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YEAR 3 CANCER and PM > IBD > Flashcards

IBD Flashcards

1
Q

what is crohns

A

Crohn disease (CD) is an inflammatory bowel disease (IBD)

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2
Q

how does CD differe from UC

A

CD is not limited to the colon but can manifest anywhere in the gastrointestinal tract

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3
Q

what are features of CD

A

Clinical features commonly include diarrhea, weight loss, and abdominal pain

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4
Q

what are treatment aims for CD

A

induce and maintain remission

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5
Q

how are acute flares treated?

A

managed with corticosteroids but steroid-sparing regimes (e.g., thiopurine analogs, biologics) may also be used

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6
Q

how is remission induced in mild to moderate CD treated?

A

Oral systemic corticosteroids
(prednisone)

Consider sulfasalazine

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7
Q

how is remission induced in severe cd

A

IV systemic corticosteroids (e.g., IV methylprednisolone) PLUS infliximab

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8
Q

how is remission induce in moderate to severe CD (monotherapy)

A

A biologic (e.g., anti-TNF-α antibodies, ustekinumab, or vedolizumab) is preferred.

Consider methotrexate (IV or subcutaneous).

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9
Q

how is remission induce in moderate to severe CD (monotherapy)

A

Oral systemic corticosteroids (e.g., prednisone) PLUS an immunomodulator (e.g., azathioprine) OR anti-TNF-α antibodies (e.g., infliximab)

Steroid-sparing regime: anti-TNF-α antibodies (e.g., infliximab) PLUS an immunomodulator (e.g., thiopurine analogs, methotrexate)

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10
Q

how is remission maintained in mild to moderate CD

A

aymptomatic patient and/or low risk of progression of CD: supportive therapy as needed

High risk of progression of CD or continued inflammation: Consider anti-TNF-α antibodies.

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11
Q

how is remission maintained in moderate to severe CD

A

Taper and discontinue corticosteroids.

Continue non-steroid agents that resulted in remission.

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12
Q

what lifestyle advice can be given for CD

A

smoking cessation

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13
Q

how is chrohns disease mediated

A

Mediated by dysfunctional IL-23-Th17 signaling

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14
Q

how is uc mediated

A

mediated by th2 cells

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15
Q

what is UC

A

chronic mucosal inflammation of the rectum, colon

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16
Q

what are UC

A

bloody diarrhea, abdominal pain, and fecal urgency

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17
Q

what diagnostic techniques for IBD

A

elevated inflammatory markers (e.g., ESR, CRP) and elevated fecal calprotectin

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18
Q

what is the first line treatment to induce remission in UC (mild to moderate)

A

5-ASA mesalamine

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19
Q

what is the first line treatment to induce remission in UC if patient does not tolerate 5-ASA

A

Corticosteroids may be added in patients who do not tolerate 5-ASA therapy or do not achieve remission with 5-ASA monotherapy

20
Q

what is the first line treatment to induce remission in UC (moderate to severe)

A

Oral corticosteroids (e.g., budesonide MMX or prednisone)
OR anti-TNF therapy (e.g., infliximab, adalimumab, golimumab) with or without azathioprine
OR integrin receptor antagonist (e.g., vedolizumab)
OR JAK3 inhibitor (e.g., tofacitinib)

21
Q

what is the first line treatment to induce remission in UC (acute severe)

A

Intravenous corticosteroids (e.g., methylprednisolone)
Consider cyclosporine or infliximab for patients who do not achieve remission after 3–5 days of systemic corticosteroids.

22
Q

when should systemic cortcosteroids be used?

A

Systemic corticosteroids should only be used for induction of remission.

23
Q

when should steroid sparing agents be used?

A

Steroid-sparing agents are preferred for maintenance of remission

24
Q

what is remission

A

absence of active disease

25
Q

where can chrons disease affect

A

mouth to anus

26
Q

where is ulceritis colitis

A

colon and rectum

27
Q

what is mild IBD

A

fewer than 4 bowel movements

28
Q

what is moderate ibd

A

4-6 bowel movements

29
Q

what is severe ibd

A

6+ bowel movements

30
Q

does mild and moderate ibd include anaemia

A

no

31
Q

does severe ibd include anaemia

A

yes

32
Q

are aminosalicyates preparations interchangeable

A

no

33
Q

what is the active component of Aminosalicylates

A

5-ASA (mesalazine) is the active component

34
Q

is * 5-ASA (mesalazine) stable in acidic conditions? what can be done

A
  • 5-ASA is unstable in acidic conditions
    oral preparations are formulated to withstand the acidic conditions of the stomach
35
Q

what is the aim of suppositores in IBD

A

reach rectum

36
Q

what is the aim of foam enemas in IBD

A

reach rectum and sigmoid colon

37
Q

what is the aim of liquid enemas in IBD

A

reach rectum and rectosigmoid colon

38
Q

is ciclosporin used in both ibd diseases

A

only used in UC not crohns

39
Q

when is ciclosporin used in UC

A

acute severe active UC unresponsive to IV steroids after 72hrs or if symptoms worsen on steroids

40
Q

what happens if there is no response to ciclosporin

A

coleoctomy

41
Q

what monitoring needs to be done on ciclosporin

A

BP, Mg, K, lipids, FBC, Ur and Cr, LFTs before and during therapy

42
Q

when is infliximab used

A

used to induce remission in severe UC when ciclosporin is contraindicated

43
Q

what is infliximab contraindicated in

A

heart failure

44
Q

when are vedolizumab, ustekinumab etc used

A

when anti tnf alpha agents cannot be tolerated

45
Q

when is methotrexate used

A

maintain remission and used when thiopurines are not tolerated

46
Q

what do you need to take with methotrexate

A

folic acid

YEAR 3 CANCER and PM (13 decks)

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