Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

THE PATIENT > IBD > Flashcards

IBD Flashcards

1
Q

What is IBD?

A

A group of chronic diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What conditions come under IBD?

A

Crohn’s disease

Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Crohn’s disease?

A

Patchy transmural ulceration of all layers of the intestinal wall and can affect the whole of GIT mouth to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Ulcerative Colitis?

A

Confluent mucosal inflammation and ulceration of colon and rectum mucosa affecting mucosal and submucosal layers
Superficial inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the implications of inflammation of gastric mucosa?

A

Relapsing and remitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the implications of continuous inflammation?

A

Local destruction of GIT mainly bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of IBD?

A

Genetic
Air pollution
Smoking
Infection
Medication
Diet
Gut microbes
Immunological
 Toxic response to luminal contents
 Specific microbial pathogen
 Abnormal luminal constituents
 Increased absorption of luminal macro molecules
 Enhanced immunologic response to normal constituents
 Autoimmune response
 To epithelial cell or mucus glycoproteins
 Molecular mimicry (cross-reactivity of intestinal microflora and epithelia)
 To immune cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the signs and symptoms?

A 
Abdominal pain
Diarrhoea- watery, bloody, mucous
Tiredness
Fatigue
Urgency
Weight loss
Anaemia
Fever
Nausea
Vomiting
Abdominal bloating and distension
UC= more bleeding
CD= more obstruction 
Extra intestinal manifestations 
    	Swollen joints- arthritis
    	Eye problems- episcleritis, iritis, uveitis
   	Erythema nodosum- swollen fat under skin causing redness, bumps + lumps
   	Pyoderma gangrenosum- skin ulceration
   	Primary sclerosing cholangitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What complications does CD cause?

A

STRICTURES
- narrowed bowel segments causing blockage, acute dilation, perforation
FISTULAS
- Abnormal channels lined with granulation tissue between intestine and skin or other parts of intestine or organs like the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What variables are used in the CD activity index?

A 
Number of liquid or soft stools
Severity of Abd pain
General well being
Complications present
Fever
Is loperamide being used
Is there anaemia
Body weight
Is there an abdominal mass or not
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What indicates the presence of severe active CD?

A 
Poor general health
Weight loss
Severe Abd pain
Fever 
Frequent diarrhoeal stools 3-4x daily 
New fistulae
Extra intestinal manifestations 
Score >300 
Harvey Bradshaw score >8-9
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What diagnostic tests and investigations are used?

A 
Full history and detailed clinical exam
Full blood count
Inflammatory markers
U + E
Thyroid function test
Liver function test
Bone profile 
Stool culture to rule out c.difficile 
Coeliac screen 
Faecal calprotectin 
Abdominal imaging
Endoscopy + capsule endoscopy
Colonoscopy
Biopsies to differentiate between CD and UC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What index is used to assess UC and its variables?

A 
Truelove and wits severity index
Bowel movements
blood in stool
pyrexia
pulse rate
anaemia
erythrocyte sedimentation rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is monitored in the case of acute relapse or flare?

A 
Faecal calprotectin
Stool frequency
Blood or mucous in stool
Temp
C reactive protein
U + E
HR- tachycardia 
BP- hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the management aims of IBD?

A 
Achieve remission
Maintain remission 
Improve quality of life 
Avoid surgery
Reduce long term steroid use 
Reduce risk of  colorectal cancer 
Reduce risk of other complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the formulations used and where is the drug released in the bowel?

A 
Suppository = Rectum
Foam = Sigmoid colon
Enemas = Descending colon to distal parts of transverse colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do you need to consider when choosing pharmacological treatment?

A

Patient preference
Route of admin
Preferred formulation
Licensed indications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the treatments/managements used in IBD?

A 
Corticosteroids
Amino-salicylates
Immunodulating agents
Biologics
Antibiotics
Novel treatments
Surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the MOA of corticosteroids specifically prednisolone?

A 
Induce disease remission
Treats flares
Doesn’t prevent progression or complications
Reduce inflammation
Modulate immune system

PREDNISOLONE
Binds to cellular glucorticoid receptor
Inhibits inflammatory cells
Suppresses expression of inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What corticosteroids are used in IBD?

A

Prednisolone- 40mg OD
Hydrocortisone IV for severe-acute in hospital 100mg QDS
Budesonide
Methylprednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When are the indications of corticosteroids?

A

Mild
Moderate
Severe

22
Q

What are the ADRs of corticosteroids?

A 
GI
Fluid and electrolyte imbalance
Increased appetite
Hypertension
Blood sugar effect
Mood and behaviour change 
Risk of infection
Osteoporosis risk
23
Q

What card to corticosteroid users need to carry?

A

Steroid emergency card

24
Q

Why can corticosteroids not be stopped abruptly?

A

Risk of adrenal suppression

25
Q

What is the MOA of Amino-salicylates?

A

Anti-inflammatory action throughout GIT
Decrease prostaglandin in colon
Inhibits production of pro-inflammatory cytokines
Induce and maintain remission in mild-mod UC

26
Q

What Amino-salicylates are used in IBD?

A

Sulfasalazine
Mesalazine
Balsalazide
Olsalazine

27
Q

What molecule are Amino-salicylates derived from and what makes the drugs differ?

A

5-ASA

Mesalazine= 5-ASA+ ph sensitive coating 
Balsalazide= 5-ASA + inert carrier molecule
Olsalazine = 5-ASA + 5-ASA
28
Q

What are the ADRs of Amino-salicylates?

A 
Arthralgia
Abd pain
Diarrhoea
Blood dyscrasias 
Dizziness
29
Q

What monitoring is required with Amino-salicylates?

A

Renal function

Blood dyscrasias/full blood count

30
Q

What counselling points should be given when on Amino-salicylates?

A

Report unexplained bleeding, bruising, purpura, sore throat, mouth ulcers, fever, malaise
Administration advice
Maintain same brand but if switched report symptoms

31
Q

What is the MOA of Immunodulating agent thiopurines?

A

Induce and maintain remission
Reduces GIT inflammation
Suppresses immune response and inflammation
Metabolites impact on adaptive, innate, and non-immune cells within inflamed intestine
Steroid-sparing

32
Q

What thiopurines are used?

A

azathioprine- pro drug which turns into mercaptopurine

mercaptopurine

33
Q

What is the dose range for the thiopurines?

A

Azathioprine – 2 - 2.5mg/kg/day

Mercaptopurine – 1 - 1.5mg/kg/day

34
Q

Describe the steps in mercaptopurine metabolism?

A

Mercaptopurine metabolised to thioguanine nucleotides (TGN) which is the active metabolite by thiopurine methyltransferase (TMPT)
mercaptopurine to methylmercaptopurine (MeMP)
MeMP not pharmacologically active= hepatotoxicity

35
Q

What test needs to be conducted before using thiopurine and what do the results indicate?

A

TMPT levels before and after
Low TMPT= reduced dose as there is risk of myelosuppression
High TMPT= hepatotoxicity risk
Full blood count before- then every week for first 4 weeks then every 3 months

36
Q

What are the ADRs of Immunodulating agents?

A 
Hypersensitivity= immediately withdraw
Myelosuppression
Neutropenia
Thrombocytopenia
GI- nausea, vom, diarrhoea
Liver disorders
37
Q

Describe the pharmacology of the Immunodulating agent methotrexate?

A

For maintenance in CD
Alternative to azathioprine
1 x weekly
Co prescribed with folic acid

38
Q

Describe the pharmacology of the Immunodulating agent Ciclosporin?

A

IV
Induces remission in severe acute UC
Steroid alternative

39
Q

Describe the pharmacology of the Immunodulating agent Tacrolimus?

A

Oral
Induces remission in mild/mod UC
Used if no response to other treatments

40
Q

What is the MOA of biologics?

A 
Monoclonal antibodies 
Bind to cytokine TNF alpha
TNF-a is naturally occurring cytokine
Mediates inflammatory responses
Modulates immune system
Central role in CD
Inhibit inflammatory gut effect
Mod/severe IBD 
No response to immunodulating agents
41
Q

What biologics are used?

A 
- MABS
Infliximab
Adalimumab
Vedolizumab
Ustekinumab
42
Q

Describe the pharmacology of Infliximab?

A

First approved TNF blocker
Murine and human AA sequence
IV infusion
Can cause flu like symptoms so pre-med is given
Screening before treatment of TB, Hep B and C, HIV
Risk of lymphoma
Biosimilar available

43
Q

Describe the pharmacology of Adalimumab?

A

Fully humanised
SC injection
Risk of infection reactivation and malignancy reactivating
Screening before treatment of TB, Hep B and C, HIV
Bio similar available

44
Q

Describe the pharmacology of Vedolizumab?

A

Leukocyte adhesion inhibitor so inhibits leukocyte migration to parenchymal tissue in gut and reduces inflammation
IV infusion
Risk of reactivation of infections and malignancy

45
Q

Describe the pharmacology of Ustekinumab?

A

Blocks IL-12 and 23
Inhibits inflammatory effects in gut
Initial IV infusion then SC injection
Risk of reactivation of infections and malignancy

46
Q

What are the novel treatments?

A

Faecal microbiota transplant

Probiotics

47
Q

Explain what a Faecal microbiota transplant involves?

A

Transfer of gut micro-organisms from health donor into intestinal tract

48
Q

Describe the pharmacology of Probiotics?

A

New biologics
Small molecules
MOA= Inhibitors of RNA and intracellular cytokine pathway

49
Q

What types of surgical treatments are used?

A

Radical surgery in UC

CD surgery

50
Q

What complications require immediate surgery?

A 
Intestinal blockage
Bleeding
Perforation
Fistula
Abscess
Toxic megacolon
51
Q

What are the types of elective IBD procedures?

A 
Bowel resection
Strictureplasty
Colectomy
Proctocolectomy with ileostomy 
Fistula treatment
Abscess drainage
52
Q

What is the role of a pharmacist in IBD?

A

Recommend therapy and treatment
Ensure formulation is appropriate
Advice on administration to patient and other HCP
For corticosteroids
 Ensure dose is appropriate
 Ensure regimen is appropriate- the reduced regimen
 Co prescribed with Ca and vit d to prevent osteoporosis
 ADR monitoring
For amino salicylates
 Adjustment dose for flares/remission
Counsel on side effects- blood dyscrasias
Safe and appropriate biologics use
Plan how to stop meds for patients in remission
Rescue strategy if there is relapse
Support adherence and health literacy
Therapeutic drug monitoring
Prescribing clinics- more specialist roles
Input into IBD standards and NICE guidelines
Use of biosimilars

THE PATIENT (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions