IBD related Facts@ Flashcards
AZO 5-ASAs (Sulfasal,balsal) have greatest effect where?
The colon
Which ASAs start release in TI?
Asacol, Lialda, Delzicol, Apriso
WHat is best predictor of pouchitis after IPAA?
NSAID use
Other predictors of pouchitis?
Indet colitis, extenisve dz, pANCA+, PSC, preop extraintestinal dz
TNF induced psoriasis tx?
Topical CCS, cont TNF initially and see if can control
How to regress colonic dysplasia in IBD pts?
No known way - if confirmed at repeat chromo need colectomy
What is the goal 6-TG for AZA tx?
> 235
What is the standard goal AZA dose?
2-3 mg/kg/day
T/F: Demyelinating disease is a contraindication to anti-TNF tx in IBD pts.
true - can worsen disease and sxs
Which SEs are caused by 6TG and 6MMP and which are not related to either?
6TG - myelosuppression
6MMP - hepatotoxicity
Neither - AP, lymphona, skin CA
What is the MOA of golimumab?
Anti TNFa
Bile acid diarrhea MOA? What would stool osm gap be?
Secretory diarrhea - osm gap < 50
At what week range should anti-TNF tx be stopped in pregnancy?
Weeks 24-32
IBD pts tend to get mono, pauci, or polyarticular dz?
Pauci-articular (<5 jts)
Which skin condition in IBD tends to parallel dz activity?
EN
Which skin condition in IBD tends to have +pathergy?
Pyoderma gangrenosum
Which eye condition in IBD tends to affect visual acuity?
Uveitis more so than episcleritis
What are vaccine recs in babies delivered to IBD pt on anti-TNF?
Delay live vaccines 6 months, otherwise give vaccines normally
What is the risk of teduglutide?
Inc risk of colon polyps
What causes D-lactic acidosis?
CHO mal-assimilation - needs colon in continuity with SI to get this
What leads to Ca oxalate stones in IBD?
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
What is the principal regulator of iron homeostasis?
Hepcidin
How does hepcidin work?
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
Name features of acute colon inflammation.
LP edema, vasc congestion, acute inflamm cells, cryptitis/abscesses, goblet cell depletion
Name features of chronic colon inflammation.
Distal colon paneth cells, LCs and plasma cells in crypts, crypt dropout
What is the effect of high TPMT level?
tend to have more 6MMP which can lead to HPTox
What is the effect of low TPMT level?
Tend to have more cytopenias and BM suppression
What should be done if considering AZA and high TPMT
Either switch to MTX or add allopurinol
sulfasalazine SEs
headaches, nausea (due to sulfa portion)
name the azo-bonded 5ASAs and where do they have effect?
Sulfasal, olsalazine, balsalazide -effects in the colon
name the pH dependent 5ASAs and where do they have effect?
Delzicol, Azacol, Apriso, Lialda - effect starts in TI - release when pH at 6-7
Which 2 5-ASAs have the most even distribution of drug in colon?
Lialda and Apriso
T/F: Oral + rectal mesalamine superior to oral alone in induction of remission as well as MOR in left sided and pan-UC pts.
True
Name RFs for pouchitis in UC pt with pouch.
Postop NSAID use, indet colitis, extensive colonic dz with backwash ileitis, pANCA+, PSC, preop EI manifestations
T/F: Tobacco use is a RF for post op pouchitis.
False - it may be protective
Which type of IBD is more genetic?
Crohns
T/F: Sulfasalazine can lead to male and female infertility.
False, male only- affects sperm but not female fertility
T/F: Mothers on AZA during pregnancy and breast feeding do not need to have kids on alternate vaccine schedule.
True
HST pneumonitis AW what drug?
MTX
Pt with latent TB and want to start anti TNF. What needs to happen first?
Tx with 1 month of INH and vit B6 with plan for 9 month course
Which IBD EIMs are not related to dz activity?
AS, PSC, and uveitis
