ibd

Question 1

paragraph on IBD

Answer 1

use intro from IBD thing
allele nod2 has a 30.3 RR for ileal disease in homozygotes ( ahmed 2002)
van beelen 2007 found card15 may influence th177 and release of il17 in inflammation

Question 2

why do we need therapeutics

Answer 2

induce and maintain remission
reduce hospitalisation
reduce illness symptoms and risk of complications
reduce costs

Question 3

steroids
name 1
use
mode of delivery

Answer 3

[1] prednisone
used short term or in acutely ill due to side effects
orally, IV rectal delivery

Question 4

mode of action

Answer 4

inhibits cytokine production-proinflammatory such as iL1aplha
increase anti-inflammatory cytokines
suppress eiconsanoids inn phagocytic cells
supress COX2
work by binding in nucleus to glucocorticoid

Question 5

side effects

Answer 5

muscle wasting 
thinning of skin
increase appetite
increase infection 
osteoporosis
mania 
cataracts
abdominal mass 
easy bruising

Question 6

5ASA

Answer 6

inhibits proinflammatory cytokines 
inhibition of cyoxygenase
scavenger free radical release
inhibit nfkbeta pathay
inhibit T cell proliferation, activation and differentiation 
impairs white cell function

Question 7

side effects

Answer 7

renal impairment 
diarrhoea 
headache 
malaise 
pancreatitis
intolerance

Question 8

name an immunmodulator and its other uses

Answer 8

azathioprine

AIH and RA

Question 9

side effects

Answer 9

gi disturbances allergic reactons

heptosplenotoxicity fever rash fatigue

Question 10

methotrexate MOA

Answer 10

interfereswith dna synthesis
increase adenosine levels
increase apoptosis

Question 11

side effects

Answer 11

contraindicated in pregnancy 
bone marrow suppression 
rash
nausea 
diarrhoea 
hypersensitivity 
pneumonitis 
increased liver enzymes
fibrosis
cirrhosis 
no documentation of lymphoma or skin cancer

Question 12

ciclosporine

Answer 12

UC
can be used as anti-tnf alternative
blocks cytokine gene in t cells
binds to calcineurin to inhibit IL2 from t cells productioon

Question 13

sid efects

Answer 13

hirituism 
gumhypertrophy
renal and heoatoxicity 
hypertension 
short term use onl

Question 14

biologics

Answer 14

vedolizumab and ustekinemab new drugs

biologics

Question 15

USTEKINEMAB

Answer 15

inhibits IL12/23
cytokine receptor on t cell
used for porsiais but now approved for crohns
well tolerated less side effects
can be used on those contraindicated e.g. history of TP
sle
effecte in fisutaling disease

Question 16

vedolizumab

Answer 16

anti integrin
binds to a4b7 preventing activation of madcam1
inhibition of inflamaoty cells
alternative of antiTNF
severe UC maybe
GUT SPECIFIC 
good for those with cancer history

Question 17

anti TNF
name 2
uses
side efects

Answer 17

humira (adalimumab)
infliximab
crohns over UC
demyelation ,malginacy, heart ailure, neutropenia
increase in MS and lupus
caution -elderly, those with MS, COPD, TB
can act with aziothprine syngestically

Question 18

new options

Answer 18

liquid diet therapy-good in short bowel and children,just as effective as steroids
antibiotics esp in sepsis
FMT- role of microbiome -studies at present

Question 19

smad 7 inhibitor
function of smad7
name one inhibitor

Answer 19

GED 0301
smad7 works to downregulate smad4 and tgfbeta therefore smad 7 inhbiitro increases TGFB pathway
decrease in IL1 tnfalpha

Question 20

tofaculimab

function

Answer 20

blocks stat phosphorylation 
inhibits jak1-3
decrease t and b cell activation 
modulates proinflammatory cytokines IL4,7,9,15,21 
does not affect tregs

Question 21

cotercosteroids vs immunosupressives

Answer 21

immunosupressives severe side effects, slow onset, intolerance

cortercosteroids have side effects, no maintainence ability, resistance and lack of mucosal healing
second line therapy for cd
ineffective in maintenance

Question 22

first line for uc

Answer 22

aminosalicyclates