IBD Part 3 - Management Approach Flashcards

1
Q

IBD

Goals for Treatment:

A
Active Disease
              |
              |     Induce remission
              |     Prevent Complications
              |
             V
Disease in Remission
              |
             V 
  Maintain remission          
  Prevent relapse
  Prevent complications
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2
Q

Simplified approach to stepwise treatment of IBD

A
Surgery
                 ^
          Biologics
                 ^
     Immunomodulators
                  ^
Prednisone      Budesonide
                  ^
     5-ASA       Anatibotics
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3
Q

see slide 6

A

see slide 6

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4
Q

Approach now is “Treat to Target” especially

for CD:

A

§ Combination in improvement in:
• clinical symptoms and
• endoscopic findings.

§ Can use biomarkers such as ESR, CRP (C-reactive protein), fecal calprotectin

§ The goal is “mucosal healing”

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5
Q

Clinicians’ guide to the use of fecal calprotectin to identify and monitor disease activity in inflammatory bowel disease

A

see slide 8

< 50-100 ug/g quiescent disease likely –> cont tx

100-250: inflamm possible, further testing

> 250: active inflamm likely –> optimaize tjherapy to address inflamm

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6
Q

Disease Classification of UC

A

see slide 9

Mild disease:
  < 4 stools per day
  \+/- blood in stools
  no systemic symptoms
  no increase ESR
Moderate:
  4 - 6 stools per day
  \+/- blood in stools
  no systemic symptoms
  no increase in ESR
Severe:
  > 6 stools per day
  \+ blood
 systemic symptoms
 increase in ESR
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7
Q

Partial Mayo Scoring Index Assessment for Ulcerative Colitis Activity

A

see slide 10

stool freqency

rectal bleeding

physician global assessment (normal, mild, moderate, severe)

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8
Q

Management of UC

A

See Figure 1 Management of UC

Mild to mod –> start with oral aminosalic_+/- topicals

No response add budesonide

More mod or severe start predisione

taper
§ If proctitis or distal colitis: For mild to moderate disease consider rectal products as first choice (either
aminosalicylate or corticosteroid rectal products)
• If moderate to severe, could use rectal products in combination with oral.

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9
Q

Disease Classification of CD

A

Mild to Moderate:
• ambulatory patients able to tolerate oral
• none of the following: dehydration, high fever, abdominal tenderness, painful mass or >10% weight loss

Moderate-Severe Disease:
• failed to respond to treatment for mild-moderate disease or
• fever, weight loss, abdominal pain, N, V, or anemia

Severe-Fulminant Disease:
• persistent symptoms despite steroids as outpatient or
• high fever, persistent vomiting, intestinal obstruction, rebound tenderness, cachexia, or evidence of abscess.

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10
Q

Harvey-Bradshaw Index (HBI) - A simple index of Crohn’s disease activity

A

see slide 14

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11
Q

Management of CD

A

See Figure 2 Management of CD

Consider:
DIFFERENCE aminosalicylates dont work as well in CD compared to UD

May need oral budesonide

Immunosppressants used as maintenance therapy more

§ Antibiotics for patients with primarily perianal or colonic involvement, or patients with fistulas

§ Anti-TNF therapy can be considered to treat patients with fistulas who do not respond to standard therapy.

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12
Q

Nutrition Management

A

Malnutrition may be common (25 – 80%):
- decreased intake and malabsorption

Nutrition support is important – to meet nutrition requirements and prevent nutrient deficiencies:

  • avoid foods that worsen symptoms (ie spicy, high fat foods, caffeine, etc)
  • patients at risk for osteoporosis – ensure calcium and Vitamin D
  • multivitamins

Bowel rest may be required in acute situations:

  • Oral enteral nutrition
  • Total parenteral nutrition (IV) to meet nutritional requirements - may induce short-term remission in CD

Fish oils:

  • some benefit
  • short chain fatty acids

Probiotics:

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13
Q

In the last couple of days Nancy has had a fever (38.4C) and has been unable to keep anything down because of nausea.
Bowel movements now are at 10 or so a day. Nancy is
classified to have severe Crohn’s disease and is admitted to hospital. You are the pharmacist working on the GI unit.

What would you recommend as drug treatment for Nancy?

A

???

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14
Q

Monitoring IBD

Efficacy parameters:

A

§ Improvement in symptoms – diarrhea, abdominal pain,
blood in stools, etc

§ Improvement in extra-intestinal symptoms

§ Signs of anemia – ie Hgb, symptoms (fatigue, etc)

§ ESR, CRP, fecal calprotectin

§ No complications from disease

§ Prevention of relapse

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