IBD/IBS

Question 1

Inflammatory bowl disease

Answer 1

Classification:
1. Amino salicylates
• sulfasalazine
• olsalazine
• Balsalazide

2. Glucocorticoids
   • prednisone
   • hydrocortisone
   • prednisolon
3. Purine analogues
   • azathioprine
4. Methotrexate
5. Anti-tumor necrosis
6. Factor therapy
   • infliximab
   • adalimumab
7. Anti-integrin therapy
   • Natalizumab
8. Surgery

Question 2

Aminosalicylates

Answer 2

• aminosalicylates contain 5 aminosalicylic acid (5-ASA) which reduce inflammation in the lining of intestine
MOA:
• Act on epithelial cells; anti-inflammatory
• modulate release of cytokines
• inhibit production of IL-1 and TNF-a
• scavenger of free radicals and oxidants

-Sulfasalazine
• sulfapyridine + 5-ASA
• 5 -ASA poorly absorbed active moiety

-Indications :
• maintaining remission in UC
• reduce risk of colorectal cancer by 75%
• less effective for maintenance in CD
• inducing remisson in mild UC/CD

-Contraindications:
• 5-ASA : salicylate hypersensitivity
• sulfpyridine :
G6PD deficiency ( haemolysis)
Slow acetylator status ( risk of hepatic and blood disorder )

• Adverse effects
  • Dose related
  Headache, nausea, diarrhoea, epigastric pain

Idiosyncratic:
Blood disorders, skin reactions, steven johnson Syndrome, alopecia

Question 3

Irritable bowl syndrome

Answer 3

Classification of IBS
• IBS with diarrhoea predominance
IBS- D 27%
• alternative IBS
IBS-A 39%
• IBS with constipation predominance
IBS-C 34%

Question 4

IBS drugs

Answer 4

• Diarrhoea
Loperamide
Alosetron

• constipation
Pysllium husk
Methyl cellulose
PEG 3350
Lubiproston
70% sorbitol

• abdominal pain
Smooth muscle relaxant
Tricyclic anti depressant
SSRI