IBD Flashcards
Risk Factors
-GENETICS
-Smoking protective in UC but can worsen CD
-Diet (sugar, fat, protein)
-Infectious
-Medications (NSAIDS, ABX, CONTRA)
IBD Signs and Symptoms
CD
-weight loss
-fissures
-fistula
-ulcers
UC
-hematochezia
-tenesmus
Crohn’s Disease - Treatment Decisions
Mild/Mod
-Sulfasalazine
-Steroids
-Budesonide
-Aza, 6-merc, mtx
Mod/Sev
-IV/PO steroids
-Bio (TNF, IL, integrin)
-Aza, 6-merc. mth
-JAK
Fistulas
Drain abscess before tx
Medication
-Anti TNF or thiopurines or combo
*Infliximab preferred (ada, certo)
-ABX (metro, cipro, levo) for active infection and to decrease fistula drainage
Ulcerative Colitis - Treatment Decisions
Mild/Mod
-5 ASA
-Budesonide
-CS
Mod/Sev
-5 ASA
-Budesonide
-CS
-THIO/MTX
-TNF/integrin/IL
-JAK
-S1P
Treatment Guidelines – Maintenance (UC)
Mild/Moderate
Mild/Mod: oral/top 5 ASA
Mod/Sev: THIO/BIO/MTX/JAK/S1P
Goals of Therapy
- Treat to Target
- Resolution of symptoms
- Mucosal healing
- Endoscopic remission
- Prevent complications
- Improve quality of life
- Minimize risk for CRC
- Prevent or manage extraintestinal manifestations
Sulfasalazine
-ASA
colonic involvement
AE:
-NV
-HA
-HS (rash)
-Anemia
-Pneumonitis
-Hepatoxicity
-Nephritis
-Thrombocytopenia
-Male infertility
MON:
-Folate
-CBC
-LFT
-BUN/Scr
Folic acid supplementation
CI: SULFA allergy
Mesalamine, olsalazine, balsalazide
-ASA
colonic involvement
AE:
-Diarrhea
-Abd pain
-HA
-Nausea
MON: GI upset
Fluids
-Food: olsalazine, lialda
-WO: asacol, apriso
CS
Induction only (not main)
- Impaired glucose
- Dyslipidemia
- Hypertension
- Osteoporosis
- Edema
- Infection
- Acne
- Myopathy
- Psychosis
MON: BG, BP, inf, elev, lipids, bone density
Methotrexate
- Renal impairment (BBW)
- Myelosuppression
- Pancreatitis
- Hepatotoxicity
- Pneumonitis
- Infection
- Malignancy
- Alopecia
- Male infertility
MON: CBC, LFT, pregnancy test, SCR, Folate supplementation
DDI: NSAID, pheny, tetra, sulf
Azathioprine, 6-Mercaptopurine
- Bone marrow suppression
- Pancreatitis
- Lymphoma
- Hepatotoxicity
- Nausea
- Non-melanoma skin cancer
MON: LFT, CBC, TPMT
DDI: Allopurinol
Cyclosporine
Adverse effects
* Nephrotoxicity
* Neurotoxicity
Monitoring
* BUN/Scr
* Signs of neurotoxicity
FOR
* Acute severe UC to avoid colectomy
* Failing corticosteroids
* Short term inpatient use only
Infliximab, Adalimumab, Golimumab, Certolizumab
-ANTI TNF
IND and MAIN of IBD
CI:
-Active infection
-Latent TB (untreated)
-HF
-Recent malignancy
-Optic neuritis
-Demyelinating disorder
AE:
-BBW Infection
-BBW Malignancy
-Infusion related
-Vasculitis
-BMS
-Hepatoxicity
-MS, lupus
MON:
-TB, CBC, LFT, BP, HR
Avoid live vaccines
Natalizumab
-Anti-Integrin Therapy
BBW: PML
-progressive multifocal leukoencephalopathy
-sx: one side weak, clumsy, vision, cognitive
ONLY THROUGH REMS
CI: PML, hepatic, combo with other IS/TNF
AE:
-HA, fatigue
-Arthalgia, rash
-Infusion
-Depression
-Infection
-Hepatoxicity
-Thrombocytopenia
Vedolizumab
-Anti-Integrin Therapy
- Nausea
- Headache
- Arthralgias
- Infection
- Infusion reactions
- Rash
- Pruritis
- Immunogenicity
- Nasopharyngitis
- Injection site reactions (SQ)
MON: CBC, LFT, BP, HR, mental status
Ustekinumab, Risankizumab, Mirikizumab
-Anti IL 12/23
-Infections
-TB
-HS
-Malignancy
*warnings
AE:
* Nasopharyngitis
* Injection site erythema
* Vulvovaginal candidiasis
* Upper Respiratory Infections
* Pruritis, arthalgias
* UTI
* Sinusitis, HA, fever, fatigue, NV
* Hepatotoxicity
MON: TB, LFT
-no live vaccines
JAK
-Tofacitinib (UC), Upadacitinib
BBW
-Infections
-Thrombosis
-MACE
-Malignancy
-Mortality
MON: TB, CBC, LFT, lipids
-avoid live vaccines
DDI: 3A4 and 2C19
S1P
-Ozanimod, Etrasimod
CI:
*last 6 mo:
* Myocardial infarction
* Unstable angina
* Stroke or TIA
* Decompensated heart failure requiring hospitalization
* Class III-IV heart failure
*Mobitz type 2 AV block
AE:
* Increase in LFTs
* Upper respiratory tract infections
* Headache
* Lymphopenia
Warnings:
-Not rec in pregnancy
-PML, PRES
-BP, hepa, resp
Ozanimod only
CI: sleep apnea and MAOi
Avoid high tyramine foods
IBD Advance Age and Cancer
Age
* Vedolizumab and ustekinumab preferred
Cancer
* Melanoma history (avoid TNF)
* Active or recent malignancy
(Hold while on chemo)
(Vedolizumab if treatment needed)
