IBD Flashcards
what are the doc in mild to mod acute UC
oral/topical mesalamine or oral budesonide
if topical not tolerated then oral mesalamine
topical corticosteroids, reserved for no response to mesalamine
what are the doc in mod to severe UC
prednisolone 40 - 60 mg per day or equivalent
azathioprine/ 6MP
biologic agents if unresponsive to oral therapies
azathioprine + AZT for maximal effect
DOC in severe to fulminant UC
Iv corticosteroids
Infliximab and omalizumab - severe UC
DOC in maintenance of UC remission
oral or topical aminosalicylates
rectal aminosalicylate for proctitis or left sided disease
immunosuppressants + biologics for steroid dependants
ttt of proctitis
induction - topical 5ASA
remission - Topical 5ASA
Refractor - oral 5ASA
ttt of mild to mod distal UC
Induction - 5ASA enema or foam or 6MP
remission - 5ASA enema or foam or 6MP
Refractory - infliximab or cyclosporine IV or surgery
ttt of mild to mod proctitis
induction - oral 5ASA or AZT
remission - oral 5ASA or AZT
refractory - infliximab or cyclosporine IV or surgery
ttt of severe proctitis
induction - IV corticosteroids
Maintenance - oral 5ASA or 6Mp/ AZT
Refractory - infliximab or cyclosporine IV or surgery
ttt of mild to mod CD
duration of ttt ?
Budesonide 9mg OD
prednisolone + methylprednisolone (superior but more adv effects)
aminosalicylate
16 wks
ttt of mod to sev CD
prednislone 40-60mg daily
oral budesonide - terminal ileum or ascending colon
anti TNF alpha agents + azt = ehnaced efficacy
sev to fulminant CD
hospitalization
abdominal distention, abscesses, massess, colonic distention - surgical intervention
IC corticosteroids
Biologics
fluid electrolytes replacemnt
nutrtiional therapy eneteral or parenteral for patients who can not eat for 5-6days
maintenance of CD
AZT +/- anti TNF alpha
immunosuppressants, biologics oral or topical aminosalicylates
oral budesonide 6mg instead of corticosteroids
induction of remission in
- mild to mod
- mod to sev
- refractory to steroids
- failed immunosuppressants
- aminosalicylate (mesalamine)
- corticosteroids (prednisolone, budesonide)
- immunosuppressants (AZT. MTX)
- biologics (infliximab)
what is the major contributor of the inflammatory process in CD what do its physiological effects include
TNF a
Its physiologic effects include activation of macrophages, procoagulant effects in the vascular endothelium, and increased production of matrix metalloproteinases in mucosal cells
induce production of nuclear factor κβ - stimulates more TNF a and proinflammatory cytokines
what are skip lesions. which disease are they found in
The pattern of inflammation in CD is discontinuous; areas of inflammation are intermixed with areas of normal GI mucosa, resulting in characteristic “skip lesions.”
what are the minerals added as adjunctive therapy in IBD
Vitamin B12, folic acid, fat-soluble vitamins, and iron
which drug reduces diarrheal symptoms in patients with CD who had intestinal resection
cholestyramine
which anticholineric is used for intestinal spasm and pain
hyoscine
which diarrheal drugs are better avoided in active IBD
loperamide, diphenoxylate and codeine
which aminosalicylate drug is used in IBD. describe the mechanism of how it works locally
sulfasalazine (azulfidine)
5ASA + sulfapyridine by a diazo bond
diazo bond degraded by bacteria. sulfapyridine renally excreted. 5ASA acts in the intestine
what are the equivalent doses for corticosteroids
40 -60 mg of oral prednisolone
40-60mg of IV methylprednisolone
300mg/day of IV hydrocortisone
which corticosteroid is recommended for active disease and why
budesonide because of low systemic bioavailability
why is AZT/6MP not used in active disease
slow onset of action
mtx is used in CD or UC
CD only
