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Therapeutics > IBD & Cirrhosis > Flashcards

IBD & Cirrhosis Flashcards

1
Q

2 types of IBD

A

crohns
ulcerative colities

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2
Q

symptoms of IBD

A

diarrhea, blood in stool, abdominal pain/cramp, weight loss, fatigue, change in daily activity

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3
Q

2 markers of inflammation in the bowel looked for in stool studies for iBD

A

lactoferrin and calprotectin

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4
Q

IBD confined to the rectum and colon, often starts in rectum and moves up

A

ulcerative colitis

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5
Q

depth of ulcerative colitis and nature of disease

A

mucosa (superficial) and continuous

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6
Q

UC confined to the rectum

A

proctitis

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7
Q

UC where inflammation goes up past the rectum, sigmoid colon, and descending colon up to the splenic flexure

A

left sided/distal colitis

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8
Q

UC that passes the splenic flexure

A

extensive/pancolitis

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9
Q

complications of UC

A

toxic megacolon, colon cancer, colectomy

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10
Q

IBD located anywhere from mouth to anus

A

crohns

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11
Q

crohns is most commonly located in the

A

terminal ileum, but perianal is common too

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12
Q

depth and nature of crohns

A

deeper but patchy inflammation (cobblestone)

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13
Q

complications of crohns

A

malnutrition, strictures, fistulas

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14
Q

5-aminosalicylate (5-ASA) used for IBD

A

mesalamine

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15
Q

primary immunomodulator used for IBD

A

azathioprine

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16
Q

how long for azathioprine to work for IBD

A

~6 months

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17
Q

what is often co-administered with AZA for IBD

A

steroids (allow transition to chronic meds)
biologics- increase biologic efficacy and decrease Ab formation to biologic

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18
Q

BBW for azathioprine

A

malignancy, especially when used with anti-TNFs

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19
Q

main corticosteroid used for IBD

A

budesonide

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20
Q

brand for budesonide used for crohns and its target location

A

entocort –> terminal ileum

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21
Q

brand for budesonide for UC and its target location

A

uceric –> colon

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22
Q

how long is the budesonide regimen for IBD

A

8 weeks

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23
Q

which antibiotics are used for IBD

A

metronidazole
ciprofloxacin (3rd gen ceph alt.)

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24
Q

what risk is associated with all biologics for IBD

A

infection risk
risk of infusion related reactions

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25
Q

how long must a biologic be given for IBD to determine efficacy

A

8 weeks

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26
Q

management of an acute biologic infusion reaction

A

decrease infusion rate, give APAP/benadryl, steroids

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27
Q

management of delayed biologic infusion reaction

A

APAP, symptomatic management

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28
Q

anti-TNFs used for IBD

A

adalimumab, infliximab

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29
Q

generic for humira
dose form?

A

adalimumab, SC

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30
Q

generic for remicade
dose form?

A

infliximab, IV

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31
Q

BBW for anti-TNF

A

infection, risk for malignancy (higher with AZA)

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32
Q

which biologics are tried first in IBD

A

anti-TNF

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33
Q

selective adhesion molecule (integrin) inhibitors used for IBD

A

natalizumab, vedolizumab

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34
Q

generic for tysabri
dose form?

A

natalizumab, IV

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35
Q

generic for entyvio
dose form?

A

vedolizumab, IV

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36
Q

BBW for natalizumab (tysabri)

A

PML (has REMS)

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37
Q

IL inhibitors used for IBD

A

usetkinumab, risankizumab, mirikizumab

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38
Q

generic for stelara
dose form?

A

usetkinumab
IV then SC

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39
Q

generic for skyrizi
dose form?

A

risankizumab
IV then SC

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40
Q

generic for omvoh
dose form?

A

mirikizumab
IV then SC

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41
Q

JAK inhibitors used for IBD

A

tofacitinib, upacitinib

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42
Q

generic for xeljanz
dose form?

A

tofacitinib
PO

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43
Q

generic for rinvoq
dose form?

A

upacitinib
PO

44
Q

S1P receptor modulators used for IBD

A

ozanimod, etrasimod

45
Q

BBW for JAK inhibitors Rinvoq and Xeljanz

A

cancer, CV events/death, embolism, infection, mortality

46
Q

FDA labeling on JAK inhibitors Xeljanz and Rinvoq

A

use if failed anti-TNF therapy

47
Q

generic for zeposia
dose form?

A

ozanimod
PO

48
Q

generic for velsipity
dose form?

A

etrasimod
PO

49
Q

contraindications to S1P receptor modulators (ozanimod & etrasmiod)

A

CAD, stroke, NYHA III and IV HF

50
Q

what to use to treat mild to moderate CROHNS

A

PO budesonide x 8 weeks

51
Q

what to use to treat moderate to severe CROHNS (2 options)

A

PO systemic steroid (high dose prednisone)
or
biologic (TNFa) +/- AZA

52
Q

what to use to treat severe to fulminant CROHNS (1st then if that fails? other option)

A

IV steroids x 3 days
if fails –> IV infliximab
surgery

53
Q

what to use to treat perianal disease in CROHNS (fissures, fistulas)

A

antibiotics, infliximab

54
Q

how to treat remissive CROHNS induced by budesonide

A

AZA

55
Q

how to treat remissive CROHNS induced by a biologic

A

biologic +/- AZA

56
Q

how to treat remissive CROHNS induced by systemic steroids

A

AZA or biologic (more likely)

57
Q

how to treat mild distal RECTAL UC

A

suppository 5-ASA +/- PO 5-ASA

58
Q

how to treat mild distal LEFT SIDED UC

A

enema 5-ASA

59
Q

how to treat mild distal UC if failed other options?

A

add PO budesonide

60
Q

how to treat mild extensive UC

A

PO 5-ASA +/- budesonide

61
Q

treatment options for moderate to severe UC (3 options)

A

budesonide x 8 weeks
prednisone QD (high dose)
biologic +/- AZA

62
Q

treatment options for fulminant UC

A

IV steroid x 3 days
IV infliximab
IV cyclosporine
colectomy

63
Q

how to treat moderate, severe, or fulminant remissive UC induced by STEROIDS

A

AZA

64
Q

how to treat moderate, severe, or fulminant remissive UC induced by BIOLOGICS

A

biologic +/- AZA

65
Q

how to treat moderate, severe, or fulminant remissive UC induced by CYCLOSPORINE

A

AZA or vedolizumab

66
Q

how to treat mild remissive UC

A

topical or PO 5-ASA

67
Q

which form(s) of IBD can adalimumab (humira) be used for

A

BOTH UC and CD

68
Q

which form(s) of IBD can infliximab (remicade) be used for

A

BOTH UC and CD

69
Q

which form(s) of IBD can natalizumab (tysabri) be used for

A

CD

70
Q

which form(s) of IBD can vedolizumab (entyvio) be used for

A

BOTH UC and CD

71
Q

which form(s) of IBD can usetkinumab (stelara) be used for

A

BOTH UC and CD

72
Q

which form(s) of IBD can risankizumab (skyrizi) be used for

A

CD

73
Q

which form(s) of IBD can mirikizumab (omvoh) be used for

A

UC

74
Q

which form(s) of IBD can tofacitinib (xeljanz) be used for

A

UC

75
Q

which form(s) of IBD can upacitinib (rinvoq) be used for

A

BOTH UC and CD

76
Q

which form(s) of IBD can ozanimod (zeposia) and etrasimod (velsipity) be used for

A

UC

77
Q

primary determinant of ascites

A

abdominal paracentesis with SAAG >= 1 g/dL

78
Q

which electrolyte should be restricted for ascites

A

Na to 2g/day

79
Q

which diuretics should be used for ascites? what doses?

A

furosemide and spironolactone following 40:100 mg dosing

80
Q

what medication can be added if diuresis for ascites is not being tolerated (low BP)

A

midodrine

81
Q

alternative to medication for ascites if it is not tolerated

A

large volume paracentesis

82
Q

should IV albumin be given with large volume paracentesis for ascites

A

yes is pulling >5L of fluid

83
Q

last line option for ascites if refractory

A

TIPS

84
Q

primary AE of TIPS

A

hepatic encephalopathy

85
Q

diagnosis of portal hypertension

A

presence of varices on EGD
SAAG >= 1.1 g/dL

86
Q

what is the primary complication of portal hypertension

A

variceal bleeding

87
Q

treatment for portal hypertension

A

beta blockers
propranolol, nadolol, carvedilol

88
Q

when can beta blockers for portal hypertension be initiated

A

if varices are present

89
Q

when should beta blocker doses for portal hypertension be held or lowered

A

SBP <90 or DBP <60, HR <60, HRS, refractory ascites, SBP

90
Q

what is the HR goal with beta blocker therapy for portal hypertension

A

~60 BPM

91
Q

somatostatin analogue initiated for acute variceal bleeding

A

octreotide

92
Q

rubberbanding of a bleeding vessel

A

endoscopic variceal ligation (EVL)

93
Q

SBP prophylaxis regimen for acute variceal bleeding

A

7 days of 3rd gen cephalosporin
ceftriaxone

94
Q

last line option for refractory variceal bleeding

A

TIPS

95
Q

what should be initiated when a variceal bleed stops

A

non-selective beta blocker

96
Q

what is used to diagnose SBP

A

absolute PMN >= 250 /mm3

97
Q

treatment regimen for active SBP infection

A

3rd gen cephalosporin for 5 days
cefotaxime, ceftriaxone
alternative- ciprofloxacin

98
Q

should IV albumin be used for SBP

A

if SCr >1, BUN >30, or bilirubin >4 mg/dL

99
Q

when should SBP prophylaxis be used

A

acute variceal bleeding
history of SBP
ascitic protein <1.5 g/dL + 1 other criteria

100
Q

SBP prophylaxis regimens for history or low ascitic protein

A

indefinite
ciprofloxacin 250-500 mg QD
Bactrim DS 1 tab QD

101
Q

primary treatment and prevention option for hepatic encephalopathy and route of admin

A

lactulose
PO if tolerated
Retention enema if not

102
Q

add on therapy for hepatic encephalopathy

A

xifaxin

103
Q

what PKPD change occurs with decreased liver blood flow in cirrhosis

A

drugs with high first pass effects have increased systemic concentrations

104
Q

what PKPD changes occur with loss of hepatocyte function in cirrhosis

A

phase I metabolism affected
drugs with CYP dependent metabolism have increased therapeutic effect

105
Q

what PKPD changes occur with decreased albumin in cirrhosis

A

for heavily protein bound drugs, there is more unbound drug with more therapeutic effect

106
Q

what happens with renal function in cirrhosis

A

declines in setting of increased SCr

107
Q

what PKPD change occurs due to increased BBB permeability in cirrhosis

A

increased therapeutic response of drugs that cross

Therapeutics (29 decks)

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