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Study Notes - Gastroenterology > *IBD 3 (lecture 3) > Flashcards

*IBD 3 (lecture 3) Flashcards

1
Q

What are the 3 therapeutic strategies that can be used to treat IBD?

A

Lifestyle advice
Drugs
Surgery

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2
Q

Is diet implicated in the pathogenesis of IBD?

A

No but it can influence symptoms

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3
Q

What is the common theme of all drug therapies?

A

They have an anti-inflammatory effect (you should tailor the drugs to the patients needs e.g. mild/ moderate/ severe relapse, tropical, oral, IV administration?

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4
Q

What are the drug therapy options for UC? (4)

A

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

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5
Q

What are the drug therapy options for Crohn’s disease? (3)

A

Steroids
Immunosuppressants
Anti-TNF therapy
(used to use mesalazine but shown to be as effective)

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6
Q

How does mesalazine work?
Effect on risk of colon cancer?
Side effects? (2)

A

It has a topical effect having anti-inflammatory properties
Reduces risk of colon cancer
Diarrhoea
Idiosyncratic nephritis

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7
Q

What is a prodrug?

A

a medication or compound that, after administration, is metabolized (i.e., converted within the body) into a pharmacologically active drug.

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8
Q

What does the fact that 5-ASA are pro-drugs mean?

A

The active components are released in the colon depending on different factors such as pH, etc.

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9
Q

What type of topical preparations of mesalazine do you get?(2)

A

Suppositories

Enemas

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10
Q

What are some examples of 5-ASA conjugates?

A 
Sulphasalazine
Balsalazide
Mezavant
Asacol (pH release)
Pentasa (delayed release)
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11
Q

Where is pentasa released?

A

From the duodenum to the colon (unlike the other drugs whcih are either released in the ileum or colon)

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12
Q

What is the advantage and disadvantage of using suppositories over enemas?

A

Suppositories coat

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13
Q

What aids spread of foam and liquid enemas?

A

Reflex contraction

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14
Q

How much of an enema stays in the rectum?

A

less than 10%

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15
Q

What type of enemas do patients prefer?

A

Foam enemas as it doesn’t make them feel like they need to pass stool

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16
Q

What properties do corticosteroids have?

A

Systemic anti-inflammatory properties

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17
Q

Examples of corticosteroids? (2)

A

Prednisolone (oral or topical)

Budesonide

18
Q

What is the purpose of corticosteroids?
What is the risk with corticosteroids?
What should corticosteroids therefore be used as a bridge to?

A

To induce remission (short course - start a high dose initially and reduce over 6-8 weeks)
Patients can become dependent on them
Maintenance therapy

19
Q

What are the side effects of steroids?

A

Musculoskeletal (avascular necrosis, osteoporosis)
GI
Cutaneous (acne, thinning of skin)
Metabolic (weight gain, diabetes, hyerptension)
Neuropsychiatric
Cataracts
Growth failure

20
Q

If steroids are not effective, what is then used?

A

Immunosuppression

21
Q

What is immunosuppression used for in UC?

A

“steroid-sparing agents”

22
Q

What is immunosuppression used for in Crohns?

A

Maintenance therapy

23
Q

What are 3 examples of immunosuppressive drugs used to treat Crohns and colitis?

A

Azathioprine
Mercaptopurine
Methotrexate (used rarely)

24
Q

Azathioprine:
onset of action?
What enzyme contributes to toxicity?
What drug should not be prescribed with this?
What should be regularly monitored in patients on this?
Side effects (4)?

A 
Slow onset (16 weeks)
TPMT
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required
Pancreatitis 
Leucopaenia
Hepatits
small risk of lymphoma and skin cancer
25
Q

What is tumour necrosis factor alpha?

A

A pro-inflammatory cytokine

26
Q

What are 2 examples of antibodies to TNF?

How is each given?

A

Infliximab (IV infusion)

Adalimumab (S/C injection)

27
Q

What does anti-TNF therapy do?

A

Promote apoptosis of activated T lymphocytes (rapid onset of action)

28
Q

How long does Infliximab tend to put patients in remission for?

A

8-12 weeks (re-treatment maintains remission)

29
Q

What is infliximab approved for treatment of?

A

Initially Crohns but is now approved for treatment of moderate - severe UC

30
Q

What are the adverse effects associated with anti-TNF alpha therapy?

A

Infusion reaction in 13% of patients (HACA +ve)
Infection
Cancer (lymphoma, solid tumours)

31
Q

When should anti-TNF alpha be used?

A

As part of a long term strategy including immune supression, surgery and supportive therapy
Refractory/ fistulising disease
(exclude current infection/ TB)

32
Q

What are the names of the 2 biosimilar Anti-TNFs that have been produced by different companies and are 1/3 of the cost of Infliximab?

A

Inflectra

Remsima

33
Q

When is emergency surgery carried out for IBD?

A

Failure to respond to medical therapy, small bowel obstruction, abscess, fistulae

34
Q

When is elective IBD surgery carried out?

A

Failure to respond to medical therapy

Dysplasia of colon mucosa

35
Q

Why do you want to minimise the amount of bowel resected in Crohns disease?

A

The surgery is not curative and if the patient requires a lot of resection they can get short gut syndrome and require lifelong total parenteral nutrition = reduced life expectancy

36
Q

What is a proctocolectomy?

A

The surgical removal of the rectum and all or some parts of the colon

37
Q

What is a brooke ileostomy?

A

ileostomy in which the divided proximal ileum, brought through the abdominal wall, is evaginated and its edge is sutured to the dermis

38
Q

What surgery can be done to treat a stricture from Crohns disease?

A

A longitudinal suture can be made over the suture and then stitched in the horizontal direction

39
Q

What can be used to treat a Crohns fistula?

A

Seton suture

40
Q

What are the 2 possible curative surgery options for UC?

A

Permanent ileosotmy

Restorative proctocoloectomy and pouch

41
Q

What functions as the “new” rectum in a restorative proctocoloectomy?

A

J-pouch (pass stool 5-6 times a day as the pouch is smaller)

Study Notes - Gastroenterology (42 decks)

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