IBD

Question 1

What is IBD?

Answer 1

combination of disorder:
Crohn’s disease
Ulceratice colitis

Question 2

Causes of IBD

Answer 2

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

Question 3

What is Crohn’s disease

Answer 3

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

Question 4

Signs and symptom of Crohn’s disease

Answer 4

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

Question 5

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

Answer 5

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

Question 6

What causes the gall stones in Crohn’s disease

Answer 6

cholesterol collects and causes its formation

Question 7

What is ulcerative colitis

Answer 7

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

Question 8

what causes the non-specific inflammatory response in UC

Answer 8

abnormal helper Type 2 T cells`

Question 9

How does UC begin

Answer 9

begins in rectum and goes up through colon
=its retrograde

Question 10

Signs and symptoms of UC

Answer 10

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

Question 11

GI complications of IBD

Answer 11

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

Question 12

Extraintestinal manifestations of IBD

Answer 12

Hepatobiliary complications
arthrits
uveitis
skin lesions
aphthous ulceration of mouth

Question 13

Which are the aminosalicylates

Answer 13

Sulfasalazine
Mesalazine (5-ASA): active drug form

Question 14

What is Sulfasalazine

Answer 14

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

Question 15

MOA of Sulfasalazine

Answer 15

inhibits leukotrieine synthesis and lipoxygenase= decr. inflammation

Question 16

Indications of Sulfasalazine

Answer 16

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

Question 17

CI of Sulfasalazine

Answer 17

history of salicylate or sulphonamine sensitivity
existing gastric or duodenal ulers

Question 18

DI of Sulfasalazine

Answer 18

Digoxin/folate
iron
methotrexante/phenytoin
warfarin
sulphonylureas

Question 19

AEs of Sulfasalazine

Answer 19

NV
diarrhea
anorexia
reversible oligospermia
infertility in males

Question 20

What is Mesalazine

Answer 20

an active metabolite of sulfasalazine

Question 21

MOA of Mesalazine

Answer 21

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

Question 22

Indications of Mesalazine

Answer 22

treatment and maintenance of remission in UC

Question 23

CI of Mesalazine

Answer 23

history of salicylate sensitivity
severe renal impairment

Question 24

DI of Mesalazine

Answer 24

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

Question 25

AEs of Mesalazine

Answer 25

abdominal pain nausea colic diarrhea headache

Question 26

Which are the corticosteroids

Answer 26

prednisone Methyl prednisone Hydrocortisone

Question 27

Indications of Corticosteroids

Answer 27

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

Question 28

admin of corticosteroids

Answer 28

parenterally orally rectally

Question 29

Admin of Budesonide

Answer 29

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

Question 30

Which are the immunosuppressants

Answer 30

Azathioprine Mercaptopurine Methotrexate Cyclosporine

Question 31

Indications for Azathioprine and Mercaptopurine

Answer 31

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

Question 32

Immunosuppressants are reserved for

Answer 32

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

Question 33

when are effects of immunosuppressants seen

Answer 33

clinical benefits only seen in 3-6 months

Question 34

AE of Cyclosporine

Answer 34

risk of nephrotoxicity and neurotoxicity

Question 35

I of Methothrexate

Answer 35

use IM on a weekly basis may reduce in steroid sparing

Question 36

Which are the Biological agents

Answer 36

Infliximab Adalimumab

Question 37

MOA of Infliximab

Answer 37

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

Question 38

Indications of Infliximab

Answer 38

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

Question 39

CI of Infliximab

Answer 39

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

Question 40

AE of Infliximab

Answer 40

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

Question 41

What is Adalimumab

Answer 41

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

Question 42

Indications of Adalimumab

Answer 42

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

Question 43

CI of Adalimumab

Answer 43

actve TB severe infection

Question 44

DI of Adalimumab

Answer 44

abatacept some vaccines

Question 45

AE of Adalimumab

Answer 45

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