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competency 10/11 > gi: ibd (uc, crohn's) > Flashcards

gi: ibd (uc, crohn's) Flashcards

1
Q

crohn’s disease

A

patchy/cobblestone, can affect entire GIT

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2
Q

ulcerative colitis

A

Generally start from distal end
Starts from anus and spreads
to large intestine; small intestine
not affected (can do resection
of large intestine for cure)

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3
Q

site of release: mesalazine (Pentasa)

A

duodenum, jejunum, ileum, colon
- moisture activated, site of release over larger area
- can dissolve in water to drink

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4
Q

site of release: salofalk

A

jejunum, ileum, colon

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5
Q

site of release: mesalazine (Asacol)

A

terminal ileum, colon

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6
Q

site of release: sulfasalazine

A

colon

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7
Q

site of release: liquid enemas

A

may reach the splenic flexure
- do not frequently conc in the rectum

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8
Q

site of release: suppositories

A

reach the upper rectum (15-20cm beyond the anal verge)

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9
Q

sulfasalazine, look out for

A

sulfa allergy and g6pd deficiency

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10
Q

which 5-asa has higher risk of oligospermia?

A

sulfasalazine

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11
Q

Asacol disintegrates at

A

pH>7

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12
Q

prednisolone dose

A

40-60mg/day

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13
Q

steroids tapering regimen

A

> 5-10mg/ week until the dose is 20mg/day
Then 2.5-5mg/week until the drug is discontinued

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14
Q

acute side effects of steroids

A

difficulty sleeping, gastric discomfort, water retention, mood swings

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15
Q

other side effects of steroids

A

Growth retardation, weight gain, osteoporosis, hypertension, exacerbation of DM, depression, difficulty sleeping

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16
Q

budenofalk

A

budesonide
- acute exacerbation of cd: 9mg daily
- maintenance dosage: 3mg daily

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17
Q

cortiment

A

budesonide mmx
- taken orally but exerts its action topically in the colon, to minise systemic absorption
- 9mg daily for 8 weeks, to induce remission in mid-mod active UC

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18
Q

topical steroid preparations

A

hydrocortisone foam, budesonide foam
- reach 15-20cm (distal colitis)

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19
Q

metronidazole

A

1-2g/d

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20
Q

ciprofloxacin

A

1-1.5g/d

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21
Q

mtx

A

immunosuppressant, inhibit dihydrofolate reductase (decr leukocyte proliferation) and interfere w IL-1

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22
Q

azathioprine

A

inhibit protein nucleotide biosynthesis, inhibit T and B lymphocyte replication

23
Q

immunosuppressant

A

effective for long-term maintenance for CD/UC
- Used in patients poorly responsive or dependent on steroids to control their symptoms

24
Q

azathioprine dose

A

2-3mg/kg, slow onset of 8-12weeks

25
Q

can azathioprine be used during pregnancy?

A

Pregnancy category D, can continue in pregnancy because risk of harm from flares to
baby is greater than risk of harm from azothioprine

26
Q

azathioprine w allopurinol

A

reduce dose of thiopurine by 1/3
Gradual titration + check metabolite levels
Advise on s/sx of neutropenia
Regular blood test at initial phase (sCr, LFTs, FBCs)

27
Q

mtx dose

A

15-20mgg once weekly
onset: 4-8wks

28
Q

pancreatitis, side effect of which med

A

aza

29
Q

pneumonitis, side effect of which med

A

mtx

30
Q

NSAIDs (Diclofenac) use in patient with IBD (UC)

A

Avoid NSAIDs use if possible
On pred for IBD flare which will also help with gout flare
Use topical NSAIDs + colchicine
Last resort: COX-2 inhibitors - less likely to cause UC flare)

31
Q

biologics w evidence for both uc and cd

A

infliximab, adalimumab

32
Q

biologics for uc

A

golimumab

33
Q

c/i of biologics

A

nyha class 3/4: chf

34
Q

vedolizumab

A

a4B7 integrin inhibitor, prevents inflammatory cells form entering gut tissue

adr: headache, urti, nasopharyngitis, fatigue, arthralgia - usually q mild, less infection risk (gut-specific)

35
Q

ustekinumab

A

il-12/23 inhibitor, blocks activity of cytokines in body that trigger inflammation

36
Q

pre-biologic screening

A
  • tb quantiferon
  • hep B serology
  • hep C serology
  • hiv
  • 2d echo
37
Q

if endoscopy is not avail to assess for mucosal healing, use

A

FC (fecal calprotectin, very sensitive marker for inflammation in the gastrointestinal tract): surrogate for endoscopy

38
Q

mildly active proctatitis

A

rectal 5-asa 1g/d > ‘’

39
Q

mildly active left-sided colititis

A

rectal 5-asa 1g/d +/- oral 5-asa 2g/d
or budesonide MMX 9mg/d
> oral 2g/d

40
Q

mildly active extensive colitits

A

oral 5-asa 2mg/d > ‘’

41
Q

moderate-severe UC, induction

A

moderate: rectal + oral 5-asa (high doses), oral budesonide MMX

both: systemic corticosteroids, anti-tnfa (infliximab, adalumumab, golimumab) + thiopurine, vedolizumab, tofacitinib

42
Q

moderate-severe uc, maintenance

A

mostly maintained on thiopurines, but can cont on biologics if initiated on them

43
Q

why are thiopurines not used as induction agents?

A

slow-acting, takes up to 3 months to see benefits

44
Q

acute, severe UC

A
  • IV corticosteroid eg. iv methylprednisolone 40-60mg/d, iv hydrocortisone 100mg tds/qds
    • If no response after 3-5/7: infliximab iv cyclosporine (other anti-tnf agents don’t have good data and are not well studied)
    • Consider colectomy if no response after 7/7 of salvage
      Maintenance: thiopurines, infliximab, vedolizumab
      Goals of therapy: hemodynamic stability, achieve clinical remission, symptomatic relief
45
Q

supportive care for hospitalised adult pt w severe UC

A
  • c.diff testing
  • Fluid and electrolyte replacement, blood products
    • Prevent vte with lmwh
    • Nutrition: continue regular diet if can tolerate, stop enteral nutrition if suspecting toxic megacolon, pn may be considered if unable to take oral/meet caloric requirements
      Broad spectrum IV abx (cipro or metronidazole) if peritoneal signs, fever, fulminant colitis, toxic megacolon: to reduce septic complications
46
Q

medications to avoid in acute severe UC

A
  • all antimotility agents, opioids and anticholinergic meds - risk of worsening ileus and precipitating toxic megacolon
  • oral 5-asa
  • nsaid - a/w disease flares and ibd-related hosptialisation
47
Q

mild CD

A

budesonide PO (if disease is limited to ileum and/or ascending colon) OR parenteral MTX > thiopurines or parenteral mtx

48
Q

moderate-severe CD

A

PO systemic corticosteroids, anti-tnf agents + im thiopurine (shown for infliximab, if using ada just mono) OR vedolizumab OR ustekinumab
> THIOPURINES (AZATHIOPURINE/6-MP), BUT CAN CONTINUE ON BIOLOGICS IF INITIATED ON THEM

49
Q

why is early biologic therapy preferred?

A

benefits pt with higher inflammatory burden or bad prognosis, seen as disease-modifying so more effective when sued in the first 2 years of diagnosis

50
Q

Active perianal fistula

A
  • Cs not much use here
    • Infli +/- thiopurine
    • Adali
    • OR certolizumab pego +/- thio
    • Ustekinumab, vedolizumab, Xnatalizumab
    • Tacrolimus (a lot of side effects if used for long term, so not used for maintenance)
    • Abx may be effective in the persesnce of perianal abscess
    • For ant-tnf non responses: ves

maintenance: thiopurine, parenteral MTX, cont biologics if initiated on them

51
Q

severe, fulminant CD

A

iv cs, anti-tnf agents (induction); maintenance if using iv cs MAINTAINED ON THIOPURINES (AZATHIOPURINE/6-MP), BUT CAN CONTINUE ON BIOLOGICS IF INITIATED ON THEM

52
Q

budenofolk

A

budesonide 3mg capsules (can be opened cos the granules are coated) ileal release (pH dependent release, >6.4; terminal ileum and/or ascending colon, indicated for mild-moderate cd of illeum and/or ascending colon

53
Q

CORTIMENT PROLONGED RELEASE TABLETS 9 MG

A

colonic release, mmx with gastric acid resistant coating, >= 7, colon indicated for mild-moderate UC

competency 10/11 (31 decks)

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