Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHRM 864 > IBD > Flashcards

IBD Flashcards

1
Q

what is crohn’s disease?

A

transmural inflammation of the GI tract that can affect any part from the mouth to the anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is Ulcerative Colitis?

A

Mucosal inflammation confined to the rectum and colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

cytokine dysregulation in CD

A

increased Th1 cytokine activity (interferon gamma, interleukin 12 (IL-12))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cytokine dysregulation in UC

A

increased Th2 cytokine activity (IL-12, IL-5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CD diet association

A

refined sugars, low in fruits and veggies, high in w-6 polyunsaturated fats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

UC diet association

A

high protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does smoking affect UC and CD?

A

UC– protective? reduced disease activity with fewer flare-ups
CD– increased frequency and severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

NSAIDS IBD recommendation

A

generally avoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Drugs that may cause IBD

A

NSAIDS, antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

UC pathophys

A
  • confined to rectum and colon in the mucosal and submucosal layers
  • ulceration and mucosal damage = diarrhea and bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

UC local complications

A

hemorrhoids, anal fissures, perirectal abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

toxic megacolon

A

severe and potentially fatal UC complication; segmental or total colonic distention with acute colitis and signs of systemic toxicity
includes:
- increased ulceration depth
- vasculitis and thrombosis
- colonic dilation and/or perforation
- fever, tachycardia, distention, elevated WBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other UC complications

A

colonic perforation
massive colonic hemorrhage
colonic stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

colorectal cancer in UC

A

increased risk.
recommend screening colonoscopy with biopsies at 8 years after UC onset, and 1-2 years after that.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

crohn’s disease pathophys

A
  • transmural inflammation
  • anywhere in GI tract
  • discontinuous
  • deep ulcers
  • luminal narrowing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

crohn’s complications

A
  • small bowel stricture and obstruction
  • fistula (pathogenic connection between bowel and other tissue)
  • less bleeding than UC
  • some increased carcinoma risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

nutritional deficiency in CD

A
  • weight loss
  • growth failure
  • iron deficiency
  • vitamin B12
  • folate
  • hypoalbuminemia
  • hypokalemia
  • osteomalacia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

extraintestinal IBD manifestaions

A
  • fatty liver, pericholangitis, autoimmune hepatitis, cirrhosis
  • primary sclerosing cholangitis, cholangiocarcinoma, cholelithiasis
  • iritis, episcleritis, conjunctivitis
  • arthritis
  • osteoporosis (nutrient deficiency)
  • anemia
  • coagulation (VTE risk)
  • skin and mucosal lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

clinical presentation of UC

A
  • abdominal cramping
  • frequent BMs and blood and mucous in stool.
  • weight loss
  • constipation
  • fever/tachycardia
  • blurred vision, arthritis, dermatologic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

physical exam findings of UC

A
  • hemorrhoids, anal fissures, abscesses
  • dermatologic/ocular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

labs results of UC

A
  • decreased Hb/HCT
    Increased ESR/CRP
  • leukocytosis, hypoalbuminemia
  • fecal calprotectin (FC) (FC correlates with degree of inflammation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

diagnosis of UC

A

confirmed by endoscopy and biopsy
negative stool exam for infectious causes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

signs and symptoms CD

A

malaise, fever, abd pain, frequent BMs, hematochezia, fistula, weight loss, arthritis
abdominal mass/tenderness, perianal fissure, fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lab tests CD

A

Hb/HCT
Increased WBCs, ESR, CRP
Fecal calprotectin and fecal lactoferrin
+ anti-saccharomyces cervisiae antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Clinical presentation CD

A

variable
typically presents with diarrhea and abdominal pain
hematochezia in ~50%
endoscopy required for diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CD disease classification

A

mild-moderate: ambulatory; minimal other symptoms; no obstruction CDAI 150-220

moderate-severe: failed therapy for mild-moderate disease. Fever, weight loss, abd pain and tenderness, vomiting, obstruction, anemia. CDAI 220-450

severe-fulminant: persistent symptoms; systemic toxicity; CDAI >450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ASA Agents

A

sulfasalazine and 5-ASA (mesalamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Sulfasalazine MOA

A

cleaved by colonic bacteria to release sulfapyridine (inactive) and 5-ASA (active)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

MOA 5-ASA

A

local actions
anti-inflammatory
free radical scavenging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Mesalamine dosage forms

A
  • rapidly and completely absorbed in the small intestine (not the colon)
  • enemas (for left-sided disease)
  • suppositories (proctitis)
  • delayed/controlled release oral
  • can use topical and oral together
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Oral mesalamine

A

Apriso: releases in colon 0.375g mesalamine
Lialda: 1.2g mesalamine. released evenly throughout colon.
pentasa: 250 or 500mg. released in duodenum or ileum. dosed QID.
Asacol HD and Delzicol: 800mg (HD) or 400mg (delzicol) released in terminal ileum. TID dosing
Olsalazine (dipentum): 250mg dimer. released by bacteria in colon. BID dosing
Balsalazide (Colazal): Prodrug released by bacteria in colon. (750mg TID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Sulfasalazine ADRs

A

ADRs due to sulfapyridine
- nausea, vomiting, HA, anorexia, rash (start low-dose)
- anemia, hepatotoxicity, thrombocytopenia
- pneumonitis, lymphoma, nephritis
- hypersensitivity due to sulfonamide
Monitoring: CBCs and LFTs at baseline, every other week for first 3 months, and monthly for second 3 months, and periodically, thereafter. Monitor BUN/Scr periodically.
- interacts with anticoagulants/NSAIDS to increase bleeding risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Mesalamine ADRs

A
  • better tolerated than sulfasalazine
  • nausea, vomiting, HA
  • olsalazine: diarrhea
  • diarrhea, rash/pruritis, constipation
  • anemia, hepatitis/ abnormal LFTs, UC exacerbation
  • drug interactions: NsAIDS/antiplatelets/anticoagulants: Bleeding risk
  • PPIs, H2RAs, antacids (could influence release of dug in pH dependent dosage forms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Corticosteroids MOA

A
  • anti-inflammatory
    (parental for severe exacerbation, oral, or rectal)
  • use for remission induction only
    rectal dosing: 100-200mg per day (may be absorbed systemically)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Budesonide

A
  • PO in CR formulation
  • first-pass metabolism (only 9-21% absorbed systemically)
  • 6-8mg/day for up to 8 weeks
  • Enterocort EC (ileum) and Uceris (colon)
36
Q

Budesonide drug interactions

A

CYP3A inhibitors (ketoconazole, grapefruit, etc.) May increase systemic exposure.

37
Q

Systemic Corticosteroids

A

Prednisone or prednisolone 40-60mg/day
- TAPER
- IV methylprednisolone (16-20mg q6h)
- IV hydrocortisone (100mg q8h)
- remission induction only

38
Q

Steroids ADRs

A
  • give calcium and vitamin D while on steroids
  • may consider bisphosphonate
  • bone mineral density scan occasionally
39
Q

Azathioprine and 6-MP uses

A
  • can be used long-term for both UC and CD
  • for patients who fail 5-ASA and dependent on steroids
  • can help maintain remission (steroid sparing)
  • can use with 5-ASAs, steroids, and TNF-A
  • need to use for weeks to months to see benefit
40
Q

AZA and 6-MP dosing

A

AZA: 0.5-1.5 mg/kg IBW. Max of 2.5 mg/kg/day
6-MP: 0.25-0.5 mg/kg IBW. Max of 1-1.5 mg/kg/day

41
Q

AZA and 6-MP ADRs

A
  • N/V/D, anorexia, stomatitis
  • bone marrow suppression
    hepatotoxicity
  • fever, rash, arthralgia, pancreatitis
    monitoring: TPMT, CBC, LFTs
42
Q

Cyclosporine

A
  • can induce remission in IBD (UC)
  • Not in CD
  • Not for long-term use
  • for patients dependent on steroids
    initial IV 2-4 mg/kg/day
    PO conversion: double IV dose and administered 1/2 Q12H, then taper
43
Q

Cyclosporine ADRs

A
  • nephrotoxicity
  • neurotoxicity
  • metabolic (HTN, HLD, hyperglycemia)
  • GI upset, gingival hyperplasia, hirsutism
44
Q

Cyclosporine monitoring

A
  • BP, BUN/Scr, LFTs, trough concentration
45
Q

Cyclosporine Drug interactions

A
  • CYP3A and PGP substrate
  • conc increased due to: azole anti-fungals, macrolide abx, CCBs, grapefruit
  • conc dec due to: phenytoin, rifampin
46
Q

Tacrolimus

A

can be used in refractory disease

47
Q

Methotrexate uses

A
  • Used in Crohns
  • steroid sparing, induces remission
  • less defined role in UC (combo therapy)
  • SubQ or IM
48
Q

Methotrexate ADRs

A
  • bone marrow suppression
  • N/V/D, stomatitis, mucositis
  • cirrhosis, hepatitis, fibrosis
  • hypersensitivity pneumonitis
  • rash, urticaria, alopecia
  • teratogenic
49
Q

Methotrexate contraindications

A
  • pregnancy
  • pleural effusions
  • Chronic liver disease (EtOH use)
  • immunodeficiency
  • leukopenia/cytopenia
  • CrCl <40
  • blood dyscrasia
50
Q

methotrexate monitoring

A

CXR, CBC, SCr, LFTs

51
Q

TNF-a antagonists

A

infliximab (CD and UC)
adalimumab (CD and UC)
golimumab (UC) (go from the colon)
certolizumab pegol (CD) (larissa is a certified a-hole)

52
Q

Natalizumab (tysabri)

A
  • prevents leukocyte adhesion/migration
  • Crohn’s only
  • Natal (friends with natalia?)
53
Q

Vedolizumab

A

anti-a4b7 integrin antibody
- Both UC and CD

54
Q

IL antagonists

A
  • ustekinumab (stelara) (IL-12 and IL-23) (CD and UC)
  • risankizumab-rzaa (Skyrizi) (IL-23) (CD and UC)
  • mirikizumab-mrkz (Omvoh) (Il-23 and P19) (UC only)
55
Q

Small molecule drugs

A
  • tofacitinib (Xeljanz) (Oral JAK inhibitor) (UC only)
  • upadacitinib (Rinvoq) (Oral JAK1 inhibitor) (UC and CD)
  • Ozanimod (Zeposia) (Oral S1P receptor modulator) (UC only)
  • estrasimod (Velsipity) (Oral S1P) (UC only)
56
Q

infliximab

A

UC and CD
- induction and maintenance
- Anti-drug antibody risk
- can combine with immunosuppressives
IV infusion

57
Q

adlimumab

A

_- UC and CD
- induction and maintenance
- ADA risk
- SQ injection

58
Q

Golimumab

A
  • UC only
  • induction and maintenance
  • ADA risk
  • SQ injection
59
Q

certolizumab

A
  • CD only
  • induction and maintenance
  • SQ injection
  • ADA risk
60
Q

natalizumab

A
  • CD only
  • induction and maintenance
  • cannot use with immunosuppressants
    IV
61
Q

Vedolizumab

A
  • UC and CD
  • induction and maintenance
  • IV
62
Q

ustekinumab (stelara)

A
  • UC and CD
  • IV (induction), SQ (maintenance)
63
Q

risankizumab-rzaa (skyrizi)

A
  • CD and UC
  • IV and SQ
  • induction and maintenance (moderate to severe)
  • avoid live vaccines
64
Q

Mirikizumab-mrkz (omvoh)

A
  • UC only
  • induction and maintenance
  • IV and SQ
  • avoid live vaccines
65
Q

when should TDM be used?

A
  • most data for infliximab and adalimumab
  • also check ADA
66
Q

TDM

A
  • therapeutic drug levels no effect (always switch to out of class biologic)
  • subtherapeutic levels (detectable ADA’s change to alternate drug in same class)
    (undetectable ADAs escalate dose)
67
Q

Tofacitinib (Xeljanz)

A
  • Oral JAK inhibitor
  • UC only
  • intolerant to TNF blockers
  • do not use with immunosuppressants
  • CYD interactions
  • thrombosis risk
  • avoid live vaccines
68
Q

Upadacitinib (Rinvoq)

A
  • Oral JAK-1 inhibitor
  • UC and CD
  • intolerant to TNF blockers
  • do not use with immunosuppressants or other biologics
  • CYP interactions
  • live vaccines contraindicated
  • shingles risk
69
Q

Ozanimod (Zeposia)

A
  • S1P receptor modulatory
  • UC only
  • do not use with immunosuppressants
  • Cardiac contraindications
  • Bradycardia and AV conduction delays
  • Interactions with CYPs, MAO-Is, BB, CCBs, etc.
70
Q

estrasimod (Velsipity)

A
  • s1P receptor modulator
  • UC only
  • no immunosuppressants
  • c/i with caridac conditions
  • CYP interactions
  • JC virus
71
Q

antimicrobians

A
  • ciprofloxacin, metronidazole, rifamycin
    (may cause resistance and C.diff)
72
Q

Mild to moderate UC treatment

A
  • oral and topical ASAs
  • Oral if disease extensive
  • mesalamine enemas and suppositories
  • mesalamine better tolerated than sulfa
  • can use oral and topical together!!
73
Q

unresponsive to 5-ASA in Mild-to-moderate active UC

A

use high-dose mesalamine and rectal mesalamine

74
Q

mild to moderate

A
  • can use budesonide and prednisone
  • when non-reponsive to oral or topical 5-ASAs
  • typically limit use to short-term
75
Q

moderate to severe active UC

A
  • 4-6 stools/day, blood, and some systemic symptoms
  • 5-ASA for moderate (not severe)
  • use systemic steroids (prednisone or budesonide)
  • consider TNF-a or other biologics when 5-ASA fails and steroid-dependent
76
Q

moderate to severe active UC

A

TNF-a inhibitors: infliximab, adalimumab, golimumab
antiintegrin: vedolizumab
IL12/IL-23: ustekinumab, mirikzumab, risankizuab
JAK: upadacitinib, tofacitinib (only if fails TNF-a) Black box warnings
SP1 inhibitor: Ozanimod and etrasimod

77
Q

moderate to severe active UC

A

do not use methotrexate for induction or maintenance; use biologic monotherapy
- use steroids for induction
- may use thiopurine monotherapy for maintenance
- Combine TNF-a with thiopurines or MTX
- discontinue 5-ASA for maintenance

78
Q

Severe UC

A
  • requires inpatient tx
  • 6-10 BMs/day
  • NPO
  • Parenteral steroids (methylpred, hydrocortisone)
  • TNF-a (infliximab and cyclosporine)
    -cyclosporine and transition to thiopurines (aza or 6-MP)
79
Q

maintenance of remission

A
  • Use ASA (mesalamine) (oral and/or enema) or TNF-a
  • azathioprine or 6-MP (Combine with TNF-a to decrease antibodies)
  • do not continue steroids
80
Q

mild to moderate crohns

A

no longer recommend mesalamine derivatives
- use budesonide
- antibiotics
- may use sulfasalazine for mild disease

81
Q

moderate to severe crohns

A
  • steroids
  • biologic therapy
  • TNF-a (infliximab + AZA or MTX)
  • adalimumab + thiopurine (AZA)
  • Certolizumab (not first line)
82
Q

Do NOT USE in Crohns

A
  • 5-ASA or sulfa
  • Cyclosporine
83
Q

fulminant crohns

A

steroids, infliximab last line, then surgery

84
Q

CD maintenance of remission

A

AZA and 6-MP
or SQ MTX
- TNF-a (use with AZA or 6-MP)
- early initiation of biologic in moderate-to-severe disease

85
Q
A

PHRM 864 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions