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Clinical > IBD Therapy > Flashcards

IBD Therapy Flashcards

1
Q

Use of 5-ASA (Aminosalicylic acid) in UC?

A

Anti-inflammatory properties

Reduces risk of colon cancer

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2
Q

Side effects of 5-ASA?

A

Diarrhoea

Idiosyncratic nephritis

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3
Q

Caution with 5-ASA use?

A

Must check renal function before commencement

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4
Q

Oral version of 5-ASA and examples?

A

Pro-drugs
pH dependent release
Delayed release

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5
Q

Topical versions of 5-ASA?

A

Suppositories

Enemas

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6
Q

Examples of 5-ASA conjugate drugs?

A

Sulphasalazine - produces metabolites of sulphapyridine and 5-ASA
Balsalazide (inert carrier of 5-ASA)
Mezavant
Mesalazine

Asacol (pH release)
Pentasa (delayed release)

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7
Q

Where does pentasa release 5-ASA?

A

Entirety of small and large intestine

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8
Q

Where does asacol release 5-ASA?

A

Ileum and colon

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9
Q

Where does balsalazide release 5-ASA?

A

Colon

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10
Q

Where does salazopyrin release 5-ASA?

A

Colon

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11
Q

When and why are suppositories used in treatment of UC?

A

Coat

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12
Q

How is the suppository spread in the bowel?

A

Reflex contraction aids proximal spread of the foam or liquid enema

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13
Q

Why is foam enema preferred?

A

There is less of a need to go to the bathroom after and so patients can hold the drug for longer

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14
Q

Why are steroids used in treatment of UC and Crohn’s?

A

Systemic anti-inflammatory properties

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15
Q

How are steroids used to induce remission?

A

Begin with a high dose but reduce it over a 6-8 week period; they are used as a “bridge” to maintenance therapy

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16
Q

What is steroid dependence?

A

Sometimes, people will be removed from steroids and have a subsequent flare in there symptoms

17
Q

What are the side effects of steroids?

A

Musculoskeletal - avascular necrosis, osteoporosois

GI - nausea, vomiting, GI bleeding and gastritis (begin patient on a PPI)

Cutaneous - acne, thin skin

Metabolic - weight gain, diabetes, hypertension

Neuropsychiatric (manic and then, when removed from steroids, depression)

Cataracts

Growth failure, in children

18
Q

Mechanism of action of azathioprine?

A

Azathioprine (AKA 6-MP) is a purine analogue and interferes with DNA synthesis of T and B lymphocytes

19
Q

Metabolism of azathioprine?

A

TPMT (thiopurine methyltransferase) - metabolises 6-MP to 6-MMP

Xanthine oxidase - metabolises 6-MP to 6-TU

HPRT (hypoxanthine phosphoribyl transferase) - metabolises 6-MP to 6-TGN, which is active and has a therapeutic effect

20
Q

Why are changes in TPMT levels important/dangerous?

A

There are different forms that can be low, moderate or high metabolisers

Somebody who is homo/heterozygous for the low metaboliser should not use azathioprine, as these people are at great risk of developing life-threatening bone marrow toxicity with normal doses of azathioprine or mercaptopurine

21
Q

Onset of action of azathioprine?

A

Slow onset of action (16 weeks)

22
Q

Cautions with azathioprine use?

A

Avoid co-prescription of allopurinol (xanthine oxidase inhibitor)

Regular blood monitoring required

23
Q

Side effects of azathioprine use?

A

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma and skin cancer

24
Q

How do T cells exit the circulation?

A

MadCAM-1 on endothelium

25
Q

What is anti-TNF therapy and mechanism of action?

A

Antibodies that have been generated to prevent effects of TNF-alpha (pro-inflammatory cytokine) by promoting apoptosis of activated T-cells

26
Q

Types of anti-TNF therapy?

A

Chimeric (part mouse and part human antibodies)

Humanised (fully human antibodies)

27
Q

Onset of action of anti-TNF therapy?

A

Rapid

28
Q

Duration of remission with anti-TNF therapy?

A

8-12 weeks but this is maintained with re-treatment

29
Q

Side effects of anti-TNF therapy?

A

Lymphoma
Solid tumours
Demyelinating disease
Development of antibodies against anti-TNF antibodies

30
Q

How is anti-TNF therapy used in IBD?

A

As part of a long-term strategy, inc. immune suppression, surgery (in Crohn’s) and supportive therapy

In refractory/fistulating disease

31
Q

Cautions with anti-TNF therapy?

A

Exclude current infections by looking for abscesses

Ensure there has been no exposure to TB, as TNF (gIFN and IL-12 network) is important in preventing reactivation of latent TB

32
Q

Different versions of anti-TNFs?

A

Inflectra and Remsima

Clinical (54 decks)

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