Chapter 74: Inflammatory Bowel Disease Flashcards
Classic symptom of IBD
bloody diarrhea
Which class of drugs can cause IBD flares
NSAIDs
What is the difference between IBS and IBD
IBS does not cause inflammation
Ulcerative colitis is characterized by mucosal inflammation confined to the
rectum and colon with superficial ulcerations
When UC is limited to the descending colon and rectum, it is called ___ and can be treated with ____
distal disease
topical (rectal) treatment
Inflammation limited to the rectum is called
proctitis
Fistuals/strictures are common in crohn’s disease or ulcerative colitis
CD
Where is Crohn’s Disease located
Entire GI tract
Crohn’s Disease depth is
Transmural
CD pattern vs UC pattern
CD is non-continuous
UC is continuous
What is commonly used to treat acute exacerbations in both UC and CD
short courses of oral or IV steroids
What is used for maintenance therapy in UC (distal or mild extensive disease)
aminosalicylates
What is preferred for mild CD that is limited to the ileum and proximal colon
Budesonide for less than or = 3 months
After this course, d/c treatment or change to thiopurine or MTX
What can be used for moderate-severe CD for maintenance of remission
Anti-TNF agents (Humira, Remicade, Cimzia)
Thiopurine
MTX
Stelara
What can be used for refractory treatment or steroid dependent CD
Vedolizumab or natalizumab
What can be used for mild UC for maintenance of remission
Mesalamine (5-ASA) rectal and/or oral preferred
What can be used for moderate-severe UC for maintenance of remission
Anti-TNF agents (Humira, Remicade, Simponi) Thiopurine Cyclosporine Stelara Xeljanz
What can be used for refractory treatment or steroid dependent UC
Vedolizumab
Budesonide brand name
Entocort EC (for CD only) Uceris (for UC only)
If steroids are used long than ___ weeks, they must be tapered
2 weeks
If long-term use of steroids is required, must assess
bone density
Which drug can be used for both induction and maintenance of UC and CD
Budesonide
Rectal steroids (hydrocortisone and budesonide rectal foam) are indicated for __ only
UC
When using budesonide, must avoid strong and moderate ____ of which CYP enzyme, including ____
inhibitors
3A4
grapefruit juice and grapefruit products
Which formulations does mesalamine come in
oral and rectal
Induction with mesalamine for UC oral therapy is used for ___ weeks and rectal therapy for ___ weeks
6-8 oral
3-6 rectal
Mesalamine rectal suppository should be retained in the rectum for at least ___ hours
1-3
Mesalamine enema should be retained in the rectum for how long
Overnight
Mesalamine CI
hypersensitivity to salicylates or aminosalicylates
For distal disease/proctitis in UC, which formulation of mesalamine is more effective
Rectal
Mesalamine ER tablet (Asacol) and ER capsule (Delzicol) can
Leave a ghost tablet in the stool
Sulfasalazine CI
salicylate and sulfa allergy
Balsalazide can cause
staining of the teeth/tongue
Patients with which genetic deficiency are at increased risk of myelosuppression when using azathioprine
TPMT
Methotrexate can be used for induction & maintenance of remission in mod-severe
CD (in pts who cannot tolerate azathioprine)
How is MTX dosed in CD
once weekly by IM or SC route
Which immunosuppressive drug is recommended for severe UC
Cyclosporine
Natalizumab is only approved for
CD
How often is natalizumab given
every 4 weeks
Natalizumab should be d/c if no response by ___ weeks
12
Vedolizumab is approved for
UC and CD
Vedolizumab should be d/c if no response by ___ weeks
14
Natalizumab boxed warning
PML
Natalizumab is only available through
REMS TOUCH program
Natalizumab brand name
Tysarbi
Vedolizumab brand name
Entyvio
