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GI IBD Flashcards

1
Q

Chronic, idiopathic, relapsing inflammatory disorders

A

Inflammatory Bowel Disease

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2
Q

Mucosal inflammatory condition of the GI tract that is limited to the rectum and the colon (large intestine)

A

Ulcerative Colitis

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3
Q

Transmural inflammatory condition that can effect any part of the GI tract from the mouth to anus

A

Crohn’s Disease

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4
Q

True or false: IBD affects both sexes equally

A

True

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5
Q

What ages are patients when they are diagnosed with UC?

A

20-25

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6
Q

What ages are patients when they are diagnosed with CD?

A

Before 30

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7
Q

What race is more affected by IBD?

A

Caucasians

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8
Q

What environmental factors contribute to IBD?

A

1) Infection
2) Foods
3) Smoking

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9
Q

What dietary antigens can cause inflammation in the GI Tract?

A

Red meat and alcohol

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10
Q

True or false: smoking worsens UC, but is associated with improved symptoms of CD

A

False

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11
Q

___ degree relatives have a __-fold increased risk of developing IBD

A

1st ; 13

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12
Q

True or false: Genetics have more of an increased risk for CD over UC

A

True

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13
Q

What type of agents does IBD respond to?

A

Immunosuppressant agents

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14
Q

What are 5 presenting symptoms of IBD?

A
  1. Rectal bleeding
  2. Diarrhea
  3. Fever
  4. Weight loss
  5. Abdominal pain and cramping
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15
Q

To diagnose IBD, what do you have to rule out first?

A

Infectious etiology

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16
Q

Which type of IBD has continuous lesions?

A

Ulcerative Colitis

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17
Q

What is the mucosal appearance with UC?

A
  1. Edema
  2. Mucous Erosions
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18
Q

Type of UC where only the rectum is involved

A

Proctitis

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19
Q

Type of UC that extends to the left splenic flexure

A

Distal colitis

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20
Q

Type of UC that involves areas of the colon beyond
the left splenic flexure

A

Extensive colitis

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21
Q

What is the mucosal appearance of Crohns Disease?

A
  1. Ulcers
  2. Stricters
  3. Fistulas
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22
Q

What type of lesions are seen with CD?

A

Discontinuous (cobblestone appearance)

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23
Q

What sites in the GI Tract are the most frequently affected sites?

A
  1. Ileum
  2. Colon
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24
Q

Mild UC is described as:

A

< 4 stools/day with or without Blood and no systemic disturbances

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25
Q

Moderate UC is described as:

A

4 to 6 stools/day with or without Blood. Minimal systemic disturbances

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26
Q

Severe UC is described as:

A

7-10 stools/day With Blood and systemic disturbances

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27
Q

What 5 things describe systemic disturbances?

A
  1. Fever
  2. Tachycardia
  3. Anemia
  4. Abdominal tenderness
  5. Bowel wall edema
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28
Q

Fulminant UC is described as:

A

> 10 stools/day with continuous bleeding (may require a transfusion) and marked systemic disturbances

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29
Q

Mild/Moderate CD is described as:

A

Ambulatory patients, can tolerate P.O. ; absence of fever, dehydration and abdominal tenderness;
Non-significant weight loss (<10% weight loss )

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30
Q

Moderate/Severe CD is described as:

A
  1. Failed treatment for mild/moderate disease
    OR
  2. More prominent systemic symptoms and significant anemia
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31
Q

Severe/Fulminant CD is described as:

A
  1. Patients with persisting symptoms despite use of corticosteroids
    OR
  2. Rebound tenderness; cachexia; evidence of intestinal obstruction or abscess
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32
Q

True or false: There is more of an increased risk with CD than UC

A

False

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33
Q

The risk for colon cancer starts about __ years after IBD diagnosis

A

8

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34
Q

An abnormal communication between 2 hollow organs or between a hollow organ and the exterior

A

Fistulas

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35
Q

True or false: Fistulas are more common with CD than UC

A

True

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36
Q

Toxic Megacolon causes severe inflammation that leads to _____ and _______.

A

Colonic dilation and perforation

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37
Q

How do patients present with Toxic Megacolon?

A

High fever, tachycardia, distended abdomen, increased WBC’s; dilated colon

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38
Q

What are the 6. Goals of therapy?

A
  1. Relief of symptoms
  2. Improve quality of life
  3. Maintain adequate nutritional status
  4. Relive intestinal inflammation
  5. Decrease frequency of recurrence
  6. Resolve Complications
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39
Q

Prototype Aminosalicylate

A

Sulfasalasazine

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40
Q

What is Sulfasalazine cleaved by?

A

Colonic bacteria to active portion

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41
Q

Dose-related adverse effects with Sulfasalazine?

A
  1. GI disturbances
  2. Headaches
  3. Arthralgia
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42
Q

Idiosyncratic adverse effects seen with Sulfasalazine (5)?

A
  1. Rash
  2. Fever
  3. Hepatotoxicity
  4. Nephrotoxicity
  5. Bone marrow suppression
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43
Q

What is a good counseling point to tell patients for Sulfasalazine?

A

Can cause yellow/ orange discoloration of the skin , urine, tears, and other secretions

44
Q

What should you monitor for Sulfasalazine?

A
  1. LFTS
  2. Renal function
  3. CBC w/ differential
45
Q

What is a contraindication for the 5-ASAs?

A

Salicylate or aminosalicylate allergy

46
Q

5-ASAs should be used in caution in patients who have what?

A

Renal or liver impairment

47
Q

What form of mesalamine has a drug target for the small intestine and the colon?

48
Q

Which aminosalicylate is best tolerated?

A

Mesalamine

49
Q

True or false: Corticosteroids should be used for short time use only

50
Q

What is the indication for the use of Budesonide?

A

For CD maintenance only (for 3 months then taper)

51
Q

True or false: Budesonide undergoes extensive first pass metabolism

52
Q

True or false: corticosteroids should not be used for maintenance treatment

53
Q

What is the indication for the use of corticosteroids?

A

They work quickly to suppress inflammation and decrease flare ups

54
Q

True or false: Thiopurines can be used for induction and maintenance therapy

A

False; maintenance only

55
Q

What are the two thiopurines used?

A
  1. Mercaptopurine
  2. Azathiopurine
56
Q

How long does it take thiopurines to start working?

A

Weeks-months

57
Q

What enzyme is responsible for the metabolism of Aza and MP?

58
Q

What drug class should you use caution with when using the Thiopurines? Why should you use caution?

A

5-ASAs; can inhibit TPMT (decrease metabolism)

59
Q

What are ADRs of the Thiopurines? 7

A
  1. Pancreatitis
  2. Bone marrow suppression
  3. Anemia
  4. Thrombocytopenia
  5. Hepatotoxicity
  6. Renal toxicity
  7. N/V
60
Q

What is a boxed warning for Azathiopurine

A
  1. Chronic immunosuppression
  2. Increased risk of cancers
  3. Hematological toxicities
61
Q

What is used as a backup for Thiopurines?

A

Methotrexate

62
Q

What is the indication of cyclosporine?

A

Severe flares in UC

63
Q

What is the indication for the JAK inhibitors?

A

Treats mod-severe active UC

64
Q

What are the 5 boxed warnings for the JAK inhibitors?

A
  1. Increased risk of opportunistic infections
  2. Increased rate of cardiovascular death
  3. Increased risk for malignancies
  4. Higher rate of MACE
  5. Risk of thrombosis
65
Q

Upadacitinib

66
Q

What are the ADRs for Upadacitinib? 5

A
  1. URTIs
  2. Acne
  3. Neutropenia
  4. Increased LFTs
  5. Rash
67
Q

Infliximab

68
Q

What are TNF Inhibitors indicated for?

A

Both CD and UC

69
Q

True or False: TNF inhibitors can be used for both induction and maintenance of active disease

70
Q

What should you pretreat with before using the TNF inhibitors?

A

1.APAP
2. BENADRYL
3. CORTICOSTEROIDS

71
Q

What test should be performed before using TNF inhibitors?

72
Q

True or false: you can use live vaccines when administering TNF inhibitors

73
Q

What exacerbations are seen with the TNF inhibitors?

A

Heart failure

74
Q

What are boxed warnings of the TNF Inhibitors?

A
  1. Opportunistic infections
  2. Lymphoma and other malignancies
75
Q

What should you monitor for with the TNF inhibitors?

A
  1. TB
  2. S/S of severe infection
  3. CBC w differential
  4. LFTs
  5. HF or worsening HF
  6. Malignancy
  7. BP
76
Q

Adalimumab

77
Q

What is HUMIRA indicated for?

A

Severe Crohn’s disease and mod-severe ulcerative colitis

78
Q

How is HUMIRA administered?

79
Q

Certolizumab

80
Q

What is Certolizumab Indicated for?

A

Mod-severe Crohn’s disease

81
Q

Golimumab

82
Q

What is SIMPONI indicated for?

A

Moderate/severe UC

83
Q

What TNF Inhibitor is no longer recommended per the AGA?

A

Natalizumab

84
Q

Vedolizumab

85
Q

What is Vedolizumab indicated for?

A

Moderate to severe UC & CD

86
Q

What is a RARE SE of Entyvio?

A

Progressive multifocal leukoencephalopathy (PML)

87
Q

Ustekinumab

88
Q

What is Ustekinumab indicated for?

A

Mod-severe CD or UC

89
Q

Risankizumab

90
Q

What is Skyrizzi indicated for?

A

Moderate to severe CD

91
Q

What are ADRs of Risankizumab?

A
  1. URTIs
  2. Headache
  3. UTIs
  4. Arthralgias
92
Q

Sphingosine 1-phosphate (S1P) receptor modulator

93
Q

Ozanimod

94
Q

What is Oxanimod indicated for?

A

Mod-severe UC

95
Q

What are contraindications with Ozanimod? 4

A
  1. In the last 6 months, MI, unstable angina, stroke, TIA, Class III or IV HF
  2. Presence of AV block, unless they have a pacemaker
  3. Untreated sleep apnea
  4. Taking an MAOI
96
Q

What are ADRS of Zeposia?

A
  1. URTIs
  2. Increased LFTs
  3. Headache
  4. Nausea
97
Q

What assessments should be done prior to using zeposia? 4

A

1.CBC
2. LFT
3. ECG
4. Ophthalmic assessment

98
Q

What is first line treatment for mild DISTAL UC?

A

Topical (enema/suppository) aminosalicylates

99
Q

What is second line for mild DISTAL UC?

A

Oral aminosalicylate or topical corticosteroid

100
Q

True or False: topical corticosteroids have no role in maintenance treatment

101
Q

What should you use for remission/maintenance of mild DISTAL UC?

A
  1. Mesalamine suppository/enema 3x/week
  2. Oral aminosalicylate
102
Q

What is first line in mild EXTENSIVE UC disease?

A

Oral aminosalicylate

103
Q

What do you use for second line therapy in mild EXTENSIVE disease?

A

Oral corticosteroids

104
Q

What is preferred for remission/maintenance treatment in mild EXTENSIVE disease?

A

Oral aminosalicylates

105
Q

What is first line therapy for Moderate/Severe UC per the ACG guidelines?

A
  1. Oral aminosalicylate or oral budesonide or systemic oral corticosteroids
106
Q

What is first line therapy per AGA guidelines for moderate-severe UC?

A

Infliximab, Vedolizumab, adalimumab, golimumab

PY3 (24 decks)

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