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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
What is counselling tips for topical CS?
lie on left side for at least 30 minutes to retain
26
Max length of CS?
Pred= 4 weeks Bud=8 weeks
27
Which CS therapy do you NOT need to taper?
bud enema
28
When switching from prednisone to budesonide treatment what is the new dose of budesonide?
6 mg and needing to taper prednisone
29
When do you need eye exam if taking CS?
if LONG term >1 course a year
30
When do you see benefit of CS for IBD?
1-2 weeks
31
WHat are the aminosalicylates? Which condition used in?
5-ASA SSZ Olsalazine UC
32
Which aminosalicylate is used in CD?
SSZ
33
WHo cant get an aminosalicykate?
<30 GFR allergic hepatic impair ulcers
34
For maintenance, how do you use 5-ASA?
oral +/- topical for mild to moderate
35
For each severity of UC what is treatment with 5-ASA for induction?
Mild= oral +/- topical Mod-severe= ASA+ pred
36
MOA of 5-ASA? Does it affect platelet?
stop COX in COLON DOES NOT affect platlets
37
What does SSZ get turned into?
5 ASA
38
For dosing of Aminosalicylates what is different between maintenance and induction?
higher dose for induction
39
What is the one drug we need to know dosing for with aminosalicylates?
Mezavant 2.4-4,8g OD
40
Could we give all aminosalicylates OD, what can happen?
YES, but more risk of bad gi s/e
41
S/e of aminosalicylates?
Gi, headache, urine discoloration
42
If gi issues with 5-ASA what can we do?
EC, take with food, start lower, divide dose, wait
43
What is an interesting s/e of SSZ?
oligospermia-reversible Photosensitivity, bone marrow tox
44
DI with aminosalicylates?
PPI if pH dependant, digoxin, azathioprine/mercaptopurine tox
45
What are some pH dependent aminosalicylates?
mezavant, asacol, salofalk
46
In regards to maintenance/ induction for UC, which drug is more effective?
SSZ
47
Which aminosalicylate works in all areas of Gi?
pentasa
48
What immune modifiers can we give for IBD
azathiprine, mercaptopurine, TNF inhibitors, vedolizumab, ustekinumab
49
Does MXT help with IBD?
yes but need sub q version but bad s/e as well
50
What is key benefit of immune modulators in IBD?
steroid sparing
51
When can you use immune modifiers for IBD maintenance?
2 or more uses of steroids/year or >12 weeks of use, relapse, nonresponse
52
Why arent azathioprine/mercaptopurine not use as mono for induction?
too slow
53
How are azathioprine/mercaptopurine dosed? what route?
by weight orally
54
Which biologics are IV?
infliximab, vedolizumab
55
Onset of Biologics
M/A= 6 months most=2-8 weeks vedolizumab=20 weeks
56
Bad s/e of TNF?
malignancy, antibody, siezure, HF
57
Bad s/e of vedolizumab?
antibody, less infection risk
58
Which biologic is first line? Which one specifically?
TNF inhibitors-infliximab
59
Does CD need maintenance therapy?
not usually but mod-severe or >2 exacerbations a year
60
What combos are appropriate for UC?
CS+SSZ/ASA ASA oral and topical Biologics/AZA
61
What combos are appropriate for CD?
Pred +SSZ= more efficacy Pred+AZA= faster Bio+AZA= efficacy increase and less antibodies
62
How to manage fistula in CD?
metronidazole and cipro for 2 weeks
63
New last line treatment for IBD?
Mirikizumab/ Risankizumab janus kinase
64
For UC which is best for mild to moderate Maintenance/induction?
M= amino topical I= Amino topical CS topical
65
For UC which is best for mod-severe Maintenance/induction?
I=CS oral, TNF M= Oral Amino biologic
66
True or false: You dont HAVE to treat mild CD?
True
67
What other meds for secondary treatment?
loperamide Pain= NO NSAIDs= buscopan MMD=TCA
68

Pharmacy 255 (16 decks)

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