GI Part 2 Flashcards
1
Q
inflammatory bowel disease (IBD)
- idiopathic disease
- dysfunction of the _____ and _____ immune system
- two major types:
- -ulcerative colitis (US): limited to the _____ mucosa
- -crohns disease (CD): affects any segment of GIT from _____ to _____, involves _____ lesions and is _____
-there is a genetic predisposition for IBD, and patients are more prone to development of _____
A
innate adaptive colonic mouth anus skip transmural malignancy
2
Q
symptoms
- Abdominal cramping and pain- Commonly in _____ in CD and in _____ or _____ in UC
- Irregular bowel habits, passage of mucus with/without blood or pus, _____
- Weight loss, _____ (during flare-up)
- _____, _____, _____
- _____ (50%)
- Perianal disease (_____, _____): 50% patients with CD
- _____ and delayed or failed _____ maturation in children
- Malabsorption of _____, _____ and other nutrients leading to _____ and _____ lesions
A
RLQ periumbilical LLQ tenesmus Fever Malaise Arthralgia Uveitis Pyoderma gangrenosum fistulas abscesses Growth retardation sexual iron B12 anemia oral
3
Q
CD- oral manifestations
- Seen on _____, _____ mucosa and _____
- _____ ulcerations
- Angular _____
- _____ with or without edema of lips
- Mucosal _____ in the gingiva
- Buccal mucosa _____
A
lips buccal gingiva Aphthous cheilitis Cobblestoning tags abscesses
4
Q
MANAGEMENT- Stepwise approach (step-up)
- Step I – 5-ASA (_____) _____ daily basis (life long maintenance)
- -_____-Pentasa,Rowasa,Asacol
- -_____ – Azulfidine
- -_____ – Giazo
- MOA: exert topical _____ effect by reduction in synthesis of _____ (inhibition of _____ production, blocking of _____)
- Side effects: _____, Vomiting and GI upset (poor compliance), _____ discoloration of secretions, decrease in _____ absorption (supplements, megaloblastic anemia)
- Used during flares and for maintaining _____
- Overall: safe, well-toleratedbut drug _____ is very imp
- Caution: Patients prescribed anti-inflammatory drugs may have an _____ effect
A
Aminosalicylic acid twice Mesalazine Sulphasalazine Balsalaside anti-inflammatory inflammatory cytokines arachidonic acid metabolite PG synthesis Nausea yellow-orange folate remission compliance additive
5
Q
CLINICIAN’S CONCERNS drug induced: -\_\_\_\_\_ -\_\_\_\_\_ disturbance -\_\_\_\_\_
-may decrease _____ effect of the anticoagulants like _____ and _____
A
agranulocytosis taste parotitis anticoagulant heparin warfarin
6
Q
STEP 1A- ANTIBIOTICS
- Used more often for _____ disease, _____, _____ masses in CD
- Most commonly used antibiotics are :
- -_____
- -_____
A
perianal fistulas intra-abdominal inflammatory Ciprofloxacin Metronidazole
7
Q
STEP II- CORTICOSTEROIDS(ANTI-INFLAMMATORY)
- For _____ disease flares only
- Decrease inflammation by reversing _____ and suppressing _____ activity
- Not effective in preventing complications or progression of disease
- Long-term use is _____ due to side effects
- _____ and _____ Prep (Suppositories, enemas and rectal foams)
- -_____ (O)
- -_____ (O, Top)
- -_____ (O, Inj)
- -_____ (O, Top) an enteric-coated controlled-release capsule delivers active _____ to the _____ and _____
A
acute increased capillary permeability PMN discouraged Oral rectal Prednisone hydrocortisone methylprednisone budesonide glucocorticoid distal small intestine colon
8
Q
STEP III-IMMUNOMODULATORS (Steroid-Sparing drugs)
- MOA: inhibit _____ mediated and _____ mediated immune reactions- _____
- inhibit _____, _____ and _____ of cells
- used if:
- -No-response or intolerance to _____, _____ or _____
- -_____ disease or frequent need for steroids
- -Perianal disease that does not respond to _____
- -_____
- -To bolster the effect of a _____ drug and prevent the development of resistance to biologic drugs
- -Prevent recurrence after surgery
A
cell antibody immunosuppressants production differentiation proliferation Amino-salicylates antibiotics corticosteroids Steroid-dependent Antibiotics fistulas biologic
9
Q
STEROID SPARING: Decrease the long-term need for steroids for recurring flares
- takes _____ months (slow onset of action) for improvement in symptoms, steroids are started at the same time to produce a faster response and are withdrawn rapidly
- oral: _____ (Azasan, Imuran )and _____ (Purinethol)
- used to maintain _____
- Other examples : _____ (weekly injections), _____ and _____ (Topical- for Pyoderma Gangrenosum)
A
3-6 Azathioprine 6-Mercaptopurine remission Methotrexate Cyclosporine A Tacrolimus
10
Q
STEP IV: BIOLOGIC THERAPY WITH MONOCLONAL ANTIBODIES
- _____: If not responded or intolerant to Corticosteroid and/or an Immunosuppressant
- -_____ (IV) – Remicade
- -_____ (SC) – Humira
- -_____ – Cimzia
- TNF is a _____ agent in the body’s immune response and is _____ in IBD
- Watch-out for reactivation of latent _____ and other opportunistic infections, _____
- Cautious use in pts with _____
A
Tumor necrosis factor (TNF) inhibitors Infliximab Adalimumab Certolizumab pegol cytokine upregulated TB Hepatitis B heart failure
11
Q
treatment of oral lesions
- Local _____ injections to the lesion
- _____ 2% in severe cases
- Topical _____ at low concentrations of 0.5 mg/kg
- 1% _____ ointment three times daily
- Steroid _____ (Dexamethasone elixir)
- Topical _____ ointment for refractory aphthous ulcers
A
Corticosteroid Lidocaine Tacrolimus Hydrocortisone mouthwashes Dexamethasone
12
Q
COMMON SIDE EFFECTS WITH IMMUNOSUPPRESSANT DRUGS
- _____ and _____: Canker sores, bone marrow suppression (increase the risk of infection or serious bleeding) and increased risk of non-Hodgkin’s lymphoma
- _____ and _____: increased risk of infections, high blood pressure, swollen gums, tingling of the fingers and feet, increased facial hair
- _____: Severe mouth sores and low WBC count. Addition of folic acid may reduce some side effects.
A
Azathioprine 6MP Cyclosporine tacrolimus Methotrexate
13
Q
ANALGESIC OF CHOICE IN PUD AND IBD PATIENTS
- Avoid prescribing _____ and _____
- Use _____ or _____ (selective COX-2inhibitor) in combination with _____ or _____
- IBD pt – avoid long term use of _____, especially in elderly and debilitated to minimize risk of _____
- Monitor for signs and symptoms of _____
- Selection of antibiotics for oral infections may be influenced by recent use of antibiotics for _____
A
Aspirin NSAIDs Acetaminophen Celecoxib PPI Misoprostal antibiotics pseudomembranous colitis diarrhea PUD
