E4 IBD Flashcards
1
Q
rectum and colon
A
UC
2
Q
any part of Gi tract
A
CD
3
Q
mucosal inflammation
A
UC
4
Q
transmural inflammation
A
CD
5
Q
more common in men
UC
or
CD
A
UC
6
Q
more common in women
UC
or
CD
A
CD
7
Q
T or F: IBD has both autoimmune and non-autoimmune mechanisms
A
tru
8
Q
what happens when the gut wall is infiltrated by WBCs
A
granuloma formation and cytokine dysregulation
9
Q
T or F: IBD has genetic etiology
A
true
10
Q
diet stuff:
refined sugars, diets low in fruit/vege, high in unsat fats = _______
high protein= ____
A
CD
UC
11
Q
smoking:
protective in ___
bad with _____
A
UC - good
CD - bad
12
Q
T or F:
NSAIDs are a mainstay therapy in both IBD conditions
A
no fuck NSAIDs
13
Q
T or F:
UC affects mucosal and submucosal layers
A
true
14
Q
mucosal damage from UC can result in what two things
A
diarrhea and bleeding
15
Q
3 local complications of UC
A
hemorrhoids
anal fissures
perirectal absesses
16
Q
whats the potentially fatal UC complication we talked about?
A
toxic megacolon
17
Q
what is the physiological result of toxic megacolon
A
segmental or total colonic distension with acute colitis and signs of systemic toxicity
18
Q
cobblestone appearance
A
CD pathophys
19
Q
what is the most common site of inflammation in CD
A
terminal ileum
20
Q
UC or CD: ulcers tend to be deeper
A
CD
21
Q
UC or CD: small bowel stricture and obstruction possible
A
CD
22
Q
T or F: CD pts typically have more bleeding than UC
A
false
23
Q
UC or CD: More risk of nutritional deficiencies
A
CD because whole GI tract = more things absorbed and shit
24
Q
hepatic manifestations of IBD
A
fatty liver, pericholangitis, autoimmune hepatitis, cirrhosis
25
biliary manifestations of IBD
primary sclerosing cholangitis (PSC), cholangiocarcinoma, cholelithiasis
26
what extraintestinal manifestation of IBD should you immediately refer an evaluation for
anything with eyes
27
Bone and joint manifestations:
symmetrical or asymmetrical
asymmetrical
28
super common manifestation of IBD (hematologic)
anemia
29
when is the risk of VTE highest?
during flares
30
lab tests for UC:
- (increased/decreased) Hb/HCT
- (increased/decreased) ESR/CRP
- fecal calprotein (FC)
increased
increased
31
what does fecal calprotein (FC) correlate with?
degree of inflammation
32
T or F:
fecal calprotein (FC) is less sensitive and specific than serum markers
false, more
33
what are the main ways to diagnose UC
-oscopies
- negative stool exam for infectious causes
34
distal to splenic flexure
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis
A
35
extending proximal to splenic flexure
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis
B
36
involving the rectal area
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis
C
37
involving rectum and sigmoid colon
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis
D
38
involving majority of colon
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis
E
39
typical presentation of CD includes what 2 things
diarrhea and abdominal pain
40
what is hematochezia
blood in stool
41
when running an FC test, what does it help distinguish from?
IBD from IBS
42
clinical presentation of CD:
- (increased/decreased) Hb/HCT
- (increased/decreased) WBCs, ESR, CRP
decreased
increased
43
what is the most frequently used thing in research to gauge response to therapy and determine remission
CDAI (Chrons disease activity index)
44
mild/mod
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450
A
45
mod/sev
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450
B
46
sev/fulminant
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450
C
47
severe-fulminant CD:
- persistent sxs or evidence of systemic _______ despite _______ or biologic treatment
or
- presence of _______, rebound tenderness, intestinal obstruction, or _______
toxicity
corticosteroid
cachexia
abscess
48
which diet has shown to be beneficial for IBD
none shown
49
what to do with PN in regards to nutrition support in IBD
avoid unless absolutely necessary
50
UC or CD:
indications for surgery
UC (still for CD but less established)
51
which agents are considered curative?
none, no drugs at all cure either
52
what are the 2 ASAs?
sulfasalazine and mesalamine
53
what are the 4 immunomodulators
azathioprine
mercaptopurine
cyclosporine
MTX
54
what 2 antimicrobials are indicated in IBD tx
metronidazole
cipro
55
sulfasalazine is cleaved by _______ _______ to release _________ and 5-ASA
colonic bacteria
sulfapyridine
56
5-ASA mainly remains in ______ and is excreted in ______
lumen
stool
57
T or F:
sulfapyridine is active and associated with ADRs
false, inactive but still associated
58
2 things listed under MOA of 5-ASA
anti-inflam
free radical scavenging
59
T or F:
mesalamine can be administered alone
true
60
mesalamine rapidly and completely absorbed in ______ _______ but not ______
small intestine
colon
61
what form of mesalamine do you give for left-sided disease
topical (enemas)
62
what form of mesalamin do you give for proctitis
suppository
63
what form of mesalamine do you give for delayed/controlled release
oral
64
T or F:
topical mesalamine is more effective than oral
true
65
better tolerated
A. Sulfasalazine
B. Mesalamine
B
66
significance of olsalazine
more diarrhea
67
2 drug interactions for mesalamine
anything that increases bleeding
drugs affecting ph (ppil, H2RA, antacids)
68
T or F:
corticosteroids are used for induction and maintenance
False, induction of remission but not maintenance
69
what is budesonide and how is it administered
cortico
PO in CR formulation
70
T or F:
budesonide associated with extensive first pass metabolism
true
71
1 drug interaction for budesonide
CYP3A inhibitors (grapefruit, ketoconazole) -> increase systemic exposure
72
how much oral prednisone/prednisolone a day
40-60mg/day
73
do we need to taper off of the preds?
yes
74
oral preds may be used for disease _______ or ________
flares or induction
75
4 short term ADRs with cortico
hyperglycemia
gastritis
mood changes
inc BP
76
6 long term ADRs with cortico
necrosis
cataracts
obesity
growth failure
HPA suppression (what?)
osteoporosis*
77
what 2 things should you give pts on corticos and for what reason
calcium and vitamin d for risk of osteoporosis
78
AZA and 6-MP can be effective in long term treatment of ?
UC AND CD
79
T or F:
you can combine AZA with prednisone
true
80
AZA is a prodrug rapidly converted to?
6-MP
81
T or F:
AZA and 6-MP primarily play a role in maintenance
false, primarily maintenance with little to no role in induction
82
ADR "we worry about most" with AZA and 6-MP
hematologic -> bone marrow suppression and he said something about deadly anemia too
83
niche thing to monitor with AZA and 6-MP
TPMT
84
cyclosporine can be effective in ______ in pts with refractory IBD (not recommended for __)
inducing remission
not rec for CD
85
3 AEs for cyclosporine
nephrotoxicity (dose related)
neurotoxicity
metabolic effects
86
weird monitoring thing for cyclosporine
cya tr. conc.
goal is 200-400
87
2 drug interactions with cyclosporine
CYP3A and PgP !!
88
MTX used in?
just CD
89
T or F:
MTX may have steroid sparing effects
truee
90
what do we want to add to MTX and why?
folic acid for bone marrow suppression (I think)
91
few main CI's for MTX
pregnancy
CrCL <40
liver disease
pleural effusions
92
niche monitoring for MTX
chest xray
93
TNF inhibitor class ADRs:
test for which two things before starting?
tuberculin test, hep b/c
94
TNF inhibitor class ADRs:
contraindicated
live vaccines
95
TNF inhibitor class ADRs:
weird risk of what?
lymphoma and hepatosplenic T-cell lymphoma
oh my fucking god another one for demyelinating disease
96
TNF inhibitor class ADRs:
may exacerbate?
CHF, dont give in class III/IV
97
Infliximab:
indication:
class:
mod/sev CD and UC
TNF inhibitor
98
what do you need to know about combining infliximab with immunosuppressives
basically makes the risk of everything exceptionally worse
99
Adalimumab:
indication:
class:
mod/sev CD and UC
TNF inhibitor
100
Adalimumab may use for pts with poor response to ______
infliximab
101
T or F:
Infliximab has lower likelihood of developing ADAs than adalimumab
false, backwards
102
Golimumab:
indication:
class:
UC only
TNF inhibitor
103
T or F:
All 4 tnf inhibitors are used in induction and maintenance therapy
true
104
Certolizumab pegol:
indication:
class:
CD only
TNF inhibitor
105
Natalizumab:
indication:
class:
CD only
anti a-subunit integrin
(prevents leukocyte adhesion/migration)
106
Natalizumab induction or maintenance
both
107
can use natalizumab in pts who fail/dont tolerate ?
TNF-a inhibitors
108
Do we use natalizumab in combo with immunosuppressants?
no
109
when to d/c natalizumab in pts that start it
pts w/ no benefit by 12 weeks and/or who are still steroid dependent within 6 months (fuck this is so much info)
110
Natalizumab associated with ? (scary thing from past topics)
PML
111
T or F:
can see hypersens reactions and ADAs
true
112
natalizumab increased risk of PML with what 3 things
- Longer duration of therapy
- prior immunosuppressant use
- JC antibody positive
113
Vedolizumab:
indication:
class:
UC and CD
anti-a4-b7-integrin
114
Vedolizumab induction or maintenance
both
115
T or F:
PML also observed in Vedolizumab
false
116
where is a4-b7 integrin expressed?
subset of T-lymphocytes
117
Ustekinumab:
indication:
class:
CD and UC
IL-12 and IL-23 antagonist
118
Ustekinumab induction or maintenance
both
119
Reports of rapidly developing cutaneous cell carcinoma in pts with risk factors:
A. Natalizumab
B. Vedolizumab
C. Methotrexate
D. Ustekinumab
D
120
