7: IBD therapy Flashcards
Which habit is altered in patients with IBD?
Bowel habit
What is the main aim of IBD therapy?
Control inflammation
Heal mucosa
What are the general therapy options for IBD?
Lifestyle advice
Drugs
Surgery
Which lifestyle factor aggravates Crohn’s disease?
Smoking
Diet influences the gut ___ and therefore the symptoms of IBD patients.
microbiome
Quitting smoking reduces the recurrence of which inflammatory bowel disease?
Crohn’s disease
Drug therapy for IBD tends to have an anti____ effect.
anti-inflammatory
Which class of drug was used exclusively for UC in the past?
5-ASAs (mesalazine)
Which classes of drugs are used in IBD?
Steroids
Immunosuppressants
Anti-TNF therapy
5-ASAs are used in ___ ___ and reduce the risk of ___ ___.
ulcerative colitis
colorectal cancer
What are the side effects of 5-ASAs e.g mesalazine?
Diarrhoea
Nephritis (check renal function regularly)
How can 5-ASAs be administered?
Oral
Suppositories
Enemas
Higher doses of 5-ASAs tend to produce (greater / smaller) responses in UC patients.
greater
5-ASAs are (oral/rectal/topical) therapies.
TOPICAL
route of admin may be oral / enema but the drug coats the wall of the GI tract so it’s topical
What is the first line therapy in Crohn’s disease (and after 5-ASAs in UC)?
Corticosteroids
Corticosteroids have a systemic ___-___ effect.
anti-inflammatory
What are some examples of oral steroids used in IBD?
Prednisolone
Budesonide
Why are corticosteroids only used short-term in the treatment of IBD?
Steroid dependence / resistance
side effects: osteoporosis, see slides
What are some GI side effects of steroids?
Increased appetite
Ulcers
What are steroid-sparing agents?
Medications used instead of corticosteroids in UC:
Immunosuppressors
used after steroids (to avoid steroid dependence)
What drugs are used as a maintenance therapy in Crohn’s disease?
Immunosuppressors
Name some examples of immunosuppressors used in IBD therapy.
Azathioprine
Mercaptopurine
(Methotrexate)
Which tests are done on someone who is taking azathioprine?
FBCs (leukopaenia)
LFTs (hepatitis)
Azathioprine has a (fast / slow) onset of action.
What would be prescribed in the mean time?
slow
Steroids
What are some possible side effects of azathioprine therapy?
Pancreatitis
Leucopaenia
Hepatitis
Skin cancer
Which cells secrete TNFalpha?
Macrophages
Dendritic cells
during antigen presentation.
What is the function of TNFalpha?
Pro-inflammatory cytokine
drives recruitment of inflammatory immune cells
Which protein, involved in white cell adhesion in acute inflammation, is blocked by some IBD drugs?
Integrins
Which drugs are used to inhibit the action of TNFalpha in IBD?
Monoclonal antibodies
e.g infliximab, adalimumab
What respiratory disease may be reactivated by the action of anti TNFalpha drugs?
TB
When would surgery be indicated in IBD?
Failure to respond to drugs
Small bowel obstruction
Abscess
Fistula
Surgery for Crohn’s disease involves ___ of the bowel and (is / isn’t) curative.
resection
isn’t curative
What can occur if a Crohn’s patient has repeated bowel resections until there isn’t much left?
Short bowel syndrome
How is a patient with short bowel syndrome fed?
Parenteral nutrition
Which type of surgery is used to cure ulcerative colitis?
Permanent ileostomy
Is surgery for UC curative or non-curative?
Curative
