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BIOM2010 > IBD > Flashcards

IBD Flashcards

1
Q

List 3 different symptoms of IBD

A
  • abdominal pain and cramping
  • diarrhoea
  • blood in stool
  • unintended weight loss
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2
Q

Can diet and chronic stress cause IBD?

A

No. They can only aggravate the condition

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3
Q

List 2 main causes of IBD

A
  • autoimmune

- hereditary

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4
Q

For which condition is cigarette smoking particularly bad?

A

Crohn’s

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5
Q

Briefly explain the immune response that can cause IBD.

A

An impaired barrier allows microbial products to enter the cell which activates an immune response. Regulatory mechanisms fail, leading to chronic inflammation due to an imbalance of pro and anti inflammatory markers

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6
Q

Name an anti-inflammatory regulatory mechanism

A

Regulatory T cells

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7
Q

Which drug class is a risk factor for IBD and should be substituted out?

A

NSAIDs

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8
Q

Name the drug that can be used for first line treatment of mild to moderate ulcerative colitis

A

5-asa’s. mesalamine / mesalizine

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9
Q

MOA of mesalamine?

A

Stops the production of leukotrienes

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10
Q

Are leukotrienes pro or anti inflammatory?

A

Pro

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11
Q

Patients with Crohn’s disease confined to the colon can be given which drug commonly used for ulcerative colitis?

A

Mesalamine

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12
Q

Explain the use of sulfasalazine as opposed to mesalamine

A

Mesalamine is given as an enema.
It can be conjugated to form sulfasalazine which has an azo bond. When given orally, the azo bond prevents absorption in the stomach and small intestine. The colonic bacteria cleaves the bond and activates the molecule

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13
Q

Mesalamine is also known as…

A

Mesalizine

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14
Q

Glucocorticoids are used for IBD when other treatments fail. Explain their MOA

A

They inhibit phospholipase A2, which consequently inhibits the production of pro-inflammatory molecules

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15
Q

Explain the longer term MOA of glucocorticoids

A

Can alter gene expression, resulting in more anti-inflammatory marker production and less pro-inflammatory markers

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16
Q

Cushing syndrome is an ADR of glucocorticoids. Give som examples of Sx

A

Puffy face, increased facial hair, insomnia, high BP, osteoporosis, etc

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17
Q

Corticosteroids can — remission but cannot — it.

A

Can induce remission but cannot maintain it

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18
Q

Give 2 examples of glucocorticoids and their dosage form for IBD

A

Prednisone (rectal)

Budesonide (slow release in colon)

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19
Q

What treatment option is there for severe IBD or steroid-dependent or steroid-resistant IBD?

A

Immunosuppressive agents

20
Q

Mercaptopurine and azothioprine are examples of which class of drugs?

A

Immunosuppressive agents

21
Q

Explain the MOA of mercaptopurine and azothioprine

A

Impairs purine synthesis which inhibits proliferation of fast replicating cells (immune cells)

22
Q

Before starting immunosuppressive agents, which test should be done?

A

Need to test for TPMT (thiopurine methyltransferase) activity. Because some people have varying levels

23
Q

Explain the action of TPMT enzyme

A

Converts mercaptopurine and azothioprine into their active forms

24
Q

What TDM is required when using immunosuppressive agents?

A

Need to monitor circulating blood counts, because bone marrow can be suppressed.

25
Q

List some ADRs of mercaptopurine use

A

Pancreatitis, nausea, vomiting, fever, etc

26
Q

Which drug both induces and maintains remission in Crohn’s disease

A

Methotrexate

27
Q

Why is methotrexate used at higher doses in Crohn’s than in rheumatoid arthritis?

A

Because of its unpredictable absorption in the intestine

28
Q

Methotrexate MOA?

A

Inhibits DNA synthesis, causing cell death. It is an immunosuppressant

29
Q

List 3-4 ADRs of methotrexate

A

Hepatotoxicity, leukopenia (low white blood cell count), predisposition to infections, teratogenic

30
Q

Name a treatment option for severe ulcerative colitis in patients who are not responsive to glucocorticoids

A

Cyclosporine

31
Q

Cyclosporine MOA?

A

Inhibits the activation of T cells by inhibiting calcineurin

32
Q

What does the suffix -mab indicate?

A

Monoclonal antibodies

33
Q

Explain the use of monoclonal antibodies in IBD

A

They are TNF-alpha antagonists. TNF is an inflammatory cytokine produced by macrophages

34
Q

Which supplements can be used as supportive therapy for IBD?

A

Iron - if intestinal bleeding is present
Vitamin B12
Calcium and vitamin D

35
Q

Explain the use of anticholinergics in IBD

A

Reduces abdominal cramps, pain and rectal urgency

36
Q

Which IBD condition has an increased need for surgery?

A

Crohn’s

37
Q

Implications of IBD surgery?

A

The affected part of the colon is removed. This reduces the absorption capacity of the colon

38
Q

What is a characteristic feature of Crohn’s disease

A

Narrowing of the lumen

39
Q

List some complications of Crohn’s disease

A

Bowel obstruction
Fistula
Malnutrition
Increased risk of colon cancer

40
Q

Describe the characteristic features of ulcerative colitis

A

Inflammation causes ulcers to develop on lining of colon and rectum.
Tissue is eroded away and the lumen is very thin / narrow.

41
Q

What would you see in a colonoscopy of ulcerative colitis?

A

Polyps (actually pseudopolyps that are not cancerous)

42
Q

Name some complications of ulcerative colitis

A 
Severe bleeding 
Perforated colon (life threatening)
Dehydration due to diarrhoea 
Bone loss 
Increased risk of colon cancer
43
Q

Drug used for acute attacks of IBD?

A

Glucocorticoids. Prednisolone or budesonide

44
Q

Main drug used to maintain IBD remission?

A

Mesalamine

45
Q

Drug reserved for severe IBD?

A

Infliximab

46
Q

When are methotrexate and immunosuppressive agents like mercaptopurine used for IBD?

A

In severe cases or when steroid resistant / dependent

BIOM2010 (12 decks)

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