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Gastro Review > IBD related Facts@ > Flashcards

IBD related Facts@ Flashcards

1
Q

AZO 5-ASAs (Sulfasal,balsal) have greatest effect where?

A

The colon

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2
Q

Which ASAs start release in TI?

A

Asacol, Lialda, Delzicol, Apriso

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3
Q

WHat is best predictor of pouchitis after IPAA?

A

NSAID use

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4
Q

Other predictors of pouchitis?

A

Indet colitis, extenisve dz, pANCA+, PSC, preop extraintestinal dz

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5
Q

TNF induced psoriasis tx?

A

Topical CCS, cont TNF initially and see if can control

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6
Q

How to regress colonic dysplasia in IBD pts?

A

No known way - if confirmed at repeat chromo need colectomy

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7
Q

What is the goal 6-TG for AZA tx?

A

> 235

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8
Q

What is the standard goal AZA dose?

A

2-3 mg/kg/day

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9
Q

T/F: Demyelinating disease is a contraindication to anti-TNF tx in IBD pts.

A

true - can worsen disease and sxs

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10
Q

Which SEs are caused by 6TG and 6MMP and which are not related to either?

A

6TG - myelosuppression
6MMP - hepatotoxicity
Neither - AP, lymphona, skin CA

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11
Q

What is the MOA of golimumab?

A

Anti TNFa

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12
Q

Bile acid diarrhea MOA? What would stool osm gap be?

A

Secretory diarrhea - osm gap < 50

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13
Q

At what week range should anti-TNF tx be stopped in pregnancy?

A

Weeks 24-32

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14
Q

IBD pts tend to get mono, pauci, or polyarticular dz?

A

Pauci-articular (<5 jts)

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15
Q

Which skin condition in IBD tends to parallel dz activity?

A

EN

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16
Q

Which skin condition in IBD tends to have +pathergy?

A

Pyoderma gangrenosum

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17
Q

Which eye condition in IBD tends to affect visual acuity?

A

Uveitis more so than episcleritis

18
Q

What are vaccine recs in babies delivered to IBD pt on anti-TNF?

A

Delay live vaccines 6 months, otherwise give vaccines normally

19
Q

What is the risk of teduglutide?

A

Inc risk of colon polyps

20
Q

What causes D-lactic acidosis?

A

CHO mal-assimilation - needs colon in continuity with SI to get this

21
Q

What leads to Ca oxalate stones in IBD?

A

Fat mal-assimilation - Ca binds to FFA in the gut lumen and so have increase in free oxalate which is absorbed and can form stones

22
Q

What is the principal regulator of iron homeostasis?

A

Hepcidin

23
Q

How does hepcidin work?

A

Decreased hepcidin due to low iron –> better absorption. Inc hepcidin in high iron state –> dec absorption. If inflamed, hepcidin can go up and limit absorption even in low Fe state, so would need Iv replacement

24
Q

Name features of acute colon inflammation.

A

LP edema, vasc congestion, acute inflamm cells, cryptitis/abscesses, goblet cell depletion

25
Q

Name features of chronic colon inflammation.

A

Distal colon paneth cells, LCs and plasma cells in crypts, crypt dropout

26
Q

What is the effect of high TPMT level?

A

tend to have more 6MMP which can lead to HPTox

27
Q

What is the effect of low TPMT level?

A

Tend to have more cytopenias and BM suppression

28
Q

What should be done if considering AZA and high TPMT

A

Either switch to MTX or add allopurinol

29
Q

sulfasalazine SEs

A

headaches, nausea (due to sulfa portion)

30
Q

name the azo-bonded 5ASAs and where do they have effect?

A

Sulfasal, olsalazine, balsalazide -effects in the colon

31
Q

name the pH dependent 5ASAs and where do they have effect?

A

Delzicol, Azacol, Apriso, Lialda - effect starts in TI - release when pH at 6-7

32
Q

Which 2 5-ASAs have the most even distribution of drug in colon?

A

Lialda and Apriso

33
Q

T/F: Oral + rectal mesalamine superior to oral alone in induction of remission as well as MOR in left sided and pan-UC pts.

A

True

34
Q

Name RFs for pouchitis in UC pt with pouch.

A

Postop NSAID use, indet colitis, extensive colonic dz with backwash ileitis, pANCA+, PSC, preop EI manifestations

35
Q

T/F: Tobacco use is a RF for post op pouchitis.

A

False - it may be protective

36
Q

Which type of IBD is more genetic?

A

Crohns

37
Q

T/F: Sulfasalazine can lead to male and female infertility.

A

False, male only- affects sperm but not female fertility

38
Q

T/F: Mothers on AZA during pregnancy and breast feeding do not need to have kids on alternate vaccine schedule.

A

True

39
Q

HST pneumonitis AW what drug?

A

MTX

40
Q

Pt with latent TB and want to start anti TNF. What needs to happen first?

A

Tx with 1 month of INH and vit B6 with plan for 9 month course

41
Q

Which IBD EIMs are not related to dz activity?

A

AS, PSC, and uveitis

Gastro Review (15 decks)

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