ibd Flashcards
paragraph on IBD
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
why do we need therapeutics
induce and maintain remission
reduce hospitalisation
reduce illness symptoms and risk of complications
reduce costs
steroids
name 1
use
mode of delivery
[1] prednisone
used short term or in acutely ill due to side effects
orally, IV rectal delivery
mode of action
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
side effects
muscle wasting thinning of skin increase appetite increase infection osteoporosis mania cataracts abdominal mass easy bruising
5ASA
inhibits proinflammatory cytokines inhibition of cyoxygenase scavenger free radical release inhibit nfkbeta pathay inhibit T cell proliferation, activation and differentiation impairs white cell function
side effects
renal impairment diarrhoea headache malaise pancreatitis intolerance
name an immunmodulator and its other uses
azathioprine
AIH and RA
side effects
gi disturbances allergic reactons
heptosplenotoxicity fever rash fatigue
methotrexate MOA
interfereswith dna synthesis
increase adenosine levels
increase apoptosis
side effects
contraindicated in pregnancy bone marrow suppression rash nausea diarrhoea hypersensitivity pneumonitis increased liver enzymes fibrosis cirrhosis no documentation of lymphoma or skin cancer
ciclosporine
UC
can be used as anti-tnf alternative
blocks cytokine gene in t cells
binds to calcineurin to inhibit IL2 from t cells productioon
sid efects
hirituism gumhypertrophy renal and heoatoxicity hypertension short term use onl
biologics
vedolizumab and ustekinemab new drugs
biologics
USTEKINEMAB
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
vedolizumab
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
anti TNF
name 2
uses
side efects
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
new options
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
smad 7 inhibitor
function of smad7
name one inhibitor
GED 0301
smad7 works to downregulate smad4 and tgfbeta therefore smad 7 inhbiitro increases TGFB pathway
decrease in IL1 tnfalpha
tofaculimab
function
blocks stat phosphorylation inhibits jak1-3 decrease t and b cell activation modulates proinflammatory cytokines IL4,7,9,15,21 does not affect tregs
cotercosteroids vs immunosupressives
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
first line for uc
aminosalicyclates
