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CDM > IBD > Flashcards

IBD Flashcards

1
Q

What is Crohn’s diease?

A
  • Can affect any part of the GIT
  • Patchy, transmural (goes through the gut wall) inflammation
  • Defined by location/pattern (inflammatory, fistulating, sticturing)

Can be mild to fulminant (severe(

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2
Q

What are the symptoms of Crohn’s disease?

A
  • Small bowel- pain after eating, more likely to obstruct
  • Large bowl- pain, diarrhoea
  • Peri-anal- fistulas
  • Weight loss, fever, general tiredness, diarrhoea (sometimes bloody)
  • Lower right abdominal pain or central
  • Tender lower abdomen mass
  • Malabsorption, hypovitaminosis
  • Anorexia
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3
Q

What is UC?

A
  • Limited to the colon
  • Diffuse mucosal inflammation
  • Distal – rectum/sigmoid colon
  • Extensive disease- left sided colitis or whole colon (pancolitis)
  • Not associated with fistulae/fissures so no peri-anal disease
  • Most are limited to left side
  • Mild to fulminant (severe)
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4
Q

What are the symptoms of UC?

A
  • Bloody, mucousy diarrhoea, anaemia (due to bleeding), nausea and vomiting, dehydration
  • Lower abdominal cramps and pain on defaecation
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5
Q

What are the complications associated with IBD?

A
  • Strictures
  • Dietary restriction
  • Vitamin deficiencies
  • Anaemia
  • Fistulae
  • Dehydration
  • Adverse effects on work/study
  • Surgery
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6
Q

What is proctitis?

A

Inflammation of lining of rectum

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7
Q

How do you manage mild to moderate CD (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • Oral prednisolone
  • OR budesonide/5-ASA

Add on therapy:

  • Azathioprine/mercaptopurine
  • OR methotrexate if >2 exacerbations in 12 months or steroids can’t be weaned

Maintenance:

  • Azathioprine/mercaptopurine
  • OR methotrexate
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8
Q

How do you manage moderate to severe CD (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • Glucocorticoids
  • Consider biologic e.g. infliximab

Add on therapy:

  • Azathioprine/mercaptopurine
  • OR methotrexate

Maintenance therapy:
- Biologic e.g. infliximab
Potentially with azathioprine/mercaptopurine

Or methotrexate only

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9
Q

How do you manage fistulating disease CD (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • Antibiotics and drainage
  • Consider infliximab or adalimumab

Add-on therapy:

  • Azathoprine/mercaptopurine
  • OR methotrexate

Maintenance therapy:
Maintenance therapy:
- Biologic e.g. infliximab
Potentially with azathioprine/mercaptopurine

Or methotrexate only

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10
Q

How do you manage mild UC (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • Oral 5-ASA (or topical if appropriate)
  • OR topical/oral beclomethasone/budesonide/prednisolone if no improvements after 4 weeks of 5-ASA

Add on therapy/maintenance:
- Oral 5-ASA (or topical if appropriate)
AND
Azathioprine/mercaptopurine if > 2 exacerbations in 12 months needing systemic corticosteroids or if 5-ASA did not work

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11
Q

How do you manage moderate UC (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • Oral 5-ASA (or topical if appropriate)
  • OR topical/oral beclomethasone/budesonide/prednisolone if no improvements after 4 weeks of 5-ASA
  • OR tacrolimus (immunosupressant) if no response after 2-4 weeks steroids

Add on therapy/maintenance:
- Oral 5-ASA (or topical if appropriate)
AND
Azathioprine/mercaptopurine if > 2 exacerbations in 12 months needing systemic corticosteroids or if 5-ASA did not work

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12
Q

How do you manage severe UC (induce remission, add on therapy and maintenance)?

A

Inducing remission:

  • IV hydrocortisone
  • IV ciclosporin (immunosupressant) if no response to steroids after 72 hours
  • Infliximab
  • Consider surgery

Add on therapy/maintenance:

  • Infliximab/adalimumab/golimumab/ vedolizumab
  • AND azathioprine/mercaptopurine
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13
Q

When would a topical treatment be appropriate and what drugs can have a local effect?

A

5-ASA and steroids

Enemas for left sided

Suppositories for rectum

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14
Q

Budesonide has different indications due to its different formulations. What are the following indicated for and why?

  1. Cortiment
  2. Endocort/Budenofalk
A
  1. Cortiment is for UC as it is released in the colon

2. Entocort/Budenofalk is for CD as it is released in terminal ileum/colon

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15
Q

What drugs have a fast onset for IBD?

A

Steroids

5-ASA

Anti-TNFs

Ciclosporin

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16
Q

What drugs have a slow onset for IBD?

How long do they take to have an effect?

A

Azathioprine

Mercaptopurine

Methotrexate

2-3 months for onset of action

17
Q

What 2 IBD drug classes interact with heart failure?

A

Steroids - fluid retention

Biologics - can worsen HF

18
Q

What IBD drug class interacts with diabetes?

A

Steroids can affect glycaemic control

19
Q

What should you make sure in osteroporosis IBD patients in terms of their steroid treatment?

A

Avoid repeated course of steroids

20
Q

What are the extra intestinal effects of IBD?

A

Pyoderma - skin disease

Arthopathy - disease of joints

21
Q

How often should methotrexate be given?

A

Once a week

22
Q

How long do you need adequate contraception for after stopping methotrexate?

A

3-6 months

23
Q

What serious side effects come with methotrexate use?

A

Cirrhosis

Pulmonary fibrosis

24
Q

What should be prescribed with methotrexate?

A

Folic acid 5mg once weekly on a different day to methotrexate

25
Q

If a methotrexate patient is planning on getting pregnant, what advice would you give?

A
  • Consult with doctor
  • Aim to withdraw treatment with plenty of time before conceiving and look at alternatives
  • How is her disease progressing?
26
Q

What test should you do when determining an azothioprine or mercaptopurine dose?

A
  • TPMT level (thiopurine methyltransferase)
  • Azathioprine is a pro drug and converts to 6-mercaptopurine in the body
  • Mercaptopurine is broken down by TPMT
  • TPMT levels are based on genetic mutation so can have deficiency
27
Q

What is the risk of having a TPMT deficiency when on azathioprine or mercaptopurine?

A

Build up of drug and risk of bone marrow toxicity

28
Q

What test should you do when determining an azothioprine or mercaptopurine dose?

A
  • TPMT level (thiopurine methyltransferase)
  • Azathioprine is a pro drug and converts to 6-mercaptopurine in the body
  • Mercaptopurine is broken down by TPMT
  • TPMT levels are based on genetic mutation so can have deficiency

Round up to closest number of tablets

29
Q

What are the counselling points for azathioprine and mercaptopurine?

A
  • To report sign and symptoms of myelosuppression and hypersensitivity reactions
  • Live vaccines should be avoided. Before you start, recommended you take pneumonia vaccine.
  • Patients should be advised to use a sunscreen with a high protection factor to reduce sunlight exposure. No tanning beds
  • Use of patient held blood monitoring booklet
  • Monitor every week until 8 weeks and then it is every 3 months especially liver functions
  • Going to be long term treatment, around 5 years
  • Take on an empty stomach as it marginally improves absorption. However in reality, this may not be realistic
  • May feel like they feel ill within the first couple of weeks- nausea, dizziness, headache, flu like symptoms. Because it is an immunosuppressant
  • Any symptoms of pancreatitis go to A&E
  • Need to be regularly monitored by clinical team
30
Q

What is the Harvey Bradshaw Index?

A

Questionnaire to assess severity of CD

May have a low score as it does not quantify everything so may be eligible for treatment still

31
Q

What class is infliximab?

A

Anti-TNFa biologic

32
Q

When having a flare up of IBD, what should you test for?

A

Inflammatory markers

WBC and CRP

33
Q

What can abrupt withdrawal of a steroid lead to?

A

Adrenal insufficiency

34
Q

What is an advantage of oral beclomethasone compared to prednisolone in terms of side effects?

A

High 1st pass metabolism so local effect so wouldn’t get systemic effects e.g. psychosis like you would with prednisolone

35
Q

What is tacrolimus?

A

Immunosupressant

36
Q

What is ciclosporin?

A

Immunosupressant

CDM (17 decks)

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