IBD

Question 1

How do you treat bile salt diarrhoea in IBD?

Answer 1

Colestryramine= bile salt binder

Question 2

How do you treat the infection that might be exacerbating IBD?

Answer 2

Metronidzole, ciprofloxacin

Question 3

What steroids are used to treat IBD?

Answer 3

Predinsolone (acute use), budesonide (topical, slow release), hydrocrotisone if v. sever

Question 4

When would you use aminosalicylates? Give examples

Answer 4

To treat ulcerative colitis and maintain remission
Mesalazine- mild and moderate UC
Sulfasalazine- severe UC
5-ASA (topical, active component)

Question 5

SE of aminosalicylates?

Answer 5

Orange sweat
Oligospermia
Decreased platelets and white blood cells
Ulcers of the mouth

Question 6

Name a really expensive treatment for Crohn’s disease

Answer 6

Infliximab MAB to TNF-alpha

Question 7

Why are antimotility drugs avoided when in remission from ulcerative colitis?

Answer 7

Can cause paralytic ileus

Question 8

When in remission from ulcerative colitis, what is standard treatment?

Answer 8

Low fibre diet, antipasmodics (propantheline) and aminosalicylates (mesalazine)

Question 9

What immunosuppressants can be used?

Answer 9

Anti-metabolites: 6-MP, methotrexate

Calcineurin inhibitors: cyclosporin, tacrolimus

Question 10

How do calcineurin inhibitors work and when are they used?

Answer 10

Immunosuppressants
Stop IL-2 signalling
Used in steroid resistant ulcerative colitis