Brainscape's Knowledge GenomeTM

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


See full index

GI Therapeutics > IBD > Flashcards

IBD Flashcards

1
Q

IBD

A
  • Inflammatory bowel disease, that is chronic inflammatory disease of the GI tract
  • Results in edema, ulceration, and tissue destruction
  • Treatment requires flare therapy as well as maintenance therapy that prevents flare reoccurrence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IBD s/s

A

Diarrhea, blood in stool, abdominal pain, cramping, weight loss, fatigue, change in daily activities

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

Diagnosis of IBD

A
  • Non invasive lab tests (ESR, CRP which are non specific markers of inflammation in the body)
  • Stool studies (look for leukocytes in the stool)
  • Endoscopy-colonoscopy (can look at entire colon and ileum, very invasive)
  • CT/MRI (see if there is penetration of the disease into neighboring organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IBD disease location (UC)

A
  • Confined to the rectum (proctitis)
  • Inflammation up rectum, sigmoid colon, descending colon and stop at splenic flexure (left sided colitis or distal)
  • Inflammation past splenic flexure (extensive disease or pan colitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

UC

A
  • superficial inflammation
  • confined to mucosa (continuous)
  • anal involvement is not common
  • patients at risk for megacolon or colon cancer
  • Colectomy: removal of colon (cure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IBD disease location (CD)

A
  • Anywhere from mouth to anus
  • Most common is terminal ileum (2/3 of patients)
  • Perianal involvement is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CD

A
  • deep
  • can go through all layers of intestinal wall
  • patchy inflammation, cobblestone appearance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CD complications

A
  • Malnutrition
  • vitamin deficiencies
  • strictures
  • fistulas
  • no cure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

5-ASA

A
  • Mesalamine
  • Sulfasalazine
  • Balsalazide
  • Olsalazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Immunomodulators

A
  • Azathioprine
  • 6-mercap
  • Methotrexate
  • Cyclosporine
  • Tacrolimus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antibiotics

A
  • Metronidazole

- Ciprofloxacin or 3GC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Corticosteroids

A
  • Prednisone
  • Methylprednisolone
  • Budesonide
  • Hydrocortisone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Biologics

A
  • Infliximab (UC/CD)
  • Adalimumab (UC/CD)
  • Certolizumab (CD)
  • Golimumab (UD)
  • Natalizumab (CD)
  • Vedolizumab (UC/CD)
  • Ustekinumab (UC/CD)
  • Tofacitinib (UC)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5-ASA

A
  • act topically to reduce inflammation in GI tract

- have to get to intestinal sire to work, have to modify drug delivery to get to site.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sulfasalazine

A
  • Sulfa is carrier
  • Mesalamine is active component
  • Sulfa is responsible for ADR: GI, rash, photosensitivity, blood dycrasias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Olsalazine

A
  • 2 ASA molecules linked together and cleaved apart by gut bacteria in colon
  • better tolerated than sulfasal but high diarrhea rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Balsalazide

A
  • Sulfasalazine without sulfa

- lots of drug to take

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

Mesalamine products

A
  • not used in CD
  • supp can only penetrate rectum
  • enema can penetrate all the way to splenic flexure
  • PO products will release somewhere in small or large intestine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Immunomodulators

A

maintain therapy remission

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

Azathioprine

A

-UC or CD (usually used in combo b/c takes a while to go into effect)

21
Q

Methotrexate

A
  • IM or SQ
  • CD only
  • CDC at least every 3 months
  • LFTs and pancreatic enzymes
  • Lymphomas (AZA alone or in combo with Infliximab)
22
Q

Corticosteroids

A
  • work quickly and dec inflammation
  • no role in maintenance therapy
  • topical hydrocortisone (enema, supp, or foam)
  • PO pred
  • IV hydro or methylpred
23
Q

Budesonide

A
  • more local, less systemic SE
  • enteric coated capsule
  • Entocort
  • Uceris
24
Q

Abx

A
  • best for perianal (fistulas, fissures)

- CD only

25
Q

Biologics

A
  • Induce and maintain remission
  • Anti-TNF (I, A, C, G)
  • Selective adhesion (integrin) inhibitors (N, V)
  • JAK inhibitor (T)
  • IL inhibitors (U)
26
Q

Biologic ADR

A
  • IV: acute; HA, dizziness, nausea, flushing, fever, chest pain, cough, dyspnea, pruritis (pre medicate with Tylenol or antihistamine to dec effects)
  • delayed: myalgias, arthralgia, fever, rash, pruitis, urticaria, HA (flu-like symp)
  • SQ: injection site pain
27
Q

Infections (biologics)

A
  • warning on all
  • BBW for TNF inhibitors and JAK inhibitors
  • acute TB
  • fungal infections
  • monitor for s/s of infection
  • should not receive live vaccines if on biologic
28
Q

BBW biologics

A

Malignancy (TNF and JAK inhibitors)

29
Q

Natalizumab

A
  • can cause progressive multifocal leukoencephalpy
  • lethal infection of CNS (JC virus)
  • must be monotherapy (w/o steroids or immunomodulators
  • TOUCH safety program
  • last line therapy
30
Q

JAK inhibitor (T)

A
  • inc risk of cancer, death, thrombosis, cardiovascular events
  • BBW
  • only allowed for patients who have not responded or cannot tolerate TNF inhibitors
31
Q

CD mild-mod

A
  • in the community
  • no fever
  • no abd pain
  • no obstruction
  • < 10 % weight loss
32
Q

CD mod-severe

A
  • failed mild-mod therapy
  • fever
  • > 10% weight loss
  • abd pain
  • N/V with obstructions
  • anemia (dec Hgb)
33
Q

CD severe-fulminant

A
  • persistent symp despite steroids or biologics
  • need hospital treatment
  • high fevers
  • persistent N/V
  • obstructions
  • not eating
  • intestinal abssesses
  • severe abd pain
34
Q

Mild-mod active therapy (CD)

A
  • 1st line: budesonide (Entocort) for 8 weeks

- Patients with CD should not use 5-ASA products unless they have colonic involvement only (sulfsal specifically)

35
Q

Mod-severe active therapy (CD)

A
  • Systemic steroids (PO prednisone)
  • Biologics (start with TNF inhibitor - Infliximab) - try others if no relief within 2-4 weeks
  • AZA (reduces immune response but takes 4 months to get full effect
    • steroid sparing
    • better response rate when added with biologic
    • reduce antibody production to biologic therapies
36
Q

Severe-fulminant active therapy (CD)

A
  • May need surgery
  • IV steroids
  • Infliximab of steroids don’t work
37
Q

Perianal disease - fistulas or fissures

A
  • Abx
  • surgery
  • Infliximab
  • Don’t use abx if patient doesn’t have fistulas
38
Q

Maintenance therapy (CD)

A
  • 1st line: 5-MP/AZA/MTX
  • Budesonide - can be used for additional 3 months
  • Biologics: Infliximab or whatever was used for active
  • 5-ASA should not be used in CD
39
Q

Mild UC

A
  • < 4 stools/day
  • intermittent blood in stool
  • Hgb normal
  • ESR normal
  • CRP elevated
  • FC >150
40
Q

Mod-severe UC

A
  • > 6 stools/day
  • frequent blood in stool
  • Hgb <75% of normal
  • elevated ESR/CRP
  • FC >150
41
Q

Fulminant UC

A
  • > 10 stools/day
  • continuous blood in stool
  • blood transfusions
  • Hgb < 8
  • Elevated ESR/CRP/FC
42
Q

Mild distal active therapy (UC)

A
  • 1st line: topical 5-ASA
  • 2nd line: oral 5-ASA
  • combo PO + PR
  • if doesn’t work use budesonide (Uceris)
43
Q

Mild extensive active therapy (UC)

A

PO 5-ASA +/- budesonide

44
Q

Mild extensive maintenance therapy (UC)

A

PO 5-ASA

45
Q

Mild distal maintenance therapy (UC)

A

Topical 5-ASA or PO 5-ASA

46
Q

Mod-severe active therapy (UC)

A
  • budesonide, prednisone, biologic +/- 6-MP/AZA

- cannot use Methotrexate

47
Q

Mod-severe maintenance therapy (UC)

A
  • use what induced remission
  • steroid: use 6-MP/AZA
    biologic: continue +/- AZA
48
Q

Fulminant active therapy (UC)

A
  • 1st line: IV steroids, IV Infliximab
  • IV cyclosporine
  • surgery (colectomy) - cure
49
Q

Fulminant maintenance therapy (UC)

A
  • Use what induced remission
  • Steroids: 6-MP/AZA
  • biologic: continue +/- AZA
  • cyclosporine: 6-MP/AZA or vetalizumab

GI Therapeutics (6 decks)

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