GI disorders Flashcards
pathologic features of Chrohn’s disease
no rectal involvement, ilieal involved, strictures, fistulas, transmural involved, cobble stone appearance, granulomas, linear cleft, fever, bleeding, tenderness, mass, pain, fistulas, discontinuous, linear ulcers
Pathologic features of UC
Involves rectum, no ileal involved, no strictures, no fistulas, no transmural involved, no granulomas, no linear cleft, no fever, rectal bleeding, sometimes tenderness, no mass, no pain, no fistulas, continuous, no linear ulcers
Factors to consider when treating IBD
severity, location, drug factors
Severity to of acute disease
mild- 4 BM/day +/- blood; severe- >6 bloody BM/ day; >10 BM/day w/ continuous bleeding
Pharm options for IBD
5-aminosalicylates acid derivatives, corticosteroids, immunosuppressive agents, antimicrobials, biologics
5- aminosalicylate acid derivative MOA
anti-inflammatory, immunosuppressive, inhibition of leukocyte motility, interference w/ TNFa, transformation of growth factor B and nuclear factor, inhibition of leukotriene and prostaglandin production, suppression of IL-1 production
Sulfasalazine (Azulfidine)
large sulfa comp, treatment of mild to mod UC, adjunctive treatment in severe UC, prolonged remissions between UC acute attacks
Mesalamine (Canasa, rowasa, lialda, etc)
treatment of ulcerative proctitis, tx mild-mod distal UC, proctosigmoiditis or proctitis, induce and maintain remission in active, mil-mod UC, etc
Basalazide (Colazal)
treatment of mild to mod UC
Osalazine (Dipentum)
to maintain remission in UC who are intolerant of sulfasalazine
ADRs of 5-ASA
HA, nausea, rash, interstitial nephritis, pericarditis, pancreatitis, hepatitis, parodoxial exacerbation of colitis
ADRs of sulfasalazine
dose related rxns, hypersensitivity rxns, male infertility, discoloration
Balsalazide, olsalazine, mesalamine ADRs
hair loss, pneumotitis, diarrhea (olsalazine)
Sulfasalazine dose related ADRs
Dose >4 g/d, depends on metabolism status, ADRs- nausea dyspepsia, HA, fatigue, dizziness
Sulfasalazine hypersensitivity rxns
rash, fever, arthralgia, hepatic dysfunction, hematological toxicities
Corticosteroid agents
prednisone, prednisolone, methylprednisolone, budesonide, hydrocortisone, parenteral, oral, or rectal
Indication of corticosteroids
treatment of active UC or chrohn’s, induce remission
MOA of corticosteroids
antiinflammatory, inhibit cytokine and prostaglandins, immunosuppression, decreased margination of monocytes and neutrophils
Withdrawal sx of short-term steroid use
mood and sleep disturbances, inc appetitie, acne, adrenal insufficiency, fluid retention, impaired glucose metabolism
Withdrawal sx of long-term steroid use
abnormal fat deposits, hirsutism, htn, glaucoma/cataracts, osteopenia, osteoporosis, DM
Immunosuppressive agents
Azathioprine, 6-mercaptopurine, Methotrexate, cyclosporine & tacrolimus
Azathioprine and 6-mercaptopurine indication
not-FDA approved for tx of IBD, steroid sparing, combo w/ biologics
Azathioprine and 6-mercaptopurine MOA
immunosuppression, thought to suppress cell mediated hypersensitivities and cause alteration in ab productions
Azathioprine and 6-mercaptopurine onset
slow, 3 months
Azathioprine and 6-mercaptopurine black box warning
chronic immunosuppression cana inc risk of neoplasia, hematological toxicities, mutagenic potential
Azathioprine and 6-mercaptopurine adrs
GI upset, LFT, rash, hematologic toxicities, Preg cat D
Methotrexate indication
not FDA approved for tx of IBD, steroid sparing
Methotrexate MOA
immunosuppression