Exam III: Chron's Disease Management Flashcards
What is CDAI
Chron’s Disease Activity Index.
CDAI <150 is indicative of
Remission
CDAI 150-220 is ______
mild-moderate chron’s disease
CDAI 220-450 is ______
Moderate - Severe Chron’s Disease
CDAI > 450 is ______
Severe/ Fulminant Chron’s Disease
What is the first line therapy for mild-moderate Chron’s Disease?
Budesonide 9 mg Daily
Oral for Ileal/Colonic Disease, if distal —> use suppository.
Note: Mesalamine has been used historically but has minimal effectiveness compared to placebo.
What is the first line treatment for moderate to severe Chron’s Disease?
What is the alternative first line agent?
1st Line = 40-60 mg Prednisone for 7-28 days. (may consider adding immunomodulator)
Alternative —> Infliximab +/- immunomodulator.
Alternative ALternative–> any biologic.
What biologic should be used last only if failed all other therapies for chron’s disease?
Natalizumab.
How do we treat severe/fulminant Chron’s Disease?
Abcess = Surgical Drainage.
IV corticosteroids, TNF-inhibitors, Supportive Care
Which TNF-alpha inhibitor has the best efficacy for chron’s disease?
Infliximab.
How do we treat perianal chron’s disease?
Abcess = Drainage
Fissures/Fistulas =
TNF Inhibitor +/- immunomodulator +/- metronidazole +/- Ciprofloxacin
What are the first and second line agents in CD for remission?
1st line = immunomodulators.
2nd line = biologics
In CD, for remission in each of the following situations what therapy should be used:
Induced by budesonide?
Induced by biologic?
Induced by steroid?
Budesonide —> Immunomodulator
Biologic —> biologic +/- immunomodulator
Steroid —> try immunomodulator first, then biologic.
For biologics if an effect is not observed within ______, treatment should be considered to have failed.
8 weeks.
What are the two scoring tools used to determine the severity of CD?
CDAI (chron’s Disease Activity Index)
Harvey Bradshaw
