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GI Therapeutics Exam > IBD > Flashcards

IBD Flashcards

1
Q

what part of mucosa expands in IBD

A

lamina propria

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2
Q

dx of IBD

A

sx (bloody stool, weight loss, BAD abdominal cramping)
lab (inc ESR = erythrocyte sedimentation rate
(inc CRP = c reactive protein)
stool studies (lactoferrin and calprotectin detect leukocytes in stool)
ENDOSCOPY IS A MUST
CT scans
MRIs

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3
Q

are ESR and CRP specific or non specific markers

A

non specific markers of inflammation

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4
Q 
no anal involvement
prochitis
left sided distal colitis
pancolitis
all describe \_\_\_\_\_\_
A

ulcerative colitis

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5
Q

extensive vs. non-extensive disease in UC

A

determined by whether or not it extends beyond the left splenic flexure

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6
Q

CD location

A

can be anywhere from mouth to anus
BUT
2/3 of cases are in the terminal illeum
perianal involvmenet is common (fissures and fistulas)

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7
Q

Does UC or CD involve the anus

A

CD!

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8
Q

prochitis

A

UC in rectum

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9
Q

pancolitis

A

UC that spreads from the rectum to beyond the left splenic flexure

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10
Q 
UC
confined to \_\_\_\_\_
superficial or deep?
continuous or discontinuous?
complications?
cure?
A

mucosa
superficial
continuous

toxic megacolon, colon cancer
colectomy (bowel removal) is only cure

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11
Q

CD
superficial or deep?
continuous or discontinuous?
complications?

A

deep (mucosa–> submucosa–> muscularis–> serosa
discontinuous, patchy, cobblestone
complications
- malnutrition, vitamin deficiency
- strictures (narrowing)
- fistulas
- strictures and fistulas require surgery

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12
Q

IBD 5-ASA options, MOA, dosage forms

A

5-ASA is Mesalamine
Sulfasalazine (sulfapyridine + 5-ASA)
Osalazine (5-ASA + 5-ASA)
Balsalazide (4-aminobenzoyl-B-alanine + 5-ASA)

“topical aspirin”, dec PGs, dec Leukotrienes via COX
PO and PR

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13
Q

sulfasalazide AE

A

due to the sulfapyridine metabolite

GI, rash, photosensitivity, blood dyscrasias

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14
Q

balsalazide vs sulfasalazine

A

balsalazide is better tolerated than sulfasalazine

both are generic

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15
Q

balsala and osala po release at

A

terminal ileum

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16
Q

mesalamine po releases at

A

jejunum

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17
Q

mesalamine suppository releases at

A

rectum

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18
Q

tx options for IBD

A

5-ASAs, immunmdulators, corticosteroids, biologics,

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19
Q

immunomodulators for IBD

AE/monitor

A 
Azathioprine
6-MP
Methotrexate
AE: bone marrow suppression/leukocytopenia, thrombocytopenia--> CBC q3mo
LFTs and pancreatic enzymes
lymphomas (esp AZA + infliximab)
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20
Q

corticosteroids for IBD
use
drugs

A 
work acutely to decrease inflammation, not for chronic use!
topical hydrocortisone 100mg 
   - topical enema
   - 25mg suppository
   - 10% HC foam
prednisone 20-60mg po
IV HC or MEPN
Budesonide
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21
Q

Budesonide for PUD
vs prednisone?
local or systemic?
dosage forms and indication

A
  • 15x more potent than prednisone
  • more local, less systemic AE
  • Entocort releases in terminal ileum (2/3rds of CD cases!)
  • Uceris releases throughout colon so use for Ulcerative colitis
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22
Q

ENtocort

A

ER budesonide capsule

releases in terminal ileum so use for CD bc 2/3rds of CD cases are in the terminal ileum

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23
Q

Uceris

A

ER budesonide capsule

releases throughout colon so use for UC!

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24
Q

Biologics options for PUD

A 
infliximab
adalimumab
certolizumab
golimumab
natalizumab
Vedolizumab
Ustekinumab
Upatacitinib
Tofacitinib

Can I Get A New Vest Until Tomorrow???

25
what drugs are for CD?
AZA, 6-MP, MTX Infliximab Budesonide
26
which biologics are IV | AE?
Infliximab (Remicade) Natalizumab (Tysabri) Vedolizumab (Entyrio) Ustekinumab (Stelara) AE are infusion related: ACUTE = HA, dizzy, flushing, angina, cough, dyspnea, priuritis DELAYED 13-14d = myalgias, fever, rash, arthralgias, priuritis, urticaria, HA
27
which biologics are SQ` | AE?
Adalimumab (Humira) Certolizumab (Cimzia) Golimumab (Simponi) injection site rxn!
28
which biologics are po
Tofacitinib (Xeljanz) | Upacitinib (Rinvoq)
29
which biologics are anti-TNFa
Infliximab (Remicade) Adalimumab (Humira) Certolizumab (Cimzia) Golimumab (Simponi)
30
which biologics are selective adhesion molecule (integrin) inhibitors
Natalizumab (Tysabri) | Vedolizumab (Entyvio)
31
which biologic is a IL-2, IL-23 - i
Ustekinumab
32
JAK-i s
Tofacitinib (Xeljanz) | Uptacitinib (Rinvoq)
33
how to prevent AE with IV biologica for IBD
pre med w 1000mg APAP 50 mg IV/PO Benadryl +/- IV HC 50mg
34
all biologics AE what is done before tx initiation
infections (BBW TNFa-i and JAK-i) active or reactivates TB invasive fungal infection (candida, aspergillis) bacterial (legionella, listeria) --> monitor s/sx infxn ** do not admin live vaccines before tx... - TB skin test - Chest X Ray - Hepatitis B status (need HepB vaccine)
35
JAKi and TNFai have BBW for
``` infection malignancy (lymphomas in children and adolescents) ```
36
Natalizumab brand AE caveats
Tysabri, integrin-i PML (progressive, multifactorial leukoencephalopathy) (reactivation of human JC polyoma virus --> CNS infection) must admin as monotherapy pt and prescriber enroll in TOUCH safety program
37
JAK-i drugs and AE | use
Tofacitinib (Xeljanz) Upadacitinib (Rinvoq) cancer, CV events, thrombosis, death all BBW only use if patient cannot tolerate more than 1 TNFa-i
38
mild to moderate CD s/sx
``` ambulatory no fever no abd pain no obstruction weight loss <10% ```
39
``` ambulatory no fever no abd pain no obstruction weight loss <10% ``` which class of CD severity?
mild-moderare
40
``` fever >38C weight loss >10% abdomonal pain and tenderness N/V NO obstructions anemia dec Hgb ``` which class of CD severity?
mod-severe
41
mod-severe CD s/sx
``` fever >38C weight loss >10% abdomonal pain and tenderness N/V NO obstructions anemia dec Hgb ```
42
severe CD s/sx
``` persistent sx (fatigue, abd pain, anemia, malnutrition) despite steroids or biologic treatment often inpatient fever >39C persistent NV intestinal obstruction cant eat abscesses ```
43
mild to mod CD treatment
po Budesonide x8weeks (+ 8 more prn) | add sulfasalazine ONLY if colonic involvement
44
mod-severe CD treatment
Prednisone 40-60mg po qd Infliximab (try other TNFa-i if no change in 2-4wks) +/- AZA/6MP/MTX
45
why add AZA/6MP/MTX in mod-severe CD
decreases Ab production to the biologics | as they onset at 4-6mo, the steroids can hold the patient over in that time with steroid maintenance then taper
46
severe-fulminant CD treatment
surgery IV steroids (HC, MEPN) not improving on IV steroids --> IV Infliximab IV fluids and TPN also
47
patient with mild to mod CD, given budesonide po x8 weeks and has colonic involvement so sulfasalazine is added to the regimen after 8 weeks there is no improvement/change what should the patient be given
40-60mg po prednisone then taper down Infliximab should probably add AZA/MTX/6-MP to prevent antibody production and cover the patient as they taper down the steroid
48
patient with mod-severe CD gets po prednisone, infliximab and AZA after 2-4 weeks there is no improvement so the patient is switched to Humira (adalimumab) after 2-4 weeks there is no improvement so the patient is switched to Certolizumab at this point the patient has tried several biologics, has a fever of 39.5C, has abscesses and severe abdominal pain what should be given to the patient?
at this point the patient is considered to have progressed to severe/fulminant surgery IV steroids (HC, MEPN) probs no IV infliximab bc they already tried it also admin IV fluids, TPN etc.
49
maintenance treatment for CD
first line = 6-MP/AZA/MTX budesonide <4mo biologics no 5-ASAs unless sulfasalazine for colonic involvement
50
UC remission s/sx
``` asx formed stools no blood Hgb, ESR, CRP all wnl low FC <150-200 ```
51
UC mild s/sx
``` <4 stools a day intermittent blood Hgb, ESR wnl CRP inc FC >150 ```
52
mod-severe UC s/sx
``` >6 stools a day frequent blood Hgb dec >25% inc ESR, CRP FC >150 ```
53
fulminant UC s/sx
``` >10 stools a day continuous blood need blood transfusion Hgb <8 inc ESR, CRP, FC ```
54
mild UC and distal (not past left splenic flexure) active and maintenance treatment
``` active - topical mesalamine supp or enema - pr mesalamine - both is preferred just depends on if they want butt stuff - refractory --> Budesonide (Uceris!!) x 8 weeks maintenance - po or pr mesalamine ```
55
mild UC and extensive (past left splenic flexure) active and maintenance treatment
``` active - po 5-ASAs - +/- budesonide x8weeks maintenance - po 5-ASAs ```
56
mod-severe UC active treatment
budesonide prednisone 40-60mg po biologic (infliximab) +/- 6MP/5ASA
57
fulminant UC active treatment
IV steroids (MEPN, HC) and/or IV infliximab IV CYA blood products if tried biologics, steroids, blood products and no relief --> surgery!
58
mod-severe and fulminant UC maintanance treatment
if remission with budesonide/IV steroid --> 6-MP/AZA | if remission with CYA --> 6-MP/AZA or vadolizumab

GI Therapeutics Exam (10 decks)

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