GIT - IBD Treatment Flashcards
What are the aims of IBD treatment?
treat the symptoms
induce remission
maintain remission
reduce the incidence of the relapses
improve quality of life
pharmacological treatment, lifestyles changes or surgery
What are the different types of pharmacological treatment?
antibiotics
- metronidazole, ciprofloxacin
anti-inflammatory
- aminosalicylates, glucocorticoids
immunosuppressants
- azathioprine, 6-mercaptopurine, methotrexate, cyclosporine
biologicals
- infliximab, adalimumab, ustekinumuab, vedoluzumab, tofacitnib
probiotics
- E.coli Nissle 1917, VSL#3
prebiotics
What are aminosalicylates? What are examples? What do treat? How do they work?
anti-inflammatory drugs
- sulfasalazine, mesalazine, olsalazine
= 5-aminosalcylate is the active compound
treats active ulcerative colitis and maintenance of ulcerative colitis
activate peroxisome proliferator activated receptor gamma (PPAR)
- inhibit eicosanoid synthesis = LTB4, TXA2,PGE2
- inhibit production of pro-inflammatory cytokines = IL-1 beta
- inhibit adhesion molecule expression
- stimulate production of anti-inflammatory molecules
- modulates proliferation, differentiation and survival of immune cells
What are glucocorticoids? What are examples? What do treat? How do they work?
anti-inflammatory drugs
- prednisolone, budesonide
treats moderate to severe relapses in Crohn’s disease and Ulcerative colitis
modify gene transcription
- inhibit inflammatory pathways
= inhibit production of pro-inflammatory cytokines and synthesis of pro-inflammatory enzymes
What are immunosuppressants? What are examples? What do treat? How do they work?
treats active Crohn’s disease, maintenance CD (steroid sparing), maintenance of CD and UC
thiopurine - azathiopurine, 6-mercaptopurine
- inhibit T and B cell proliferation
methotrexate
- inhibit production of inflammatory mediators
cyclosporin
- inhibit synthesis of IL-3 and IL-2R which inhibits clonal expansion of T cells
What are biologicals? What are examples? What do treat? How do they work?
drugs that target pro-inflammatory cytokines
- treat severe active CD and fistulating CD, intolerance to immunosuppression
anti-TNF drugs - infliximab, adalimumab, golimumab
infliximab - binds to TNF trimers preventing the cytokine from binding to its recptors, binds to membrane TNF to neutralise activity, reduces serum TNF levels
anti-IL23/IL12 - ustekinumab
anti-integrin - natalizumab, vedolizumab
JAK inhibitor - toficitnib
anti-IL6 - tocilizumab
What are antibiotics ? What are examples? What do treat? How do they work?
used to treat infections associated with IBD
- metronidazole, ciprofloxacin
treat pouchitis, active fistulous and perianal CD, patients with UC and toxic megacolon (dilated colon)
minocyline
- immunomodulatory antibiotics = act on the immune system and fight infection
What are natural compounds? What are examples? What do treat? How do they work?
probiotics
- preparation containing viable, defined microorganisms to alter the microbiota by implantation or colonisation in a compartment of the host, and exert beneficial effects on host health
= E.coli Nissle 1917, VSL#3
prebiotics
- indigestible carbohydrates, which stimulate the growth of particular species of the microbiota of the host, resulting in an ameliorated enteric function
= promote growth of beneficial bacteria
What is the order of treatment?
Crohn’s disease
UC - mild to moderate
- oral 5-ASA with/without enema
UC - moderate to severe
- oral corticosteroid
UC maintenance
- oral 5-ASA
acute severe UC
- high dose IV corticosteroid
What is the order of treatment?
Ulcerative colitis
CD - active
- systemic corticosteroids
extensive CD
- early biological therapy
fistulating CD
- anti-TNF
maintenance CD
- azathioprine, mercaptopurine or methotrexate as monotherapy (immunosuppressants)
