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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
how long must a biologic be given for IBD to determine efficacy
8 weeks
26
management of an acute biologic infusion reaction
decrease infusion rate, give APAP/benadryl, steroids
27
management of delayed biologic infusion reaction
APAP, symptomatic management
28
anti-TNFs used for IBD
adalimumab, infliximab
29
generic for humira dose form?
adalimumab, SC
30
generic for remicade dose form?
infliximab, IV
31
BBW for anti-TNF
infection, risk for malignancy (higher with AZA)
32
which biologics are tried first in IBD
anti-TNF
33
selective adhesion molecule (integrin) inhibitors used for IBD
natalizumab, vedolizumab
34
generic for tysabri dose form?
natalizumab, IV
35
generic for entyvio dose form?
vedolizumab, IV
36
BBW for natalizumab (tysabri)
PML (has REMS)
37
IL inhibitors used for IBD
usetkinumab, risankizumab, mirikizumab
38
generic for stelara dose form?
usetkinumab IV then SC
39
generic for skyrizi dose form?
risankizumab IV then SC
40
generic for omvoh dose form?
mirikizumab IV then SC
41
JAK inhibitors used for IBD
tofacitinib, upacitinib
42
generic for xeljanz dose form?
tofacitinib PO
43
generic for rinvoq dose form?
upacitinib PO
44
S1P receptor modulators used for IBD
ozanimod, etrasimod
45
BBW for JAK inhibitors Rinvoq and Xeljanz
cancer, CV events/death, embolism, infection, mortality
46
FDA labeling on JAK inhibitors Xeljanz and Rinvoq
use if failed anti-TNF therapy
47
generic for zeposia dose form?
ozanimod PO
48
generic for velsipity dose form?
etrasimod PO
49
contraindications to S1P receptor modulators (ozanimod & etrasmiod)
CAD, stroke, NYHA III and IV HF
50
what to use to treat mild to moderate CROHNS
PO budesonide x 8 weeks
51
what to use to treat moderate to severe CROHNS (2 options)
PO systemic steroid (high dose prednisone) or biologic (TNFa) +/- AZA
52
what to use to treat severe to fulminant CROHNS (1st then if that fails? other option)
IV steroids x 3 days if fails --> IV infliximab surgery
53
what to use to treat perianal disease in CROHNS (fissures, fistulas)
antibiotics, infliximab
54
how to treat remissive CROHNS induced by budesonide
AZA
55
how to treat remissive CROHNS induced by a biologic
biologic +/- AZA
56
how to treat remissive CROHNS induced by systemic steroids
AZA or biologic (more likely)
57
how to treat mild distal RECTAL UC
suppository 5-ASA +/- PO 5-ASA
58
how to treat mild distal LEFT SIDED UC
enema 5-ASA
59
how to treat mild distal UC if failed other options?
add PO budesonide
60
how to treat mild extensive UC
PO 5-ASA +/- budesonide
61
treatment options for moderate to severe UC (3 options)
budesonide x 8 weeks prednisone QD (high dose) biologic +/- AZA
62
treatment options for fulminant UC
IV steroid x 3 days IV infliximab IV cyclosporine colectomy
63
how to treat moderate, severe, or fulminant remissive UC induced by STEROIDS
AZA
64
how to treat moderate, severe, or fulminant remissive UC induced by BIOLOGICS
biologic +/- AZA
65
how to treat moderate, severe, or fulminant remissive UC induced by CYCLOSPORINE
AZA or vedolizumab
66
how to treat mild remissive UC
topical or PO 5-ASA
67
which form(s) of IBD can adalimumab (humira) be used for
BOTH UC and CD
68
which form(s) of IBD can infliximab (remicade) be used for
BOTH UC and CD
69
which form(s) of IBD can natalizumab (tysabri) be used for
CD
70
which form(s) of IBD can vedolizumab (entyvio) be used for
BOTH UC and CD
71
which form(s) of IBD can usetkinumab (stelara) be used for
BOTH UC and CD
72
which form(s) of IBD can risankizumab (skyrizi) be used for
CD
73
which form(s) of IBD can mirikizumab (omvoh) be used for
UC
74
which form(s) of IBD can tofacitinib (xeljanz) be used for
UC
75
which form(s) of IBD can upacitinib (rinvoq) be used for
BOTH UC and CD
76
which form(s) of IBD can ozanimod (zeposia) and etrasimod (velsipity) be used for
UC
77
primary determinant of ascites
abdominal paracentesis with SAAG >= 1 g/dL
78
which electrolyte should be restricted for ascites
Na to 2g/day
79
which diuretics should be used for ascites? what doses?
furosemide and spironolactone following 40:100 mg dosing
80
what medication can be added if diuresis for ascites is not being tolerated (low BP)
midodrine
81
alternative to medication for ascites if it is not tolerated
large volume paracentesis
82
should IV albumin be given with large volume paracentesis for ascites
yes is pulling >5L of fluid
83
last line option for ascites if refractory
TIPS
84
primary AE of TIPS
hepatic encephalopathy
85
diagnosis of portal hypertension
presence of varices on EGD SAAG >= 1.1 g/dL
86
what is the primary complication of portal hypertension
variceal bleeding
87
treatment for portal hypertension
beta blockers propranolol, nadolol, carvedilol
88
when can beta blockers for portal hypertension be initiated
if varices are present
89
when should beta blocker doses for portal hypertension be held or lowered
SBP <90 or DBP <60, HR <60, HRS, refractory ascites, SBP
90
what is the HR goal with beta blocker therapy for portal hypertension
~60 BPM
91
somatostatin analogue initiated for acute variceal bleeding
octreotide
92
rubberbanding of a bleeding vessel
endoscopic variceal ligation (EVL)
93
SBP prophylaxis regimen for acute variceal bleeding
7 days of 3rd gen cephalosporin ceftriaxone
94
last line option for refractory variceal bleeding
TIPS
95
what should be initiated when a variceal bleed stops
non-selective beta blocker
96
what is used to diagnose SBP
absolute PMN >= 250 /mm3
97
treatment regimen for active SBP infection
3rd gen cephalosporin for 5 days cefotaxime, ceftriaxone alternative- ciprofloxacin
98
should IV albumin be used for SBP
if SCr >1, BUN >30, or bilirubin >4 mg/dL
99
when should SBP prophylaxis be used
acute variceal bleeding history of SBP ascitic protein <1.5 g/dL + 1 other criteria
100
SBP prophylaxis regimens for history or low ascitic protein
indefinite ciprofloxacin 250-500 mg QD Bactrim DS 1 tab QD
101
primary treatment and prevention option for hepatic encephalopathy and route of admin
lactulose PO if tolerated Retention enema if not
102
add on therapy for hepatic encephalopathy
xifaxin
103
what PKPD change occurs with decreased liver blood flow in cirrhosis
drugs with high first pass effects have increased systemic concentrations
104
what PKPD changes occur with loss of hepatocyte function in cirrhosis
phase I metabolism affected drugs with CYP dependent metabolism have increased therapeutic effect
105
what PKPD changes occur with decreased albumin in cirrhosis
for heavily protein bound drugs, there is more unbound drug with more therapeutic effect
106
what happens with renal function in cirrhosis
declines in setting of increased SCr
107
what PKPD change occurs due to increased BBB permeability in cirrhosis
increased therapeutic response of drugs that cross

Therapeutics (34 decks)

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