IBD Flashcards
Distal/left sided IBD
Mesalamine suppository, enema
Sulfasalazine
Supplement folic acid
Extensive IBD
Oral therapy
Rowasa
Mesalamine suppository
Pentasa
Slow release oral mesalamine, reaches the jejunum (released in small intestine and throughout entire colon)
Asacol
Delayed, pH dependent, enteric coated tablet
Lialda
Once daily enteric coated delayed release
Apriso
Extended release granules
Olsalazine
2 mesalamines, diarrhea
Balsalazide
Prodrug
Canasa
Mesalamine enema
Sulfasalazine, olsalazine, balsalazide
require bacteria to cleave into mesalamines
Hydrocortisone 5x dose methylprednisolone
Cortisone 5x dose prednisone
Corticosteroids
Supplement calcium and vitamin D
Immunomodulators
3rd line to ASA and steroids
Azathioprine, 6-mercaptopurine, MTX, CsA
Can measure 6-thioguanine for adherence
Phenotype TPMT for thiopurine effectiveness
Cyclosporine
Useful for unresponsive to steroid UC and fistulizing chrohns disease
Nephrotoxicity, bone marrow suppression
Methotrexate
Induce clinical remission in CD and spare steroid usage
Low CBC-pancytopenia, hairloss, hepatotoxicity
Infliximab
TNF alpha antibody
Pretreat with diphenhydramine or APAP for ADRs
Contraindicated in 3/4 heart failure
Fistulizing CD
1) cyclosporine
2) infliximab
3) metronidazole
4) ciprofloxacin
IBD CHF or respiratory disease
VTE prophylaxis w/LMWH or UFH
UC remission maintenance
ASAs no steroids
Steroid dependent: Azathioprine
Moderate/severe CD
PO steroid prednisone
Hospitalized - IV methylprednisolone
CD remission maintenance
Azathioprine/ 6-MP first line
Toxic megacolon
Aggressive fluid/electrolyte management
Avoid opiates/anticholinergics that slow the bowels
High dose steroids
Anemia complication
Ferrous sulfate
Osteoporosis complication
Calcium, vit D
Biphosphonate
Mild/mod CD
ASA
Budesonide
Mod corticosteroids
If fail infliximab
