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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
can azathioprine be used during pregnancy?
Pregnancy category D, can continue in pregnancy because risk of harm from flares to baby is greater than risk of harm from azothioprine
26
azathioprine w allopurinol
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
mtx dose
15-20mgg once weekly onset: 4-8wks
28
pancreatitis, side effect of which med
aza
29
pneumonitis, side effect of which med
mtx
30
NSAIDs (Diclofenac) use in patient with IBD (UC)
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
biologics w evidence for both uc and cd
infliximab, adalimumab
32
biologics for uc
golimumab
33
c/i of biologics
nyha class 3/4: chf
34
vedolizumab
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
ustekinumab
il-12/23 inhibitor, blocks activity of cytokines in body that trigger inflammation
36
pre-biologic screening
- tb quantiferon - hep B serology - hep C serology - hiv - 2d echo
37
if endoscopy is not avail to assess for mucosal healing, use
FC (fecal calprotectin, very sensitive marker for inflammation in the gastrointestinal tract): surrogate for endoscopy
38
mildly active proctatitis
rectal 5-asa 1g/d > ''
39
mildly active left-sided colititis
rectal 5-asa 1g/d +/- oral 5-asa 2g/d or budesonide MMX 9mg/d > oral 2g/d
40
mildly active extensive colitits
oral 5-asa 2mg/d > ''
41
moderate-severe UC, induction
moderate: rectal + oral 5-asa (high doses), oral budesonide MMX both: systemic corticosteroids, anti-tnfa (infliximab, adalumumab, golimumab) + thiopurine, vedolizumab, tofacitinib
42
moderate-severe uc, maintenance
mostly maintained on thiopurines, but can cont on biologics if initiated on them
43
why are thiopurines not used as induction agents?
slow-acting, takes up to 3 months to see benefits
44
acute, severe UC
- 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
supportive care for hospitalised adult pt w severe UC
- 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
medications to avoid in acute severe UC
- 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
mild CD
budesonide PO (if disease is limited to ileum and/or ascending colon) OR parenteral MTX > thiopurines or parenteral mtx
48
moderate-severe CD
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
why is early biologic therapy preferred?
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
Active perianal fistula
- 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
severe, fulminant CD
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
budenofolk
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
CORTIMENT PROLONGED RELEASE TABLETS 9 MG
colonic release, mmx with gastric acid resistant coating, >= 7, colon indicated for mild-moderate UC

competency 10/11 (31 decks)

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