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PHA223 > IBD > Flashcards

IBD Flashcards

1
Q

what is IBD?

A

irritable bowel disease

chronic recurring inflammation of the GI tract

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2
Q

what are examples of IBD

A

crohn’s disease

ulcerative colitis

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3
Q

Describe crohns disease

A
  • inflammation of ANY part of the GI tract
  • involves ileum, caecum, colon
  • effects regions in a DISCONTINOUS pattern - skip lesions
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4
Q

what are the complications of CD

A

malignancy
anal lesions
abdominal mass

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5
Q

What is ulcerative colitis

A
  • confine to the colon
  • effects region in a CONTINOUS pattern
  • starts in the rectum and progresses upwards
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6
Q

what are the complications of UC?

A 
blood loss
electrolyte disturbances
blood in stool
mucus 
sometimes pain
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7
Q

Does UC respond to antibiotics?

A

no but CD does

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8
Q

Is there a possibility for UC to reoccur after surgery?

A

no but CD does

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9
Q

Is fistulas present in UC or CD?

A

CD

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10
Q

What are symptoms of IBD

A 
bloody diarrhoea 
urgency to empty bowels 
malnutrition
fever
weight loss
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11
Q

What is a ESR test? Describe the process.

A

measures severity of CD and UC

RBCs places in a tube sediment at a set rate, if inflamed they clump together and sediment faster
- indication of inflammation

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12
Q

What are extra intestinal manifestations as a result of IBD/treatment?

A

dermatological
rheumatological
ocular
general - kidneys and live

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13
Q

What are skin lesions and when are they most common?

A

erythema nodosum - tender red bumps

pyoderma gangrenosum - deep chronic ulcers - more common in UC

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14
Q

What happens to the bine due to IBD?

A

30-60% of Pt with IBD have lower bone density - osteoporosis/ ostroperia
- prolong use of steroids, inflammation and Vit B deficiency may contribute

spinal arthritis causing inflammation and fusing of vertebra - rare

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15
Q

describe ocular.

A
  • commonly conjunctivitis, iritis, episderitis
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16
Q

what are the symptoms of ocular?

A

ocular pain
photophobia
blurred vision
headache

17
Q

describe malignancy screening

A

pt with extensive colitis of more than 8-10 years are under surveillance programmes and undergo regular colonoscopy with multiple biopsies

18
Q

what are the risk factors of IBD

A

more common in CD
genes implicated - NOD2 and ATG16L1
immune response
luminal microbial antigens and adjuvants

environmental
smoking 
diet 
drugs 
stress
antibiotics 
lifestyle 
pollution 
geography
19
Q

What is the target for treating IBD

A 
IBD - lifelong condition with no cure 
induction of remission 
maintenance of remission
improved quality of life 
prevent bowel complications/EIM
mucosal healing to decrease risk of cancer
20
Q

What are the drug treatments for IBD

A 
Aminosalicylates - 1st line 
Corticosteroids 
immunosuppressants 
TMPT - thiopurine methyl tranferase 
methotrexate 
biologics 
antibiotics
21
Q

describe aminosalicylates

A

1st line therapy for induction of remission in UC and to decrease efficacy in CD

anti inflammatory effects - works locally not systemically
sulfasalizine-5ASA linked to sulfapyridine by diazo bond cleaved by colonic bacteria - 5ASA delivery

22
Q

what is the MOA of aminosalicylates

A

inhibition of leukocyte movement
decrease cytokine levels and TNF
inhibition of inflammatory mediators - prostaglandins, leukotriense and PAF

23
Q

what are the side effects of aminosalicylates

A

headaches
dizziness
fever

24
Q

describe corticosteroids and state examples

A

induce rapid remission in CD and UC - not used long term due to side effects

used in mild/moderate disease where aminosalicylates failed
may use in conjunction with 5-ASA

examples - prednisolone, hydrocortisone, methylprednisolone

25
Q

what are the long term adverse effects of corticosteroids?

A 
HPT
hyperglycaemia 
cataract
osteoporosis
osteonecrosis
26
Q

describe immunosuppressants

A

for failed 5-ASA and pt taking chronic corticosteroids for CD and UC

  • 3-6 months for effect
  • MAINTENANCE not remission
27
Q

what is the MOA of immunosuppressants

A

thiopurines - azothioprine is converted to 6-mercaptopurine to TIMP - purine analogue
TIMP is unstable and disrupts DNA synthesis in lymphocytes
cell and antibody mediated immune reactions are suppresssed
screen for TMPT enzyme polymorphism - mutation

28
Q

What is TMPT?

A

Thiopurine methyl transferase

  • enzyme responsible for metabolism of azathioprine
  • individuals with no TMPT enzyme can become severely ill if treated with normal dose of thiopurine drugs - increase risk of marrow suppression and death
29
Q

What is methotrexate used for?

A

used as alternative of azathioprine

30
Q

what is the MOA of methotrexate

A

inhibits dihydrofolate reductase leading to suppression of inflammation and DNA synthesis.
adenosine accumulation is anti inflammatory
MXA is an anti-folate that blocks pyrimidine/purine pathway and B-cell proliferation

31
Q

describe biologics and give and example

A
  • monoclonal antibody therapy
  • anti-TNF- alpha inhibitor
  • inhibits signalling and cytokine production
  • increase NFK beta inflammation

example - infliximab

32
Q

describe antibiotics and give an example

A
  • for mild/moderate CD treatment - maintenance

- when failed sulfasazine

PHA223 (10 decks)

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