Gastrointestinal Conditions: Inflammatory Bowel Disease Flashcards
Ulcerative Colitis classifications
Moderate disease = > 4 stools per day
severe disease = > 6 bloody stools per day
Fulminant disease = > 10 stools per day, risk to progress to toxic mega colon
Crohn’s disease for mild disease txm
oral budesonide for < 3 months then d/c or change to thiopurine/methotrexate
Crohn’s moderate-severe disease txm
Anti-TNF agents = Humiram Remicade, Cimzia
Thiopurine
Methotrexate
Stelara
Crohn’s refractory disease txm
Entyvio
Tysabri
Ulcerative colitis mild disease txm
mesalamine rectal or oral
Ulcerative colitis moderate/severe disease txm
Anti-TNF agents: Humira, Remicade, Simponi
thiopurine
Cyclosporine
Stelera
Ulcerative Colitis refractory disease txm
Entyvio
Xeljanz
Steroids for txm notes
avoid long term use
if longer than 2 weeks, then taper to avoid withdrawal
if using long term, assess bone mineral density
Rectal steroids are indicated only for….
ulcerative colitis
Aminosalicylates used for UC txm?
Mesalamine
Sulfasalazine = Azulfidine
Balsalazide = Colozal
Olsalazine = Dipentum
Mesalamine Contraindications
Hypersensitivity to salicylates or aminosalicylates
Mesalamine warings
acute intolerance syndrome
hypersensitivity reactions
photosensitivity
inc risk of blood dyscrasias
Mesalamine side effects
abdominal pain
nausea
headache
flatulence
belching
Sulfasalazine contraindications
salicylate allergy
sulfa allergy
Balsalazide (Colazal) info
CI: salicylate allergy
warning: Gastric retention
SE: Headache, N/V/D
notes: can stain teeth/tongue
Thiopurines are recommended as option in guidelines for…
indication and maintenance of remission in combo with other drugs
not FDA approved for IBD
Azathioprine (Azasan) boxed warnings
chronic immunosuppression
inc risk of malignancy in pts with IBD
Azathioprine (Azasan) warnings
Hematologic toxicities
inc risk for myleosuppression in TPMT deficiency pts
Azathiopurine (Azasan) monitoring and notes
monitor = CBC, weekly 1st month
dont use with mercaptopurine
Methotrexate in IBD?
not FDA indication
used for induction and maintenance of remission in moderate-severe CD pts who cant tolerate azathioprine
used once weekly
Which interleukin receptor antagonist binds to and interferes with IL-12 and IL-23
Ustekinumab (Stelara)
Which IL receptor does Skyrizi (Risankizumab) bind to
IL-23
Integrin receptor antagonists are used for….
induction and maintenance of remission in pts with IBD who have responded inadequately or cannot tolerate conventional therapies, or steroid dependent patient
Integrin receptor antagonists
Natalizumab = Tysabri
Vedolizumab = Entyvio
Natalizumab (Tysabri) boxed warnings
PML
only available trough REMS program
Natalizumab (Tysabri) side effects
infusion reactions
headache
fatigue
nausea
rash
When should Natalizuamab (Tysabri) be discontinued?
if no response after 12 weeks then d/c
When should Vedolizumab (Entyvio) be discontinued?
if no response after 14 weeks then d/c
