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Pharmacy 255 > IBD > Flashcards

IBD Flashcards

1
Q

What is the proximal colon and what is the distal colon?

A

Prox= Ascending and transverse
Distal= Descending and sigmoid

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2
Q

What causes IBD?

A

idiopathic
genetic probably

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3
Q

What is UC?

A

inflammation episodes limited to the mucosal layer of colon

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4
Q

Where does UC start?

A

RECTUM

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5
Q

What is CD?

A

transmural inflammation with skip lesions. from mouth to perianal area

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6
Q

Where can CD begin?

A

anywhere from mouth to rectum

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7
Q

True or false CD always involves the rectum?

A

no

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8
Q

What puts people at risk of IBD?

A

genetics
smoking
poor diet of processed foods
obese
sedentary

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9
Q

What can ellicit episode of IBD?

A

stress
antibiotics NSAIDs

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10
Q

Do Combined OC cause IBD?

A

only to the estrogen component

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11
Q

Which form of IBD has worse relapse rate and quality of life?

A

Relapse= UC
QoL= CD

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12
Q

What are complications of IBD?

A

Colectomy
ulcers
arthritis
anemia

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13
Q

Common sx of IBD?

A

ab pain, diarrhea, constipation

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14
Q

What sx indicate a flare of IBD?

A

weight loss, sweat, arthralgia

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15
Q

What is the criteria for mild to fulminant UC?

A

Mild= 1-2 stools above baseline
MOd= 3-4 stools above baseline with blood and a little systemic sx
Sev= over 5 stools, systemic tox
Fulminant- more than 6 stools needing blood transfusion

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16
Q

What is criteria for mild to severe CD?

A

Mild= <10% weight loss
mod= unresponsive to treat with>10% loss
Severe= Sx persist despite CS

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17
Q

What are some nonpharm for IBD?

A

bulk fiber, lower fat intake, stop trigger
multivitamin IRON FOR SURE
exercise

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18
Q

Which IBD does probiotics seem more helpful?

A

UC

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19
Q

Does stopping smoking help IBD?

A

helps Crohns NOT UC

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20
Q

What is the definition of remission?

A

sx free, no inflammatory consequences, no need of steroids

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21
Q

What is dosing for CS and how do they help?

A

induce remission
prednisone 40-60 mg daily for 2-4 weeks

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22
Q

What is the other CS we can use and what are the benefits/cons?

A

budesonide not systemically absorbed= less s/e but less effective
can be used for maintenance as well for 3 months
9 mg oral
2 mg topical

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23
Q

When can you use budesonide enemas?

A

ONLY for distal UCW

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24
Q

When can you use budesonide capsules?

A

only for proximal CD

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25
Q

What is counselling tips for topical CS?

A

lie on left side for at least 30 minutes to retain

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26
Q

Max length of CS?

A

Pred= 4 weeks
Bud=8 weeks

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27
Q

Which CS therapy do you NOT need to taper?

A

bud enema

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28
Q

When switching from prednisone to budesonide treatment what is the new dose of budesonide?

A

6 mg and needing to taper prednisone

29
Q

When do you need eye exam if taking CS?

A

if LONG term >1 course a year

30
Q

When do you see benefit of CS for IBD?

A

1-2 weeks

31
Q

WHat are the aminosalicylates? Which condition used in?

A

5-ASA
SSZ
Olsalazine
UC

32
Q

Which aminosalicylate is used in CD?

A

SSZ

33
Q

WHo cant get an aminosalicykate?

A

<30 GFR
allergic
hepatic impair
ulcers

34
Q

For maintenance, how do you use 5-ASA?

A

oral +/- topical for mild to moderate

35
Q

For each severity of UC what is treatment with 5-ASA for induction?

A

Mild= oral +/- topical
Mod-severe= ASA+ pred

36
Q

MOA of 5-ASA? Does it affect platelet?

A

stop COX in COLON
DOES NOT affect platlets

37
Q

What does SSZ get turned into?

A

5 ASA

38
Q

For dosing of Aminosalicylates what is different between maintenance and induction?

A

higher dose for induction

39
Q

What is the one drug we need to know dosing for with aminosalicylates?

A

Mezavant 2.4-4,8g OD

40
Q

Could we give all aminosalicylates OD, what can happen?

A

YES, but more risk of bad gi s/e

41
Q

S/e of aminosalicylates?

A

Gi, headache, urine discoloration

42
Q

If gi issues with 5-ASA what can we do?

A

EC, take with food, start lower, divide dose, wait

43
Q

What is an interesting s/e of SSZ?

A

oligospermia-reversible
Photosensitivity, bone marrow tox

44
Q

DI with aminosalicylates?

A

PPI if pH dependant, digoxin, azathioprine/mercaptopurine tox

45
Q

What are some pH dependent aminosalicylates?

A

mezavant, asacol, salofalk

46
Q

In regards to maintenance/ induction for UC, which drug is more effective?

A

SSZ

47
Q

Which aminosalicylate works in all areas of Gi?

A

pentasa

48
Q

What immune modifiers can we give for IBD

A

azathiprine, mercaptopurine, TNF inhibitors, vedolizumab, ustekinumab

49
Q

Does MXT help with IBD?

A

yes but need sub q version but bad s/e as well

50
Q

What is key benefit of immune modulators in IBD?

A

steroid sparing

51
Q

When can you use immune modifiers for IBD maintenance?

A

2 or more uses of steroids/year or >12 weeks of use, relapse, nonresponse

52
Q

Why arent azathioprine/mercaptopurine not use as mono for induction?

A

too slow

53
Q

How are azathioprine/mercaptopurine dosed? what route?

A

by weight
orally

54
Q

Which biologics are IV?

A

infliximab, vedolizumab

55
Q

Onset of Biologics

A

M/A= 6 months
most=2-8 weeks
vedolizumab=20 weeks

56
Q

Bad s/e of TNF?

A

malignancy, antibody, siezure, HF

57
Q

Bad s/e of vedolizumab?

A

antibody, less infection risk

58
Q

Which biologic is first line? Which one specifically?

A

TNF inhibitors-infliximab

59
Q

Does CD need maintenance therapy?

A

not usually but mod-severe or >2 exacerbations a year

60
Q

What combos are appropriate for UC?

A

CS+SSZ/ASA
ASA oral and topical
Biologics/AZA

61
Q

What combos are appropriate for CD?

A

Pred +SSZ= more efficacy
Pred+AZA= faster
Bio+AZA= efficacy increase and less antibodies

62
Q

How to manage fistula in CD?

A

metronidazole and cipro for 2 weeks

63
Q

New last line treatment for IBD?

A

Mirikizumab/ Risankizumab
janus kinase

64
Q

For UC which is best for mild to moderate Maintenance/induction?

A

M= amino topical
I= Amino topical
CS topical

65
Q

For UC which is best for mod-severe Maintenance/induction?

A

I=CS oral,
TNF
M= Oral Amino
biologic

66
Q

True or false: You dont HAVE to treat mild CD?

A

True

67
Q

What other meds for secondary treatment?

A

loperamide
Pain= NO NSAIDs= buscopan
MMD=TCA

68
Q
A

Pharmacy 255 (16 decks)

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