IBD Flashcards
1
Q
what is ulcerative colitis
A
mucosal inflammation confined to rectum and colon
2
Q
what is Crohns disease
A
transmural inflammation affecting anywhere from mouth to anus
3
Q
what drugs may trigger UC and CD
A
NSAIDS
antibiotics
avoid use of NSAIDs
4
Q
which disease is fistula and strictures more common
A
Crohns
5
Q
what can happen as a complication of UC and CD
A
hepatobiliary
ocular effects
arthritis - bone dx and osteo
anemia
coagulation
derm conditions
6
Q
what lab may be used to check for UC and CD vs IBS
A
fecal calprotectin
7
Q
cigarette smoking is risk factor in which dx
A
Crohns
8
Q
cigarette smoking protective in which dx
A
UC
9
Q
rectal involvement common in which dx
A
UC
10
Q
perianal dx common in which dx
A
Crohns
11
Q
sulfasalazine contains what ingredients
A
sulfapyridine
mesalamine
12
Q
what does sulfapyridine do in sulfasalazine
A
inactive
carries drug to colon
responsible for side effects
13
Q
what does mesalamine (5-ASA) do in sulfasalazine
A
active component
exerts local action
anti-inflammatory effects
14
Q
what dosage form most effective of mesalamine
A
topical (oral is absorbed in small intestine not colon)
15
Q
can you use oral mesalamine with topical?
A
yes
16
Q
what dosage forms does mesalamine come in
A
oral (EC)
topical
suppository
17
Q
sulfasalazine side effects (8)
A
N/V
headache
anorexia
rash
thrombocytopenia
hepatotoxicity
anemia
hypersensitivity to sulfa
18
Q
what to monitor if taking sulfasalazine
A
CBC and LFTs
every other week for 3 months
19
Q
drug interactions with sulfasalazine
A
NSAIDs/anticoag/antiplatelets increase bleeding risk
20
Q
if patients develop bad side effects to sulfasalazine what can they try?
A
mesalamine
21
Q
drug interaction with mesalamine
A
NSAIDs/antiplatelt/antiocoag bleed risk
H2RA/PPI - might affect release
22
Q
use of corticosteroids in IBD
A
induction of remission
23
Q
corticosteroid options
A
rectal hydrocortisone
PO budesonide
PO prednisone or prednisolone
IV methylprednisolone or hydrocortisone
24
Q
rectal hydrocortisone absorption
A
systemic absorption possible
25
budesonide absorption
extensive first pass
minimal systemic
26
budesonide brands
Enterocort pH >5.5
Uceris pH > 7
27
budesonide drug interactions
CYP3A4 inhibitors (grapefrutit, ketoconazole)
increase systemic exposure
28
short term adverse effects of corticosteroids
hyperglycemia
gastritis
mood changes
elevation of BP
29
long term adverse effects of corticosteroids
osteoporosis
obesity
HPA suppression
aseptic necrosis
cataracts
growth failure
30
supplements to give while on corticosteroids
vitamin D 800 U/day
calcium 1000-1500 mg/day
bisphosphonates for >3 month, recurrent use, osteo pt
31
what might we monitor with corticosteroids and who
bone mineral density (DEXA scan)
>60 year
risk osteo
> 3 month use
reccurent users
32
immunosupressants used in IBD
methotrexate
azathiopurine
mercaptopurine
cyclosporine
33
when do we use azathiopurine or mercaptopurine in IBD
failure on ASA
dependent or refractory on steroids
34
azathiopurine and mercaptopurine induction or maintenance of remission?
maintain remission
35
how long do we use mercaptopurine and azathiopurine
long term (weeks to months)
36
side effects of azathiopurine and 6 mercaptopurine
N/V/D
anorexia
stomatitis
bone marrow supression
hepatotoxicity
fever, rash, arthralgia, pancreatitis
37
monitoring for azathiopurine and mercaptopurine
TPMT
CBC
LFTs
38
cyclosporine use in IBD
induce remission in UC
39
how long to use cyclosporine in IBD
short term
bridge therapy
40
when to give cyclosporine in IBD
refractory/dependent on steroids
41
side effects of cyclosporine
nephrotoxicity
neurotoxicity
HTN, hyperlipidemia, hyperglycemia
GI upset, gingival hyperplasia, hirsutism
42
monitoring for cyclophosporine
BP
BUN/SCr
LFTs
trough concentration
43
drug interactions for cyclosporine
CYP3A and Pgp substrate
increase conc: azole, macrolide, CCBs, grapefruit
decrease conc: phenytoin, rifampin
44
methotrexate used in which disease for what
Crohns
induce remission
45
methotrexate dosage form
SQ/IM
46
methotrexate adverse effects
bone marrow supression
N/V/D
stomatitis
cirrhosis
teratogenic
rash
pulmonary pneumonitis
47
contraindications to methotrexate
pregnancy
pleural effusions
chronic liver disease/ alcohol abuse
immunodeficiency
blood dyscrasias
leukopenia
CrCl < 40 ml/min
48
TNF alpha inhibitors
infliximab
adalimumab
golimumab
certolizumab pegol
49
infliximab MOA
TNF alpha inhib
50
adalimumab MOA
TNF alpha inhib
51
golimumab MOA
TNF alpha inhib
52
certolizumab pegol MOA
TNF alpha inhib
53
infliximab disease states IBD and uses
CD and UC
mod to severe
induction and maintenance
54
infliximab dosage form
IV infusion
55
risk of what increased with infliximab and azathiopurine?
HSTCL
56
what could we combine with TNF inhibitors to decrease risk of antidrug antibodies
azathiopurine
mercaptopurine
methotrexate
57
adalimumab disease states IBD and use
CD and UC
induction and maintenance of remission
poor response to infliximab
58
adalimumab dosage form
SQ injection
59
golimumab disease states IBD and use
UC
induction and maintenance
60
certolizumab pegol disease states IBD and use
CD
induction and maintenance
61
natalizumab MOA
anti alpha integrin
62
vedolizumab MOA
anti alpha 4b7 integrin
gut selective
63
natalizumab disease states IBD and use
CD
induction and maintenance remission
fail TNF alpha inhibs
64
what agents can we not use with natalizumab
TNF alpha inhibs
immunosupressants
65
vedolizumab disease states IBD and use
UC and CD
induction and remission
66
natalizumab dosage form
IV infusion
67
ustekinumab MOA
IL-12 and IL23 antagonist
68
risankizumab MOA
IL-23 antagonist
69
mirikizumab MOA
IL-23 p19 antagonist
70
ustekinumab disease states IBD and use
CD and UC
induction and maintenance
71
risankizumab disease states IBD and use
CD and UC
induction and maintenance
72
mirikizumab disease states IBD and use
UC
induction and maintenance
73
tofacitinib MOA
oral JAK inhibitor
74
updacitinib MOA
oral JAK 1 inhibitor
75
ozanimod MOA
oral SP1 inhibitor
76
etrasimod mOA
oral SP1 inhibitor
77
tofacitinib disease states IBD and use
UC
induction and maintenance ONLY if failed TNF alpha inhibitor
78
updactinib disease states IBD and use
UC
CD
induction and remission
only if fail a TNF alpha inhibitor
79
ozanimod disease states IBD and use
UC
induction and maintenance
80
etrasimod disease states IBD
UC
induction and maintenance
81
TNF inhibitors class side effects (7)
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
82
monitoring for TNF inhibitors baseline
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
LFTs
83
monitoring for natalizumab
neuro for PML !!!!!
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
LFTs
84
side effects natalizumab
PML
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
85
what do we test for prior to natalizumab therapy
JC antibody - predicts increased risk of PML
86
vedolizumab side effects
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
87
vedolizumab monitoring
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
LFTs
88
what can we use with vedolizumab
methotrexate
azathiopurine
6 mercaptopurine
89
ustekinumab side effects
cutaneous cell carcinoma
neurotoxicity
CV events
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
90
ustekinumab monitoring
skin
CV
neuro
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
LFTs
91
risankizumab side effects
hepatotoxicity/ inc LFTs
inc lipids
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
92
risankizumab monitoring
LFTs
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
93
mirikizumab side effects
increase in LFTs / hepatotox
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
94
mirikizumab monitoring
LFTs
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
95
what to consider if loss of treatment response?
TDM
check anti-drug antibodies and drug concentration
adalimumab and infliximab
96
what drug levels would be a PK issue?
sub therapeutic
97
what drug levels would be a PD issue?
therapeutic
98
what to do if pt has subtherapeutic drug levels and antibodies present?
immune mediated PK failure
switch to diff agent in same class
99
what to do if pt has subtherapeutc drug levels and no antibodies present?
non-immune mediated PK failure
dose increase
100
what to do if pt has therapeutic drug levels and no antibodies
mechanistic failure
switch to diff agent in diff class
101
what to do if pt has therapeutic drug levels and antibodies
test again: false positive?
if still positive switch to diff class
102
when can we not switch to a biosimilar?
if failure on the Brand name
103
can we use tofacitinib with other drugs?
not biologics or immunosupressants
104
can we use updacitinib with other drugs
no biologics or immunosupressants
105
tofacitinib side effects
neutropenia
black box warning: increase in mortality, CV events, clots, malignancies if CV risk
upper respiratory infections
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
106
tofacitinib monitoring
skin checks
lipids
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolytes
107
upadacitinib side effects
neutropenia
anemia
increased LFTs
upper respiraotry
acne
black boxed warning inc risk mortality, CV risk, clots, malignancy
infections
infusion related reactions
risk malignancy
HSTCL
demyelinating disease
CHF exacerbation
hepatotoxicity
108
upadacitinib monitoring
lipids
skin exams
CXR
PPD
Hep B, C
s/sx infection
UA
CBC
SCr
electrolyte
109
which drugs are teratogenic
upadacitinib
methotrexate
110
ozanimod side effects
like biologics
PML
brady/AV delays
LFT increase
increase BP
decreased FEV1
macular edema
RPLS
111
ozanimod dosing consideration
7 day titration
112
ozanimod monitoring
BP
spirometry
ECG
optho
113
etrasimod monitoring
BP
spirometry
ECG
ortho
114
etrasimod side effects
brady/AV delays
inc LFTs
inc BP
decreased FEV1
macular edema
RPLS
115
ozanimod and etrasimod can not be used with what
immunosupressives
116
ozanimod contrainidcated for who
CV event in past 6 months
sleep apnea
MAOi
117
etrasimod contraindicated for who
CV event in past 6 months (stroke, TIA, MI, HF, angina)
118
ozanimod drug interactions
adrenergic/serotenergic drugs
MAOis
CCBs/BBs
tyramine foods
119
mild-moderate UC symptoms
4-6 stool/day
minimal systemic symptoms
120
left sided UC mild-moderate treatment
enema
oral mesalamine
topical mesalamine
121
proctitis UC treatment mild-moderate dosage forms
mesalamine suppository
122
mild-moderate UC treatment first line extensive dx
oral 5-ASA or mesalamine
CR budesonide
123
can we use a combo of ASAs
yes, oral and topical
124
in mild-moderate UC, if unresponsive to 5-ASA what do we do?
change formulation
high dose mesalamine + Rectal mesalamine
CR budesonide
oral prednisone
topical corticosteroids
125
CR budesonide limited to how long
<8-16 weeks
126
moderate to severe UC symptoms
4-6 stool per day
+/- blood in the stool
systemic symptoms
127
moderate to severe active flare treatment
PO prednisone
TNF alpha inhibs / biologics
128
what drugs should we not use in mod-severe UC induction
methotrexate
thiopurine monotherapy
129
can we use thiopurines in mod to severe UC
yeah in maintenance
130
moderate to severe maintenance treatment
TNF alpha inhibs, vedolizumab, ustekinumab with azathioprine potetially
131
severe fulminant UC symptoms
6-10 BMs per day, blood, systemic
132
severe-fulminant UC treatment induction
parenteral corticosteroids (methylpred or hydro)
TNF alpha inhibs
cyclosporine
133
UC maintenance of remission drugs
what we used to induce
mesalamine - mild
biologic
thiopurines
134
mild - moderate CD treatment induction
sulfasalazine if colonic - not great
CR budesonide
135
moderate-severe CD treatment induction
PO prednisone
IV methylprednisolone/hydrocrotisone
infliximab/adalimumab + azathioprine (naive to biologics)
136
thiopurines not reccommended for what
monotherapy in UC and CD moderate to severe
137
cyclosporine not used for what
crohns
138
severe- fulminant CD treatment induction
IV methypred or hydro
infliximab or TNF
139
moderate CD remission tx
thiopurine
methotrexate
TNF alpha antags
(inflix or adal with thiopurine if naive to biologics or immuno)
