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Gastrointestinal Week 5 2016/17 > 7: IBD therapy > Flashcards

7: IBD therapy Flashcards

1
Q

Which habit is altered in patients with IBD?

A

Bowel habit

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2
Q

What is the main aim of IBD therapy?

A

Control inflammation

Heal mucosa

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3
Q

What are the general therapy options for IBD?

A

Lifestyle advice

Drugs

Surgery

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4
Q

Which lifestyle factor aggravates Crohn’s disease?

A

Smoking

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5
Q

Diet influences the gut ___ and therefore the symptoms of IBD patients.

A

microbiome

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6
Q

Quitting smoking reduces the recurrence of which inflammatory bowel disease?

A

Crohn’s disease

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7
Q

Drug therapy for IBD tends to have an anti____ effect.

A

anti-inflammatory

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8
Q

Which class of drug was used exclusively for UC in the past?

A

5-ASAs (mesalazine)

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9
Q

Which classes of drugs are used in IBD?

A

Steroids

Immunosuppressants

Anti-TNF therapy

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10
Q

5-ASAs are used in ___ ___ and reduce the risk of ___ ___.

A

ulcerative colitis

colorectal cancer

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11
Q

What are the side effects of 5-ASAs e.g mesalazine?

A

Diarrhoea

Nephritis (check renal function regularly)

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12
Q

How can 5-ASAs be administered?

A

Oral

Suppositories

Enemas

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13
Q

Higher doses of 5-ASAs tend to produce (greater / smaller) responses in UC patients.

A

greater

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14
Q

5-ASAs are (oral/rectal/topical) therapies.

A

TOPICAL

route of admin may be oral / enema but the drug coats the wall of the GI tract so it’s topical

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15
Q

What is the first line therapy in Crohn’s disease (and after 5-ASAs in UC)?

A

Corticosteroids

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16
Q

Corticosteroids have a systemic ___-___ effect.

A

anti-inflammatory

17
Q

What are some examples of oral steroids used in IBD?

A

Prednisolone

Budesonide

18
Q

Why are corticosteroids only used short-term in the treatment of IBD?

A

Steroid dependence / resistance

side effects: osteoporosis, see slides

19
Q

What are some GI side effects of steroids?

A

Increased appetite

Ulcers

20
Q

What are steroid-sparing agents?

A

Medications used instead of corticosteroids in UC:

Immunosuppressors

used after steroids (to avoid steroid dependence)

21
Q

What drugs are used as a maintenance therapy in Crohn’s disease?

A

Immunosuppressors

22
Q

Name some examples of immunosuppressors used in IBD therapy.

A

Azathioprine

Mercaptopurine

(Methotrexate)

23
Q

Which tests are done on someone who is taking azathioprine?

A

FBCs (leukopaenia)

LFTs (hepatitis)

24
Q

Azathioprine has a (fast / slow) onset of action.

What would be prescribed in the mean time?

A

slow

Steroids

25
Q

What are some possible side effects of azathioprine therapy?

A

Pancreatitis

Leucopaenia

Hepatitis

Skin cancer

26
Q

Which cells secrete TNFalpha?

A

Macrophages

Dendritic cells

during antigen presentation.

27
Q

What is the function of TNFalpha?

A

Pro-inflammatory cytokine

drives recruitment of inflammatory immune cells

28
Q

Which protein, involved in white cell adhesion in acute inflammation, is blocked by some IBD drugs?

A

Integrins

29
Q

Which drugs are used to inhibit the action of TNFalpha in IBD?

A

Monoclonal antibodies

e.g infliximab, adalimumab

30
Q

What respiratory disease may be reactivated by the action of anti TNFalpha drugs?

A

TB

31
Q

When would surgery be indicated in IBD?

A

Failure to respond to drugs

Small bowel obstruction

Abscess

Fistula

32
Q

Surgery for Crohn’s disease involves ___ of the bowel and (is / isn’t) curative.

A

resection

isn’t curative

33
Q

What can occur if a Crohn’s patient has repeated bowel resections until there isn’t much left?

A

Short bowel syndrome

34
Q

How is a patient with short bowel syndrome fed?

A

Parenteral nutrition

35
Q

Which type of surgery is used to cure ulcerative colitis?

A

Permanent ileostomy

36
Q

Is surgery for UC curative or non-curative?

A

Curative

Gastrointestinal Week 5 2016/17 (11 decks)

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