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PHRM 864 > E4 IBD > Flashcards

E4 IBD Flashcards

1
Q

rectum and colon

A

UC

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2
Q

any part of Gi tract

A

CD

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3
Q

mucosal inflammation

A

UC

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4
Q

transmural inflammation

A

CD

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5
Q

more common in men
UC
or
CD

A

UC

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6
Q

more common in women
UC
or
CD

A

CD

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7
Q

T or F: IBD has both autoimmune and non-autoimmune mechanisms

A

tru

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8
Q

what happens when the gut wall is infiltrated by WBCs

A

granuloma formation and cytokine dysregulation

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9
Q

T or F: IBD has genetic etiology

A

true

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10
Q

diet stuff:
refined sugars, diets low in fruit/vege, high in unsat fats = _______
high protein= ____

A

CD
UC

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11
Q

smoking:
protective in ___
bad with _____

A

UC - good
CD - bad

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12
Q

T or F:
NSAIDs are a mainstay therapy in both IBD conditions

A

no fuck NSAIDs

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13
Q

T or F:
UC affects mucosal and submucosal layers

A

true

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14
Q

mucosal damage from UC can result in what two things

A

diarrhea and bleeding

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15
Q

3 local complications of UC

A

hemorrhoids
anal fissures
perirectal absesses

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16
Q

whats the potentially fatal UC complication we talked about?

A

toxic megacolon

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17
Q

what is the physiological result of toxic megacolon

A

segmental or total colonic distension with acute colitis and signs of systemic toxicity

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18
Q

cobblestone appearance

A

CD pathophys

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19
Q

what is the most common site of inflammation in CD

A

terminal ileum

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20
Q

UC or CD: ulcers tend to be deeper

A

CD

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21
Q

UC or CD: small bowel stricture and obstruction possible

A

CD

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22
Q

T or F: CD pts typically have more bleeding than UC

A

false

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23
Q

UC or CD: More risk of nutritional deficiencies

A

CD because whole GI tract = more things absorbed and shit

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24
Q

hepatic manifestations of IBD

A

fatty liver, pericholangitis, autoimmune hepatitis, cirrhosis

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25
Q

biliary manifestations of IBD

A

primary sclerosing cholangitis (PSC), cholangiocarcinoma, cholelithiasis

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26
Q

what extraintestinal manifestation of IBD should you immediately refer an evaluation for

A

anything with eyes

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27
Q

Bone and joint manifestations:
symmetrical or asymmetrical

A

asymmetrical

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28
Q

super common manifestation of IBD (hematologic)

A

anemia

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29
Q

when is the risk of VTE highest?

A

during flares

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30
Q

lab tests for UC:
- (increased/decreased) Hb/HCT
- (increased/decreased) ESR/CRP
- fecal calprotein (FC)

A

increased
increased

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31
Q

what does fecal calprotein (FC) correlate with?

A

degree of inflammation

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32
Q

T or F:
fecal calprotein (FC) is less sensitive and specific than serum markers

A

false, more

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33
Q

what are the main ways to diagnose UC

A

-oscopies
- negative stool exam for infectious causes

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34
Q

distal to splenic flexure
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis

A

A

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35
Q

extending proximal to splenic flexure
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis

A

B

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36
Q

involving the rectal area
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis

A

C

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37
Q

involving rectum and sigmoid colon
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis

A

D

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38
Q

involving majority of colon
A. Left-sided
B. Extensive
C. Proctitis
D. Proctosigmoiditis
E. Pancolitis

A

E

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39
Q

typical presentation of CD includes what 2 things

A

diarrhea and abdominal pain

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40
Q

what is hematochezia

A

blood in stool

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41
Q

when running an FC test, what does it help distinguish from?

A

IBD from IBS

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42
Q

clinical presentation of CD:
- (increased/decreased) Hb/HCT
- (increased/decreased) WBCs, ESR, CRP

A

decreased
increased

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43
Q

what is the most frequently used thing in research to gauge response to therapy and determine remission

A

CDAI (Chrons disease activity index)

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44
Q

mild/mod
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450

A

A

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45
Q

mod/sev
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450

A

B

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46
Q

sev/fulminant
A. CDAI 150-220
B. CDAI 220-450
C. CDAI>450

A

C

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47
Q

severe-fulminant CD:
- persistent sxs or evidence of systemic _______ despite _______ or biologic treatment
or
- presence of _______, rebound tenderness, intestinal obstruction, or _______

A

toxicity
corticosteroid
cachexia
abscess

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48
Q

which diet has shown to be beneficial for IBD

A

none shown

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49
Q

what to do with PN in regards to nutrition support in IBD

A

avoid unless absolutely necessary

50
Q

UC or CD:
indications for surgery

A

UC (still for CD but less established)

51
Q

which agents are considered curative?

A

none, no drugs at all cure either

52
Q

what are the 2 ASAs?

A

sulfasalazine and mesalamine

53
Q

what are the 4 immunomodulators

A

azathioprine
mercaptopurine
cyclosporine
MTX

54
Q

what 2 antimicrobials are indicated in IBD tx

A

metronidazole
cipro

55
Q

sulfasalazine is cleaved by _______ _______ to release _________ and 5-ASA

A

colonic bacteria
sulfapyridine

56
Q

5-ASA mainly remains in ______ and is excreted in ______

A

lumen
stool

57
Q

T or F:
sulfapyridine is active and associated with ADRs

A

false, inactive but still associated

58
Q

2 things listed under MOA of 5-ASA

A

anti-inflam
free radical scavenging

59
Q

T or F:
mesalamine can be administered alone

60
Q

mesalamine rapidly and completely absorbed in ______ _______ but not ______

A

small intestine
colon

61
Q

what form of mesalamine do you give for left-sided disease

A

topical (enemas)

62
Q

what form of mesalamin do you give for proctitis

A

suppository

63
Q

what form of mesalamine do you give for delayed/controlled release

64
Q

T or F:
topical mesalamine is more effective than oral

65
Q

better tolerated
A. Sulfasalazine
B. Mesalamine

66
Q

significance of olsalazine

A

more diarrhea

67
Q

2 drug interactions for mesalamine

A

anything that increases bleeding
drugs affecting ph (ppil, H2RA, antacids)

68
Q

T or F:
corticosteroids are used for induction and maintenance

A

False, induction of remission but not maintenance

69
Q

what is budesonide and how is it administered

A

cortico
PO in CR formulation

70
Q

T or F:
budesonide associated with extensive first pass metabolism

71
Q

1 drug interaction for budesonide

A

CYP3A inhibitors (grapefruit, ketoconazole) -> increase systemic exposure

72
Q

how much oral prednisone/prednisolone a day

A

40-60mg/day

73
Q

do we need to taper off of the preds?

74
Q

oral preds may be used for disease _______ or ________

A

flares or induction

75
Q

4 short term ADRs with cortico

A

hyperglycemia
gastritis
mood changes
inc BP

76
Q

6 long term ADRs with cortico

A

necrosis
cataracts
obesity
growth failure
HPA suppression (what?)
osteoporosis*

77
Q

what 2 things should you give pts on corticos and for what reason

A

calcium and vitamin d for risk of osteoporosis

78
Q

AZA and 6-MP can be effective in long term treatment of ?

79
Q

T or F:
you can combine AZA with prednisone

80
Q

AZA is a prodrug rapidly converted to?

81
Q

T or F:
AZA and 6-MP primarily play a role in maintenance

A

false, primarily maintenance with little to no role in induction

82
Q

ADR “we worry about most” with AZA and 6-MP

A

hematologic -> bone marrow suppression and he said something about deadly anemia too

83
Q

niche thing to monitor with AZA and 6-MP

84
Q

cyclosporine can be effective in ______ in pts with refractory IBD (not recommended for __)

A

inducing remission
not rec for CD

85
Q

3 AEs for cyclosporine

A

nephrotoxicity (dose related)
neurotoxicity
metabolic effects

86
Q

weird monitoring thing for cyclosporine

A

cya tr. conc.
goal is 200-400

87
Q

2 drug interactions with cyclosporine

A

CYP3A and PgP !!

88
Q

MTX used in?

89
Q

T or F:
MTX may have steroid sparing effects

90
Q

what do we want to add to MTX and why?

A

folic acid for bone marrow suppression (I think)

91
Q

few main CI’s for MTX

A

pregnancy
CrCL <40
liver disease
pleural effusions

92
Q

niche monitoring for MTX

A

chest xray

93
Q

TNF inhibitor class ADRs:
test for which two things before starting?

A

tuberculin test, hep b/c

94
Q

TNF inhibitor class ADRs:
contraindicated

A

live vaccines

95
Q

TNF inhibitor class ADRs:
weird risk of what?

A

lymphoma and hepatosplenic T-cell lymphoma
oh my fucking god another one for demyelinating disease

96
Q

TNF inhibitor class ADRs:
may exacerbate?

A

CHF, dont give in class III/IV

97
Q

Infliximab:
indication:
class:

A

mod/sev CD and UC
TNF inhibitor

98
Q

what do you need to know about combining infliximab with immunosuppressives

A

basically makes the risk of everything exceptionally worse

99
Q

Adalimumab:
indication:
class:

A

mod/sev CD and UC
TNF inhibitor

100
Q

Adalimumab may use for pts with poor response to ______

A

infliximab

101
Q

T or F:
Infliximab has lower likelihood of developing ADAs than adalimumab

A

false, backwards

102
Q

Golimumab:
indication:
class:

A

UC only
TNF inhibitor

103
Q

T or F:
All 4 tnf inhibitors are used in induction and maintenance therapy

104
Q

Certolizumab pegol:
indication:
class:

A

CD only
TNF inhibitor

105
Q

Natalizumab:
indication:
class:

A

CD only
anti a-subunit integrin
(prevents leukocyte adhesion/migration)

106
Q

Natalizumab induction or maintenance

107
Q

can use natalizumab in pts who fail/dont tolerate ?

A

TNF-a inhibitors

108
Q

Do we use natalizumab in combo with immunosuppressants?

109
Q

when to d/c natalizumab in pts that start it

A

pts w/ no benefit by 12 weeks and/or who are still steroid dependent within 6 months (fuck this is so much info)

110
Q

Natalizumab associated with ? (scary thing from past topics)

111
Q

T or F:
can see hypersens reactions and ADAs

112
Q

natalizumab increased risk of PML with what 3 things

A
  • Longer duration of therapy
  • prior immunosuppressant use
  • JC antibody positive
113
Q

Vedolizumab:
indication:
class:

A

UC and CD
anti-a4-b7-integrin

114
Q

Vedolizumab induction or maintenance

115
Q

T or F:
PML also observed in Vedolizumab

116
Q

where is a4-b7 integrin expressed?

A

subset of T-lymphocytes

117
Q

Ustekinumab:
indication:
class:

A

CD and UC
IL-12 and IL-23 antagonist

118
Q

Ustekinumab induction or maintenance

119
Q

Reports of rapidly developing cutaneous cell carcinoma in pts with risk factors:
A. Natalizumab
B. Vedolizumab
C. Methotrexate
D. Ustekinumab

PHRM 864 (29 decks)

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