IBD - Crohns and UC Drugs

Question 1

What are the 4 main drug therapy types for IBD

Answer 1

1. Aminosalicylates (ASAs)
2. Corticosteroids
3. Immunosuppressants
4. Biological therapy = Monoclonal antibodies

Question 2

What type of drug is Mesalazine

Answer 2

Aminosalycate (ASA)

Question 3

What type of drug is Prednisolone

Answer 3

Corticosteroid

Question 4

What type of drug is Hydrocortisone

Answer 4

Corticosteroid

Question 5

What type of drug is Azathioprine

Answer 5

Thiopurine -Immunosuppressant

Question 6

What type of drug is Ciclosporin

Answer 6

Immunosuppressant

Question 7

What type of drug is Infliximab

Answer 7

Bio therapy / monoc. antibody

Question 8

What type of drug is Adalimumab

Answer 8

Bio therapy / monoc. antibody

Question 9

What is first line therapy in Ulcerative Colitis?

Answer 9

ASAs

Question 10

What type of drug is Sulfasalazine

Answer 10

ASA

Question 11

What are side affects of sulfasalazine (6)

Answer 11

Allergy - (may mimic hepatitis) Rash, fever, leucopenia, agranulocytosis, male infertility, orange secretions

Question 12

Asacol, Pentasa, Mezavant are brand names of what type of drug

Answer 12

Mesalazine - ASAs

Question 13

S/E of most ASAs (minimal) (4)

Answer 13

Diarrhoea
Headache
Rash
Nausea

Question 14

Which type of steroid (Glucocortico or Mineralocortico) is anti-inflammatory and immunosuppressive? Name an example from the body

Answer 14

Glucocorticoid eg Cortisone / Hydrocortisone

Question 15

Which type of steroid affects water & electroylte balance - give an eg from the body

Answer 15

Mineralocorticoid eg Aldosterone

Question 16

Which type of steroid affects protien and carboyhydrate metabolism - give an eg from the body

Answer 16

Glucocorticoid eg Cortisone / Hydrocortisone

Question 17

Why is osteoporosis a SE of steroid use (2)

Answer 17

Reduces Ca++ and Vit D absorb

Inhibits osteoblasts

Question 18

What would you give with steroids to protect bones (2)

Answer 18

Bisphosphonates

Ca++ and Vit D

Question 19

Why should you monitor for infection in steroid use

Answer 19

It is immunosuppressive

Question 20

Why should you not stop steroid therapy immediately

Answer 20

The body stops producing its own steroids so need to taper off dose to allow body to restart prod steroids.

Question 21

3 examples of oral corticosteroids

Answer 21

Prednisolone
Budesonide
Beclometasone

Question 22

1 example of IV steroid

Answer 22

Hydrocortisone (“hydro” goes in fluid)

Question 23

2 examples of Topical steroids

Answer 23

Hydrocortisone

Prednisolone

Question 24

What form could topical steroids be given in (3)

Answer 24

Suppositories, foam, liquid enema

Question 25

Are ASAs good for UC, Crohns or both?

Answer 25

UC only - no evidence for CD

Question 26

Are corticosteroids used for UC, CD or both, and what stage of the treatment pathway would you use them for?

Answer 26

Both - only to induce remission, not for long term maintenance

Question 27

What are Thiopurines give 2 examples

Answer 27

Immunosuppressive drugs 1. Azathioprine 2. 6-mercaptopurine

Question 28

Are Thiopurines good for UC CD or both

Answer 28

Both

Question 29

When would you use Thiopurines

Answer 29

After relapse | Post-ciclosporin to induce remission in severe UC

Question 30

What is a side effect of azathioprine ( apart from allergy) (3)

Answer 30

Leukopenia (low WBCs) Bone marrow suppression Hepatotoxicity

Question 31

What are 3 main types of immunosuppressants for IBD

Answer 31

1. Thiopurines (Azathioprine) 2. Ciclosporin 3. Methotrexate

Question 32

Is Ciclosporin good for UC, CD or both

Answer 32

UC (Ciclo - colo only)

Question 33

Is Ciclosporin a CYP450 inhibitor or inducer

Answer 33

Inhibitor

Question 34

Why does ciclosporin interact with erythromycin

Answer 34

Ciclosporin is metabolised by CYP450, Erythromycin is a CYP450 inhibitor, so it will incr the plasma levels of Ciclosporin

Question 35

Why does Rifampicin interact with Ciclosporin

Answer 35

Rifampicin is a CYP450 inducer - will increase the metabolism of Ciclosporin by the enzyme so red. the plasma levels of Ciclosporin (make it less effective)

Question 36

What drug causes these side effects: Hypertension Infection Renal impair Gum hypertrophy & hirsuitism Siezures (with hypocholest. or hypomagnes.)

Answer 36

Ciclosporin

Question 37

Is methotrexate good for UC CD or both

Answer 37

Crohns only

Question 38

How does methotrx work

Answer 38

Inhibits cytokine & eicosanoid synthesis

Question 39

SE of what drug: GI irrit, Naus,vom diarrhoea Hepatotoxicity Blood dyscrasias (disorders) Drops folate

Answer 39

Methotrexate

Question 40

What do you give 2-3 days after methotrexate

Answer 40

Folic acid 5mg

Question 41

Should methotrexate ever be given daily

Answer 41

NO - once weekly only

Question 42

Biological therapy / Monoclonal antibodies - give 2 egs

Answer 42

Infliximab | Adalimumab

Question 43

Is infliximab good for CD UC or both - and when?

Answer 43

Both - CD if severe, not responsive to treatment and surgery not appropriate UC - If Ciclosporin contraind.

Question 44

Why might infliximab cause allergy

Answer 44

It is part based on human antibody tissue

Question 45

What might infliximab re-activate in some (older) patients

Answer 45

TB - do a TB screen first

Question 46

Is Adalimumab good for CD UC or both

Answer 46

CD only

Question 47

What is the mech of action of infliximab and adalimumab

Answer 47

Inhibit TNF alpha cytokine

Question 48

What would be a treatment pathway for active UC (3)

Answer 48

1. 5-ASA + corticosteroid 2. Ciclosporin / Infliximab 3. Colectomy

Question 49

What would be a treatment pathway for active CD (2)

Answer 49

1. Corticosteroid | 2. Azathioprine / Infliximab