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Pharmacology > IBD > Flashcards

IBD Flashcards

1
Q

What is IBD?

A

combination of disorder:
Crohn’s disease
Ulceratice colitis

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2
Q

Causes of IBD

A

Infectious diseases: viruses, chlamydia
Genetics: metabolic defects
Environmental factors: smoking
Immune defects: altered host susceptibility
Psychological defects: stress

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3
Q

What is Crohn’s disease

A

chronic non-inflammatory disease that most commonly affects the distal ileum and proximal colon

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4
Q

Signs and symptom of Crohn’s disease

A

-Aphthous ulcers: non-painful ulcers
-Chronic diarrhea
-Perineal fistual
-arthritis, epischoritis, skin lesions, higher risk of gall and kidney stones

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5
Q

What is the chronic diarrhea in Crohn’s disease associated with?

A

With:
abdominal pain
fever
steatorrhea
anorexia
weight loss
malnutrition
abdominal mass
Dysphagia (difficulty swallowing)
Odenphragia (painful swallowing)
watery diarrhea
B12 deficiency

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6
Q

What causes the gall stones in Crohn’s disease

A

cholesterol collects and causes its formation

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7
Q

What is ulcerative colitis

A

chronic non-specific inflammatory and ulcerative disease occurring in the colonic area

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8
Q

what causes the non-specific inflammatory response in UC

A

abnormal helper Type 2 T cells`

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9
Q

How does UC begin

A

begins in rectum and goes up through colon
=its retrograde

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10
Q

Signs and symptoms of UC

A

-abdominal pain, spells of bloody diarhoea varying intensty and duration, interspersed with asymptomatic intervals
-colicky, tenesmus, anaemia due to blood loss, arthrits, skin lesions

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11
Q

GI complications of IBD

A

Rectal fissures
fistuals (CD)
Perirectal abscess (UC)
Colon cancer (incr. risk): UC, CD
Toxic megacolon

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12
Q

Extraintestinal manifestations of IBD

A

Hepatobiliary complications
arthrits
uveitis
skin lesions
aphthous ulceration of mouth

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13
Q

Which are the aminosalicylates

A

Sulfasalazine
Mesalazine (5-ASA): active drug form

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14
Q

What is Sulfasalazine

A

a prodrug that is metabolized to its active components, Sulfapyridine & 5-ASA; mesalamine

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15
Q

MOA of Sulfasalazine

A

inhibits leukotrieine synthesis and lipoxygenase= decr. inflammation

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16
Q

Indications of Sulfasalazine

A

Prolongation of remission in CD and UC
mild to moderate cases
adjunctive therapy in severe cases

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17
Q

CI of Sulfasalazine

A

history of salicylate or sulphonamine sensitivity
existing gastric or duodenal ulers

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18
Q

DI of Sulfasalazine

A

Digoxin/folate
iron
methotrexante/phenytoin
warfarin
sulphonylureas

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19
Q

AEs of Sulfasalazine

A

NV
diarrhea
anorexia
reversible oligospermia
infertility in males

20
Q

What is Mesalazine

A

an active metabolite of sulfasalazine

21
Q

MOA of Mesalazine

A

unknown
probably inhibits prostaglandin and leukotriene synthesis and release in colon
= decr. inflammation

22
Q

Indications of Mesalazine

A

treatment and maintenance of remission in UC

23
Q

CI of Mesalazine

A

history of salicylate sensitivity
severe renal impairment

24
Q

DI of Mesalazine

A

preparations which lower pH of stool (eg lactulose) or prevent release of active ingredient

25
Q

AEs of Mesalazine

A

abdominal pain
nausea
colic
diarrhea
headache

26
Q

Which are the corticosteroids

A

prednisone
Methyl prednisone
Hydrocortisone

27
Q

Indications of Corticosteroids

A

treat relapses and induce remission (limited use in maintaining remission)
Useful in acute stages= decr. fever+diarhoea, relieve abd pain+tenderness, incr. appetite

28
Q

admin of corticosteroids

A

parenterally
orally
rectally

29
Q

Admin of Budesonide

A

rectally or Control Release formulation orally (to release in colon)

30
Q

Which are the immunosuppressants

A

Azathioprine
Mercaptopurine
Methotrexate
Cyclosporine

31
Q

Indications for Azathioprine and Mercaptopurine

A

effectively used in long-term treatment of both UC and CD

32
Q

Immunosuppressants are reserved for

A

patients who fail on aminoslaicylates
or refractory to
or dependent or corticosteroids

33
Q

when are effects of immunosuppressants seen

A

clinical benefits only seen in 3-6 months

34
Q

AE of Cyclosporine

A

risk of nephrotoxicity and neurotoxicity

35
Q

I of Methothrexate

A

use IM on a weekly basis may reduce in steroid sparing

36
Q

Which are the Biological agents

A

Infliximab
Adalimumab

37
Q

MOA of Infliximab

A

binds with high affinity and inhibits both soluble and transmembrane TNFa
=decr. intestinal inflammation and altering immune response

38
Q

Indications of Infliximab

A

used for moderate to sever active CD
fistulising CD
UC in patients who had inadequate response to conventional therapy
long-term maintenance of remission

39
Q

CI of Infliximab

A

active TB or any active infections
sepsis
abscesses
opportunistic infections
heart failure

40
Q

AE of Infliximab

A

viral infections
fever
headache
vertigo/dizziness
flushing
URTI/LRTI
nausea
diarrhoea
abd pain
dyspepsia
abnormal hepatic function
rash
pruritis
urticarial
incr. sweating
dry skin
myalgia
arthralgia
dyspahgia

41
Q

What is Adalimumab

A

binds to TNFa and inhibits its interaction with p55 and p75 cell surface TNF Receptors
=decr. intestinal inflammation

42
Q

Indications of Adalimumab

A

used in patients who have lost response or are intolerant to infilximab

43
Q

CI of Adalimumab

A

actve TB
severe infection

44
Q

DI of Adalimumab

A

abatacept
some vaccines

45
Q

AE of Adalimumab

A

injection site pain
URTI (upper respiratory tract infection)
headache
rash
nausea
abd pain
hyperlipidaemia

Pharmacology (50 decks)

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