IBD Flashcards

1
Q

What is the classic symptoms of IBD?

A

Bloody diarrhea

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2
Q

What is the main differences between Chrons and UC?

A

UC is usually confined to the superficial most part of the large intestine (rectum and colon) with superficial ulcerations. Generally called distal disease and is usually best treated with topical (rectal) treatment.

Chrons is deep, transmural inflammation of any part of the GI tract with the ileum and colon being most commonly affected. Damage to the bowel wall can cause strictures and fistulas. Symptoms are often nocturnal and symptoms include chronic diarrhea.

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3
Q

Inflammation limited to the rectum is called what?

A

Proctitis

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4
Q

What lifestyle measures can a patient take to help avoid flares?

A

Eat smaller, more frequent meals
Drink lots of water
Avoid EtOH/caffeinated beverages
Avoid sorbitol and lactose as they are excipients (binders_

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5
Q

What vitamin supplements can help prevent deficiencies related to malabsorption?

A

B12, D, calcium, iron

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6
Q

What agents are used to treat acute exacerbations of IBD flares?

A

Short course IV or PO steroids

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7
Q

What agents are used for maintenance therapy in mild UC? What about mod-severe UC?

What about those who are refractor or steroid dependent?

A

Aminosalicylates (most cases)-Mesalamine
If mod-severe that extends beyond rectum and colon, may qualify for immunosuppressive agents (Anti-TNF: Humira, Remicade, Simponi-golimumab) OR azathioprine/mercaptopurine OR cyclosporine
Steroid dependent/refractory: Vedolizumab

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8
Q

For mild Chrons disease that is limited to ileum and proximal colon, what single agent is the preferred treatment?
What agents can be considered in mod-severe CD?
What about a patient who is refractory to all of these treatment and/or steroid dependent?

A

Mild disease: PO budesonide
Mod-severe disease: Anti TNF (Humira, Remicade, Cimzia-certolizumab) OR azathioprine/mercaptopurine OR MTX OR IL receptor antagonist ustekinumab (stelara)

Steroid dependent: natalizumab, vedolizumab

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9
Q

What are the 2 brand names of oral budesonide? What are the doses and indications?

A

Entocort EC: 3mg (CD only)

Uceris: 9mg (UC only)

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10
Q

What 2 generic drugs are rectal steroids?

Rectal steroids are only indicated for which type of IBD?

A

Only indicated for UC because they only work distally
Hydrocortisone
Budesonide

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11
Q

Drug interactions regarding oral budesonide?

A

CYP3A4

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12
Q

Which drugs are aminosalicylates? What are they indicated for?

A

Aminosalicylates are only indicated in UC.
Mesalamine (ER caps: Apriso, Delzicol, Pentasa) (ER tabs: Asacol HD, Lialda) (Enema: Rowasa) (Suppos: Canasa)
Sulfasalazine
Balsalazide
Olsalazine

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13
Q

Hypersensitivity rxns are warnings for which drug used for UC?

A

Mesalamine and sulfasalazine (more likely because sulfa moeity)

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14
Q

What drug and formulation is more effective oral mesalamine and rectal steroids for distal disease/proctitis in UC?

A

Rectal masalamine

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15
Q

Which brand name of balsalazide is only approved in males only?

A

Giazo

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16
Q

Which Brand name of balsazide is a capsule that can be open and chewed if needed? What side effect can happen if they are chewed?

A

Colazal

Stained teeth/tongue

17
Q

Which 2 drugs are thiopurines used in IBD?

A

Azathioprine

Mercaptopurine

18
Q

BBW and side effects with azathioprine and mercaptopurine? Important warnings?

A

Chronic immunosuppression –>Increased risk of cancer in IBD patients
Warnings: hematologic toxicities, patients with genetic deficiency of TPMT are increased risk of bone marrow suppression.

19
Q

When would MTX or cyclosporine be indicated in IBD?

A

MTX: mod-severe CD
CSA: Severe UC

20
Q

What 2 drugs are integrin receptor antagonists?

What are their indications?

A

Natalizumab (Tysabri)-CD only
Vedolizumab (Entyvio)-CD or UC

*Refractory only

21
Q

How is Natalizumab dosed?

Discontinue if no response in how many weeks?

A

Q 4 weeks

d/c 12 weeks if no reponse

22
Q

BBW with Tysabri?

A

PML

*REMS TOUCH

23
Q

Entyvio should be d/c if no response in how many weeks?

A

14 weeks d/c

24
Q

Which mesalamine brand names can cause ghost tablet in stool?

A

Asacol HD and Delzicol