic toxicity, weight loss, tenderness, mass/obstruction
- diarrhea, abdominal pain, possible lesion
19
Q
What characterizes moderate/severe CD?
A
- Failure to respond to treatment
- fever, weight loss, abd. pain/tenderness, vomiting, anemia
20
Q
What characterizes severe/fulminant CD?
A
- Failure of outpatient corticosteroid treatment
- High fever, cachexia, rebound tenderness, abscess, obstruction, strictures
21
Q
What is CD: enteritis?
A
- located in small intestine
- left untreated will probably result in SI obstruction
22
Q
What is CD: terminal illeitis?
A
- located at the very end of the SI
- fistulas and abscesses can occur
23
Q
What is CD: colitis?
A
- located in the colon
- diarrhea, pain, fistula, abscess
- most common site for a skin/joint response; granulomatous colitis
24
Q
What is CD: entero-colitis/ ileo-colitis?
A
- involves both the small and large intestines
- diarrhea, weight loss, cramping
- MOST common form
25
What tissue does UC affect?
mucosa and submucosa
26
What are the primary lesions of UC?
crypt abscesses
27
Crypt abscesses form ________.
pseudopolyps
28
What are the local complications of UC suffered by most patients?
- hemorrhoids, anal fissures, perirectal abscess
| - toxic megacolon
29
In CD, _____ ____ injury is extensive.
bowel wall
30
In CD, the ________ ______ is often narrowed.
intestinal lumen
31
What is the typical appearance of CD?
"cobblestone" - deep, elongated ulcers
32
What are the local complications of CD?
stricture/obstruction
| fistulae
33
What are the complications and treatments for a stricture?
- can narrow enough to cause obstruction
| - may need surgery
34
Where do fistulae occur and what are the treatments for fistulae?
- occur in the worst areas of inflammation
| - frequently need surgery
35
What are the 3 main methods for IBD diagnosis?
Imaging
Biopsy
Labs
36
What image testing is commonly done in IBD?
colonoscopy
| barium radiographic contrast
37
What lab results can help diagnose IBD?
- leukocytosis
- anemia
- increased ESR, CRP
- stool studies
38
What are some extra-intestinal IBD complications?
- hepatobiliary
- joint
- ocular
- dermatologic
39
What are some hepatobiliary complications of IBD?
- pericholangitis, fatty liver, chronic hepatitis, cirrhosis
| - sclerosing cholangitis, gallstones, cholangiocarcinoma
40
What are some joint complications of IBD?
- asymmetrical arthritis: knees, hips, ankles, wrists, elbows
- sacroiliitis, ankylosing spondylitis
41
What are some dermatologic complications of CD?
- apthous stomatitis
| - erythema nodosum
42
What are some dermatologic complications of UC?
pyoderma gangrenosum
43
What are the 3 main treatment goals of IBD?
- induce remission
- maintain remission
- maintain quality of life
44
What is the active component of Aminosalicylates?
5-aminosalicylate (5-ASA)
45
What is the purpose of using aminosalicylates?
induce and maintain remission
46
Most aminosalicylates are released in the _______. These do not work well in ____ especially when it is in the _____ ______.
colon
CD
small intestine
47
What is the MOA of aminosalicylates?
anti-inflammatory effects due to inhibition of leukotriene production and anti-prostiglandin and anti-oxidant effects
48
Aminosalicylates may be protective against ______.
cancer
49
Sulfasalazine belongs in which category?
aminosalicylates
50
Sulfasalazine is the combination of what 2 drugs?
sulfapyridine + mesalamine
51
Sulfasalazine is cleaved by what?
gut bacteria
52
In Sulfasalazine, which is the active component?
mesalamine
53
In whom should you avoid using Sulfasalazine?
those with sulfa allergies
| males trying to conceive
54
What are some serious effects of Sulfasalazine?
- bone marrow suppression
- hemolytic anemia
- hepatotoxicity
55
Mesalamine is formulated by itself. (T/F)
True. Mesalamine is formulated alone and with sulfapyridine (sulfasalazine)
56
What is first line for mild/moderate UC and CD?
mesalamine
57
What formulations is mesalamine available in?
oral (and prodrugs) and topical
58
Which formulation of mesalamine is superior in inducing remission with distal disease?
the combination of the oral and topical
59
Where is the site of action for mesalamine controlled release?
continuous delivery throughout the GI tract
60
Where is the site of action for mesalamine delayed release?
delivery to the distal ileum and colon
61
Where is the site of action for Sulfasalazine and the mesalamine prodrugs?
colon
62
What is the purpose of administering corticosteroids to IBD patients?
induction of remission only (not for maintenance therapy)
63
What formulations of corticosteroids are available for IBD?
topical and systemic
64
Patients with _______ disease may become steroid _________.
severe
| dependent
65
What is the conventional dose for oral Prednisone in IBD?
0.5 - 1 mg/kg/day
66
What is the maximum dose for oral Prednisone in IBD?
40 - 60 mg/day
67
In what patient group is parenteral corticosteroid therapy indicated?
- severe colitis, refractory to oral corticosteroids who require hospitalization
- patients with systemic toxicity
68
Using the ______ formulation of corticosteroids has the _______ response time.
rectal
| faster
69
In rectal corticosteroid therapy, the foam formulation reaches __ - __ cm from the ________.
15 - 20 cm
| rectum
70
In rectal corticosteroid therapy, the enema formulation reaches to the _______ ________.
splenic fixture
71
What is the side of action for Budesonide?
terminal ileum
72
What is the dose of Budesonide?
9 mg/day
73
What formulation of Budesonide is appropriate for CD?
Entocort EC
74
What formulation of Budesonide is appropriate for UC?
Uceris
75
What is the mainstay of antibiotic therapy for IBD?
metronidazole
76
Why are antibiotics used in IBD?
They suppress cell-mediated immunity.
77
When are antibiotics indicated in IBD?
CD: perianal disease, fistulas
UC: pouchitis
78
What is the dose for metronidazole in IBD?
10-20 mg/kg/day BID to QID
79
What is the main ADR for metronidazole and is it permanent?
peripheral neuropathy 85%
| no
80
Why would Ciprofloxacin be used in IBD?
in patients who cannot tolerate metronidazole
81
Why would Rifaxamin be used in IBD?
it is not systemically absorbed, so it would remain in the GI tract and is appropriate for infectious etiology
82
What is the onset of action for immunomodulators?
3 - 6 months
83
What are the thiopurine immunomodulators?
azathioprine and 6-MP
84
Cyclosporin and Tacrolimus are dosed to _______.
target
85
Before starting a patient on a thiopurine medication, it is important to test what?
thipourine metabolite activity
86
If a patient is an intermediate metabolizer of thiopurines, what needs to be done?
50% dose reduction
87
If a patient is a poor metabolizer of thiopurines, what needs to be done?
this patient is not a candidate for this therapy
88
What is the purpose of administering allopurinol with thiopurines?
Allopurinol shunts the metabolism to the preferential 6-TG metabolite.
89
What is the most common target for biologic agents?
TNF - α
90
TNF - α plays and active role in events leading to ______ __________.
mucosal inflammation
91
In what ways does TNF - α contribute to the IBD disease process?
- Direct tissue injury
- Activation/ recruitment of inflammatory cells
- Enhanced cytokine secretion
- Direct apoptosis of mucosal epithelial cells
92
What is the drug name ending for biologic agents?
-umab
93
Biologic agents are used only for maintenance therapy. (T/F)
False: induction and maintenance
94
Which biologic agents are appropriate for CD and UC?
- Infliximab
- Adalimumab
- Vedolizumab
95
Which biologic agents are only used for CD?
- Certolizumab
| - Natalizumab
96
Which biologic agents are only used for UC?
- Golimumab
97
Biologic agents increase the risk of what?
- infection
- lymphoma
- TB
98
Infliximab targets ______.
TNF-α
99
Infliximab is indicated for what degree of disease?
moderate to severe
100
Infliximab is available in what formulation?
IV only
101
What is the target level of Infliximab
3 - 7 mcg/mL
102
What are some contraindications for infliximab?
- active infection
- untreated latent TB
- moderate - severe HF
- current or recent malignancies
103
Adalimumab targets ______.
TNF-α
104
Adalimumab is indicated for what degree of disease?
moderate to severe that is unresponsive to other therapies or to Infliximab
105
Adalimumab is available in what formulation?
SQ
106
Certolizumab is linked to ___ and targets _____.
PEG
| TNF-α
107
Certolizumab is indicated for what?
CD
108
Certolizumab is available in what formulation?
SQ
109
Golimumab targets ___.
TNF-α
110
Golimumab is indicated for what?
moderate to severe UC
111
Golimumab is available in what formulation?
SQ
112
Natalizumab targets ____.
α4-integrin
113
Natalizumab is indicated for what?
moderate to severe CD with inadequate response to conventional therapies and anti-TNFs
114
Which biologic agents are in the REMS program?
Natalizumab
115
Natalizumab is available in what formulation?
IV
116
Vedolizumab targets ____.
α4β7-integrin
117
Vedolizumab is available in what formulation?
IV
118
Nicotine replacement is appropriate for UC and CD. (T/F)
False: UC only
119
What are antispasmodics/antidiarrheals used for in IBD?
adjunctive therapy
120
What is cholestyramine used for in IBD?
- adjunctive therapy
| - bile-salt induced diarrhea after ileal resection
121
What is the only curative measure for UC?
surgery to remove diseased colon
