IBD Flashcards
What is the classic symptoms of IBD?
Bloody diarrhea
What is the main differences between Chrons and UC?
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.
Inflammation limited to the rectum is called what?
Proctitis
What lifestyle measures can a patient take to help avoid flares?
Eat smaller, more frequent meals
Drink lots of water
Avoid EtOH/caffeinated beverages
Avoid sorbitol and lactose as they are excipients (binders_
What vitamin supplements can help prevent deficiencies related to malabsorption?
B12, D, calcium, iron
What agents are used to treat acute exacerbations of IBD flares?
Short course IV or PO steroids
What agents are used for maintenance therapy in mild UC? What about mod-severe UC?
What about those who are refractor or steroid dependent?
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
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?
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
What are the 2 brand names of oral budesonide? What are the doses and indications?
Entocort EC: 3mg (CD only)
Uceris: 9mg (UC only)
What 2 generic drugs are rectal steroids?
Rectal steroids are only indicated for which type of IBD?
Only indicated for UC because they only work distally
Hydrocortisone
Budesonide
Drug interactions regarding oral budesonide?
CYP3A4
Which drugs are aminosalicylates? What are they indicated for?
Aminosalicylates are only indicated in UC.
Mesalamine (ER caps: Apriso, Delzicol, Pentasa) (ER tabs: Asacol HD, Lialda) (Enema: Rowasa) (Suppos: Canasa)
Sulfasalazine
Balsalazide
Olsalazine
Hypersensitivity rxns are warnings for which drug used for UC?
Mesalamine and sulfasalazine (more likely because sulfa moeity)
What drug and formulation is more effective oral mesalamine and rectal steroids for distal disease/proctitis in UC?
Rectal masalamine
Which brand name of balsalazide is only approved in males only?
Giazo
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?
Colazal
Stained teeth/tongue
Which 2 drugs are thiopurines used in IBD?
Azathioprine
Mercaptopurine
BBW and side effects with azathioprine and mercaptopurine? Important warnings?
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.
When would MTX or cyclosporine be indicated in IBD?
MTX: mod-severe CD
CSA: Severe UC
What 2 drugs are integrin receptor antagonists?
What are their indications?
Natalizumab (Tysabri)-CD only
Vedolizumab (Entyvio)-CD or UC
*Refractory only
How is Natalizumab dosed?
Discontinue if no response in how many weeks?
Q 4 weeks
d/c 12 weeks if no reponse
BBW with Tysabri?
PML
*REMS TOUCH
Entyvio should be d/c if no response in how many weeks?
14 weeks d/c
Which mesalamine brand names can cause ghost tablet in stool?
Asacol HD and Delzicol
