Ch 71: Inflammatory Bowel Disease Flashcards
Not the same as Irritable Bowel Syndrome (IBS)
ulcerative colitis (UC)
bloody diarrhea, smoking is protective, located in colon (usually rectum), superficial, continuous patterm, uncommon fistulas/strictures
crohns disease (CD)
bloody or non-bloody diarrhea, smoking is a risk factor, located thru out the GI tract, transmural, non-continuous patter, common fistulas/strictures
prostitis
inflammation (UC) located in rectum only
mild CD
PO budesonide
mild UC
mesalamine (5ASA)
mod/severe CD
anti-TNF (Humira, Remicade, Cimzia), thiopurine (azathioprine, mercaptopurine), MTX, IL receptor agonist (Stelara) are options
mod/severe UC
anti-TNF (Humira, Remicade, Simponi), thiopurine (azathioprine, mercaptopurine), cyclosporine are options
refractory CD or steroid dependent
integrin receptor antagonists (natalizumab or vedolizumab)
refractory UC or steroid dependent
vedolizumab
rectal steroids avail
UC only. hydrocortisone (cortifoam or cortenema) or budesonide foam (uceris). not effective for mx of remission, just induction of UC.
oral steroids avail
prednisone (deltasone) and budesonide (entocort for CD only, uceris for UC only). budesonide has extensive first pass metab and lower sys exposure. avoid long term use if possible. use alt day therapy if dec adrenal suppression. if used longer than 2 wks, taper. if long term required, assess bone density, admin ca/vit D, consider bisphosphonates.
short term ADRs of PO/IV steroids
inc appetite/wt gain, fluid retention, emotional instability, insomnia, GI upset, higher doses can cause inc in BP and BG
long term ADRs of PO/IV steroids
adrenal suppression/cushing’s syndrome, immunosuppression/impaired wound healing, HTN, hyperglycemia, cataracts, osteoporosis, others
aminosalicylates
mesalamine (5ASA) - many formulations and low ADRs, sulfasalazine - less common d/t ADRs, other “-salazine/zide”s. giazo (balsalazide) indicated for males only. all are converted to mesalamine before effect. indicated for UC, topical anti-inflamm effect in GI. rectal more effective than PO in proctitis/distal UC. warning: hypersens rxns more likely with sulfasalazine than mesalamine.
thiopurines
azathioprine or mercaptopurine. indicated for induction and mx of remission. BBW: inc risk of malignancy in pts wih IBD. warning: hematologic tox leukopenia, thrombocytopenia, anemia), pts with TPMT (thiopurine methyltransferase) deficiency have inc risk. ADRs: NVD, rash, inc LFTs.
