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957 Block 2 > 3. IBD > Flashcards

3. IBD Flashcards

1
Q

What are some key features of IBD?

A
  • abnormal activation of the immune system
  • chronic inflammation
  • lifelong disease
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2
Q

What are the racial risk factors for IBD?

A

white > African American > Hispanic and Asian

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3
Q

What are some theoretical causes of IBD?

A
  • infectious
  • genetic
  • immunologic
  • environmental
  • psychological
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4
Q

First degree relatives of people with IBD have ___x risk themselves.

A

20

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5
Q

Smoking is _______ for UC and _________ for CD

A

protective

increases

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6
Q

UC is confined to the ______ and _______.

A

rectum

colon

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7
Q

UC presents with continuous, _______, _________ inflammation.

A

diffuse

surface

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8
Q

CD can present in _________ of GI.

A

any part

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9
Q

What is the most common site of CD?

A

terminal ileum

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10
Q

What characterizes mild UC?

A

> 4 stools per day
+/- blood
No systemic disturbances
Normal ESR

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11
Q

What is ESR?

A

Erythrocyte Sedimentation Rate

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12
Q

What characterizes moderate UC?

A
  • > 4 stools/day

- minimal systemic disturbance

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13
Q

What characterizes severe UC?

A
  • > 6 stools/day
  • blood +
  • evident systemic disturbance
  • ESR > 30
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14
Q

What is UC: distal disease?

A
  • aka left-sided disease

- limited to areas below the splenic fixture

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15
Q

What is UC: extensive disease?

A

pancolitis - involves the entire colon

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16
Q

What is UC: proctitis?

A
  • most common form

- inflammation confined to the rectal area

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17
Q

What is UC: prostosigmoiditis?

A

inflammation of the rectum and sigmoid colon

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18
Q

What characterizes mild/moderate CD?

A
  • NO dehydration, systemic toxicity, weight loss, tenderness, mass/obstruction
  • diarrhea, abdominal pain, possible lesion
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19
Q

What characterizes moderate/severe CD?

A
  • Failure to respond to treatment

- fever, weight loss, abd. pain/tenderness, vomiting, anemia

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20
Q

What characterizes severe/fulminant CD?

A
  • Failure of outpatient corticosteroid treatment

- High fever, cachexia, rebound tenderness, abscess, obstruction, strictures

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21
Q

What is CD: enteritis?

A
  • located in small intestine

- left untreated will probably result in SI obstruction

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22
Q

What is CD: terminal illeitis?

A
  • located at the very end of the SI

- fistulas and abscesses can occur

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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
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24
Q

What is CD: entero-colitis/ ileo-colitis?

A
  • involves both the small and large intestines
  • diarrhea, weight loss, cramping
  • MOST common form
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25
Q

What tissue does UC affect?

A

mucosa and submucosa

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26
Q

What are the primary lesions of UC?

A

crypt abscesses

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27
Q

Crypt abscesses form ________.

A

pseudopolyps

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28
Q

What are the local complications of UC suffered by most patients?

A
  • hemorrhoids, anal fissures, perirectal abscess

- toxic megacolon

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29
Q

In CD, _____ ____ injury is extensive.

A

bowel wall

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30
Q

In CD, the ________ ______ is often narrowed.

A

intestinal lumen

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31
Q

What is the typical appearance of CD?

A

“cobblestone” - deep, elongated ulcers

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32
Q

What are the local complications of CD?

A

stricture/obstruction

fistulae

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33
Q

What are the complications and treatments for a stricture?

A
  • can narrow enough to cause obstruction

- may need surgery

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34
Q

Where do fistulae occur and what are the treatments for fistulae?

A
  • occur in the worst areas of inflammation

- frequently need surgery

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35
Q

What are the 3 main methods for IBD diagnosis?

A

Imaging
Biopsy
Labs

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36
Q

What image testing is commonly done in IBD?

A

colonoscopy

barium radiographic contrast

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37
Q

What lab results can help diagnose IBD?

A
  • leukocytosis
  • anemia
  • increased ESR, CRP
  • stool studies
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38
Q

What are some extra-intestinal IBD complications?

A
  • hepatobiliary
  • joint
  • ocular
  • dermatologic
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39
Q

What are some hepatobiliary complications of IBD?

A
  • pericholangitis, fatty liver, chronic hepatitis, cirrhosis

- sclerosing cholangitis, gallstones, cholangiocarcinoma

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40
Q

What are some joint complications of IBD?

A
  • asymmetrical arthritis: knees, hips, ankles, wrists, elbows
  • sacroiliitis, ankylosing spondylitis
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41
Q

What are some dermatologic complications of CD?

A
  • apthous stomatitis

- erythema nodosum

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42
Q

What are some dermatologic complications of UC?

A

pyoderma gangrenosum

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43
Q

What are the 3 main treatment goals of IBD?

A
  • induce remission
  • maintain remission
  • maintain quality of life
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44
Q

What is the active component of Aminosalicylates?

A

5-aminosalicylate (5-ASA)

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45
Q

What is the purpose of using aminosalicylates?

A

induce and maintain remission

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46
Q

Most aminosalicylates are released in the _______. These do not work well in ____ especially when it is in the _____ ______.

A

colon
CD
small intestine

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47
Q

What is the MOA of aminosalicylates?

A

anti-inflammatory effects due to inhibition of leukotriene production and anti-prostiglandin and anti-oxidant effects

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48
Q

Aminosalicylates may be protective against ______.

A

cancer

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49
Q

Sulfasalazine belongs in which category?

A

aminosalicylates

50
Q

Sulfasalazine is the combination of what 2 drugs?

A

sulfapyridine + mesalamine

51
Q

Sulfasalazine is cleaved by what?

A

gut bacteria

52
Q

In Sulfasalazine, which is the active component?

A

mesalamine

53
Q

In whom should you avoid using Sulfasalazine?

A

those with sulfa allergies

males trying to conceive

54
Q

What are some serious effects of Sulfasalazine?

A
  • bone marrow suppression
  • hemolytic anemia
  • hepatotoxicity
55
Q

Mesalamine is formulated by itself. (T/F)

A

True. Mesalamine is formulated alone and with sulfapyridine (sulfasalazine)

56
Q

What is first line for mild/moderate UC and CD?

A

mesalamine

57
Q

What formulations is mesalamine available in?

A

oral (and prodrugs) and topical

58
Q

Which formulation of mesalamine is superior in inducing remission with distal disease?

A

the combination of the oral and topical

59
Q

Where is the site of action for mesalamine controlled release?

A

continuous delivery throughout the GI tract

60
Q

Where is the site of action for mesalamine delayed release?

A

delivery to the distal ileum and colon

61
Q

Where is the site of action for Sulfasalazine and the mesalamine prodrugs?

A

colon

62
Q

What is the purpose of administering corticosteroids to IBD patients?

A

induction of remission only (not for maintenance therapy)

63
Q

What formulations of corticosteroids are available for IBD?

A

topical and systemic

64
Q

Patients with _______ disease may become steroid _________.

A

severe

dependent

65
Q

What is the conventional dose for oral Prednisone in IBD?

A

0.5 - 1 mg/kg/day

66
Q

What is the maximum dose for oral Prednisone in IBD?

A

40 - 60 mg/day

67
Q

In what patient group is parenteral corticosteroid therapy indicated?

A
  • severe colitis, refractory to oral corticosteroids who require hospitalization
  • patients with systemic toxicity
68
Q

Using the ______ formulation of corticosteroids has the _______ response time.

A

rectal

faster

69
Q

In rectal corticosteroid therapy, the foam formulation reaches __ - __ cm from the ________.

A

15 - 20 cm

rectum

70
Q

In rectal corticosteroid therapy, the enema formulation reaches to the _______ ________.

A

splenic fixture

71
Q

What is the side of action for Budesonide?

A

terminal ileum

72
Q

What is the dose of Budesonide?

A

9 mg/day

73
Q

What formulation of Budesonide is appropriate for CD?

A

Entocort EC

74
Q

What formulation of Budesonide is appropriate for UC?

A

Uceris

75
Q

What is the mainstay of antibiotic therapy for IBD?

A

metronidazole

76
Q

Why are antibiotics used in IBD?

A

They suppress cell-mediated immunity.

77
Q

When are antibiotics indicated in IBD?

A

CD: perianal disease, fistulas
UC: pouchitis

78
Q

What is the dose for metronidazole in IBD?

A

10-20 mg/kg/day BID to QID

79
Q

What is the main ADR for metronidazole and is it permanent?

A

peripheral neuropathy 85%

no

80
Q

Why would Ciprofloxacin be used in IBD?

A

in patients who cannot tolerate metronidazole

81
Q

Why would Rifaxamin be used in IBD?

A

it is not systemically absorbed, so it would remain in the GI tract and is appropriate for infectious etiology

82
Q

What is the onset of action for immunomodulators?

A

3 - 6 months

83
Q

What are the thiopurine immunomodulators?

A

azathioprine and 6-MP

84
Q

Cyclosporin and Tacrolimus are dosed to _______.

A

target

85
Q

Before starting a patient on a thiopurine medication, it is important to test what?

A

thipourine metabolite activity

86
Q

If a patient is an intermediate metabolizer of thiopurines, what needs to be done?

A

50% dose reduction

87
Q

If a patient is a poor metabolizer of thiopurines, what needs to be done?

A

this patient is not a candidate for this therapy

88
Q

What is the purpose of administering allopurinol with thiopurines?

A

Allopurinol shunts the metabolism to the preferential 6-TG metabolite.

89
Q

What is the most common target for biologic agents?

A

TNF - α

90
Q

TNF - α plays and active role in events leading to ______ __________.

A

mucosal inflammation

91
Q

In what ways does TNF - α contribute to the IBD disease process?

A
  • Direct tissue injury
  • Activation/ recruitment of inflammatory cells
  • Enhanced cytokine secretion
  • Direct apoptosis of mucosal epithelial cells
92
Q

What is the drug name ending for biologic agents?

A

-umab

93
Q

Biologic agents are used only for maintenance therapy. (T/F)

A

False: induction and maintenance

94
Q

Which biologic agents are appropriate for CD and UC?

A
  • Infliximab
  • Adalimumab
  • Vedolizumab
95
Q

Which biologic agents are only used for CD?

A
  • Certolizumab

- Natalizumab

96
Q

Which biologic agents are only used for UC?

A
  • Golimumab
97
Q

Biologic agents increase the risk of what?

A
  • infection
  • lymphoma
  • TB
98
Q

Infliximab targets ______.

A

TNF-α

99
Q

Infliximab is indicated for what degree of disease?

A

moderate to severe

100
Q

Infliximab is available in what formulation?

A

IV only

101
Q

What is the target level of Infliximab

A

3 - 7 mcg/mL

102
Q

What are some contraindications for infliximab?

A
  • active infection
  • untreated latent TB
  • moderate - severe HF
  • current or recent malignancies
103
Q

Adalimumab targets ______.

A

TNF-α

104
Q

Adalimumab is indicated for what degree of disease?

A

moderate to severe that is unresponsive to other therapies or to Infliximab

105
Q

Adalimumab is available in what formulation?

A

SQ

106
Q

Certolizumab is linked to ___ and targets _____.

A

PEG

TNF-α

107
Q

Certolizumab is indicated for what?

A

CD

108
Q

Certolizumab is available in what formulation?

A

SQ

109
Q

Golimumab targets ___.

A

TNF-α

110
Q

Golimumab is indicated for what?

A

moderate to severe UC

111
Q

Golimumab is available in what formulation?

A

SQ

112
Q

Natalizumab targets ____.

A

α4-integrin

113
Q

Natalizumab is indicated for what?

A

moderate to severe CD with inadequate response to conventional therapies and anti-TNFs

114
Q

Which biologic agents are in the REMS program?

A

Natalizumab

115
Q

Natalizumab is available in what formulation?

A

IV

116
Q

Vedolizumab targets ____.

A

α4β7-integrin

117
Q

Vedolizumab is available in what formulation?

A

IV

118
Q

Nicotine replacement is appropriate for UC and CD. (T/F)

A

False: UC only

119
Q

What are antispasmodics/antidiarrheals used for in IBD?

A

adjunctive therapy

120
Q

What is cholestyramine used for in IBD?

A
  • adjunctive therapy

- bile-salt induced diarrhea after ileal resection

121
Q

What is the only curative measure for UC?

A

surgery to remove diseased colon

957 Block 2 (14 decks)

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