Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NAPLEX 2024 > 74. IBD > Flashcards

74. IBD Flashcards

1
Q

Major types of IBD are ___

A

ulcerative colitis and crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

IBD is a group of inflammatory conditions of the _____

A

colon and small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Classic symptom of IBD is ___

A

bloody diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

inflammatory bowel disease can be mistaken for irritable bowel syndrome as they have similar symptoms such as ____ but unlike IBD, IBS does not cause ___

A

abd pain, bloating, gas, constipation or diarrhea
IBD does not cause inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ulcerative colitis is characterized by mucosal inflammation confined to ____

A

rectum and colon with superficial ulcerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When UC is limited to descending colon and rectum, it is called ___ and can be treated with ____

A

distal disease
can be treated with topical rectal treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inflammation limited to rectum is called ___

A

proctitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Crohn’s disease is characterized by ___

A

deep, transmural (through the bowel wall) inflammation that can affect any part of the GI tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms of Crohn’s disease include ____

A

chronic diarrhea (often nocturnal)

Others: abdominal pain, weight loss
Perianal symptoms (e.g. bleeding, fissures (tears)) can be present before bowel symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Compare Crohn’s disease and ulcerative colitis regarding fistulas/strictures

A

Common in CD
Uncommon in UC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Compare Crohn’s disease and ulcerative colitis regarding location

A

CD = entire GI tract (esp ileum and colon)
UC = colon (esp rectum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Compare Crohn’s disease and ulcerative colitis regarding depth

A

CD = transmural
UC = superficial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Compare Crohn’s disease and ulcerative colitis regarding smokine

A

CD = risk factor
UC = protective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can be used to diagnose IBD?

A

Labs and stool testing can help but usually colonoscopy with tissue biopsy is needed to dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lifestyle measures for IBD

A

eat smaller, more frequent meals that are low in fat and airy
Fiber
Drink plenty of water
Avoid alcohol, caffeine, carbonated beverages

Antidiarrheals or antispasmodic drugs (e.g. dicyclomine (Bentyl) may help diarrhea
Vit supps (e.g. B12, folate, vit D, calcium, iron, zinc) can help prevent deficiencies related to malabsorption

Probiotics Lactobacillus or Bifidobacterium infantis can reduce abd pain, bloating, urgency, constipation or diarrhea in some pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Natural products that may help with IBD?

A

Peppermint, chamomile, horehound, wheatgrass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T/F: short courses of oral or IV steroids are commonly used to treat acute exacerbations in both UC and CD.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When using systemic steroids for UC or CD, it is generally not recommended for maintenance of remission and will usually be tapered over ____ once remission is achieved

A

8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Compare CD and UC maintenance of remission for mild disease

A

CD mild disease of ileum and/or right colon: oral budesonide for ≤3 months; d/c after this course or change to thiopurine or methotrexate

UC mild disease: mesalamine (5-ASA_ rectal and/or oral preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Compare CD and UC maintenance of remission for moderate-severe disease

A

CD: anti-TNF agents (Adalimumab (Humira), Infliximab (Remicade), Certolizumab (Cimzia)), thiopurine (azathioprine, mecaptopurine), methotrexate, IL receptor antagonist (Ustekinumab (Stelara))

UC: anti-TNF agents (Adalimumab (Humira), Infliximab (Remicade), Certolizumab (Cimzia)), thiopurine (azathioprine, mecaptopurine), cyclosporine, IL receptor antagonist (Ustekinumab (Stelara))

Only difference is methotrexate for CD, cyclopsorine for UC. all other options can be used in either

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Compare CD and UC maintenance of remission for refractory to first line treatments and/or steroid dependent

A

CD: integrin receptor antagonists (vedolizumab (Entyvio), natalizumab (Tysabri))
UC: integrin receptor antagonists (vedolizumab (Entyvio)), Janus kinase inhibitor (Tofacitinib (Xeljanz))

21
Q

What formulation of budesonide is CD only vs UC only?

A

Budesonide (Entocort EC) 3mg ER cap = CD only

Budesonide (Uceris) 9mg ER tab = UC only

22
Q

Examples of oral steroids used in IBD

A

prednisone
Budesonide (Entocort EC, Uceris)

23
Q

Examples of rectal steroids used in IBD

A

Hyrdrocortisone (Cortenema, Cortifoam)
Budesonide rectal foam (Uceris)

24
Q

Rectal steroids are indicated for ___ only

A

UC

25
Q

If using steroids for IBD, pts can use alternate day therapy (ADT) to decrease ____ and other adverse effects

A

Decrease adrenal suppression

26
Q

Budesonide is a major substrate of CYP___

A

3A4
Avoid inhibitors including grapefruit juice and products

27
Q

____ is the primary aminosalicylate used in the US for UC (well tolerated and available both PO and rectal)

A

Mesalamine (5-ASA)

28
Q

Mesalamine ER suppository (Canasa) administration notes

A

1g rectally QHS, retain for at least 1-3 hrs

29
Q

Mesalamine ER enema (Rowasa) administration notes

A

4g rectally QHS, retain in the rectum overnight for approx 8 hrs

30
Q

Mesalamine ER formulations

A

ER capsules (Pentasa, Aprisa, Delzicol)
ER tabs (Asacol HD, Lialda)
Enema (Rowasa)
Suppository (Canasa)

31
Q

What formulation of mesalamine is more effective for distal disease/proctitis in US?

A

Rectal mesalamine > oral mesalamine or rectal steroids

32
Q

Which formulations of mesalamine ER can leave ghost tab in the stool?

A

Asacol and Delzicol

33
Q

Contraindications to mesalamine

A

Hypersensitivity to salicylates or aminosalicylates

34
Q

Warnings for mesalamine

A

Hypersensitivity reactions more likely with sulfasalazine than mesalamine

Others: acute intolerance syndrome, caution in pts with renal/hep impairment, delayed gastric retention can delay release of oral products in the colon, increase risk of blood dyscrasis in pts > 65 yo, photosensitivity

35
Q

Contraindications for sulfasalazine

A

Salicylate allergy, sulfa allergy, intestinal or urinary obstruction, porphyria

36
Q

Why is sulfasalazine used less commonly than mesalamine?

A

d/t many side effects a/w sulfapyridine component

37
Q

Thiopurines (Azathioprine, mercaptopurine) place in therapy for IBD

A

not FDA indicated but recommended as an option in guidelines for induction and maintenance of remission often in combo with other drugs

38
Q

Warnings for azathioprine

A

Genetic deficiency of TPMT are at increased risk of myelosuppression

Consider TPMT genetic testing prior to starting

39
Q

Azathioprine is metabolized to ___

A

mercaptopurine
Do not use the thiopurines in combination

40
Q

Monitoring for azathioprine

A

CBC (weekly for first month)

Others: LFTs, renal function, s/sx malignancy

41
Q

Methotrexate dosing and place in therapy for IBD

A

Not FDA indicated for IBD but recommended as otpion in guideline for induction and maintenance of remission in mod-severe CD pts who cannot tolerate azathioprine
Dosed once weekly IM or SC injection

42
Q

Cyclosporine place in therapy for IBD

A

Severe UC
Can be given PO or via IV continuous infusion

43
Q

Anti-TNF agents used in both CD and UC

A

Adalimumab (Humira)
Infliximab (Remicade)
Certolizumab (Cimzia)

44
Q

Integrin receptor antagonists (Natalizumab (Tysabri), Vedolizumab (Entyvio)) place in therapy for IBD

A

Induction and maintenance of remission in pts with IBD who have responded inadequately or cannot tolerate conventional therapies, or in pts who are steroid-dependent

45
Q

Natalizumab (Tysabri) dosing frequency

A

300mg IV over 1hr every 4 weeks

46
Q

Natalizumab (Tysabri) should be d/c if no response by ___

A

12 weeks

47
Q

Natalizumab (Tysabri) approved for ___

A

Crohn’s disease and multiple sclerosis

48
Q

Vedolizumab (Entyvio) should be d/c if no response by ___

A

Week 14

49
Q

Natalizumab (Tysabri) approved for ___

A

Crohn’s disease and UC

50
Q

Boxed warning for natalizumab (Tysabri)

A

Progressive multifocal leukoencephalopathy (PML) - opportunistic viral infection of brain that leads to death or severe disability)_
Only available through REMS TOUCH prescribing program

NAPLEX 2024 (74 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions