IBD therapy

Question 1

What do all IBD therapies have?

Answer 1

anti inflammatory effect

Question 2

What are the therapy options for UC?

Answer 2

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

Question 3

What are the therapy options for Crohn’s?

Answer 3

Steroids
Immunosuppressants
Anti-TNF therapy
Smoking Cessation

Question 4

What are the side effects of 5ASA?

Answer 4

diarrhoea

idiosyncratic nephritis

Question 5

What is the mechanism of action of oral 5ASAs?

Answer 5

Anti-inflammatory effects
Prodrugs
pH dependent release
delayed release

Question 6

What characteristics of topical 5ASAs?

Answer 6

suppositories - inserted into anus

enemas

Question 7

What are some forms of 5ASAs?

Answer 7

Sulphasalazine (sulphapyridine/5-ASA)
Balsalazide (5-ASA inert carrier)
Mezavant (5-ASA matrix carrier)
Mesalazine
pH release (Asacol)
Delayed release (Pentasa)

Question 8

How does 5ASA topical medication work for enemas?

Answer 8

Reflex contraction aids proximal spread of foam or liquid enemas

Question 9

How does 5ASA topical medication work for suppositories?

Answer 9

Suppositories coat 
<20cm, but have better mucosal adherence than enemas

Question 10

Name some corticosteroids used to treat IBD?

Answer 10

oral Prednisolone

topical Budesonide

Question 11

What is the role of corticosteroids in IBD?

Answer 11

Systemic anti-inflammatory properties
to induce remission
short course
high dose initially, reducing over 6 - 8 weeks

Question 12

What are the side effects of steroids?

Answer 12

Musculoskeletal
- Avascular necrosis
- Osteoporosis
Gastrointestinal
Cutaneous
- Acne
- Thinning of skin
Metabolic
- Weight gain
- Diabetes
- hypertension
Neuropsychiatric
Cataracts
Growth failure

Question 13

When is immunosupression used in UC?

Answer 13

steroid-sparing agents

Question 14

When is immunosupression used in Crohn’s?

Answer 14

maintenance therapy

Question 15

Give an example of an immunosuppresive drug?

Answer 15

azathioprine / mercaptopurine

methotrexate

Question 16

What are the characteristics of Azathioprine?

Answer 16

Slow onset of action (16 weeks)
TPMT activity contributes to toxicity
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required

Question 17

What are the side effects of Azathioprine?

Answer 17

Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer

Question 18

What is Tumour Necrosis Factor alpha(TNF)?

Answer 18

pro-inflammatory cytokine

Question 19

Name some anti-TNFalpha drugs? and their characteristics?

Answer 19

chimeric (infliximab; IV infusion)
humanised (adalimumab; S/C injection)

Promote apoptosis of activated T- lymphocytes
Rapid onset of action

Question 20

What are possible negative outcomes of anti TNFalphas?

Answer 20

infusion reactions
infection
Cancer: 
- Lymphoma
- Solid tumours

Question 21

When are anti-TNF alphas used in IBD?

Answer 21

as part of long term strategy 
immune suppression
Crohns surgery 
supportive therapy
refractory / fistulising disease
(exclude current infection / TB)

Question 22

What are biosimilar anti TNFs?

Answer 22

Produced by different company once drug patent expired
Infliximab/Remicade biosimilars:
‘Inflectra’ , ‘Remsima’ now approved for use
1/3 of the cost of Infliximab

Question 23

When is emergency surgery indicated in IBD?

Answer 23

Failure to respond to medical therapy
small bowel obstruction
abscess
fistulae

Question 24

When is elective surgery indicated in IBD?

Answer 24

Failure to respond to medical therapy

Dysplasia of colon mucosa

Question 25

Is surgery for Crohn’s curative or not?

Answer 25

NOT

Question 26

Is surgery for UC curative or not?

Answer 26

Curative
Option of permanent ileostomy
OR
Restorative proctocoloectomy and pouch