IBD Flashcards
What are the two distinct disorders seen in inflammatory bowel disease?
Ulcerative colitis: a mucosal inflammatory condition confined to the rectum and colon
Crohn’s disease: a transmural inflammation of the GI tract that can affect any part, from the mouth to the anus
Clinical features of crohn’s disease?
fever, malaise
rectal bleeding,
abd tenderness, abd mass, a wall and internal fistulas
aphthous or linear ulcers
DISCONTINUOUS distribution
clinical features of UC?
rectal bleeding
+/- abd tenderness
CONTINUOUS distribution
Tx of IBD?
agents used to relieve inflammatory process and induce disease remission
- Aminosalicylates
- Corticosteroids
- Antimicrobials
- Immunosuppressive
- Biologic TNF alpha
- Anti-intefrins
MOA Aminosalicylate?
goes through the bowel and released at a specific spot to cause a localized (not systemic) effect
What is considered low risk crohn’s disease?
no or mild sxs
norma/mild elevated CRP and/or fecal calprotectin levels
dx >30yrs
limited distribution of bowel disease
no prior intestinal resection
1st line tx fr mild crohn’s disease in adults?
Budesonde
What are some aminosalicylates?
Sulfasalazine
Olsalazine
Balsalazide
Mesalamine-various forms
What are Mesalamine Compounds?
5-ASA packaged in various ways to deliver it to different segments of the small or large bowel
ex. Pentasa, Asacol and Apriso, Lialda, Rowasa (enema) & Canasa (suppositories)
MOA of Pentasa?
contains timed-release microgranules that release 5-ASA throughout the small intestine
MOA of Asacol and Apriso?
5-ASA coated in a pH-sensitive resin that dissolves at pH 6-7
pH of the distal ileum and proximal colon
MOA of Lialda?
pH-dependent resin that encases a multimatrix core
on dissolution of the pH-sensitive resin in the colon, water slowly penetrates its hydrophilic and lipophilic core, leading to slow release of mesalamine throughout the colon
MOA of Rowasa and Canasa?
5-ASA delivered in high concentrations to the rectum and sigmoid colon
Clinical uses of 5-ASA drugs?
UC: induce & maintain remission in tx of mild-mod (1st line)
Crohn’s: efficacy unproved (1st line in mild-mod disease)
ASEs of Sulfasalazine?
20
ADEs of Olsalazine?
secretory diarrhea
ADEs of Mesalamine?
20
What should be monitored in pts given Sulfasalazine?
20
MOA of glucocorticoids?
Inhibits production of inflammatory cytokines (TNF-α, IL-1) and chemokines (IL-8)
Reduces expression of inflammatory cell adhesion molecules
inhibits gene transcription of nitric oxide synthase, phospholipase A, cox 2, etc.
What is Budesonide?
potent synthetic analog of prednisolone
PK of budesonide?
rapid first pass hepatic metabolism > low oral bioavailability
In a pt with moderate to severe active inflammatory bowel disease, should you give a higher dose of glucocorticoids?
NO
- not more efficacious
- more ADEs
in severely ill > admin IV
MOA of methotrexate?
inhibition of dihydrofolate reductase enzyme important in the production of thymidine and purines
may: interfere w/ interleukin, stimulate release of adenosine, stimulate apoptosis and death activated T lymphocytes
Use of Methotrexate?
Crohn’s disease
also: RA, CA
