IBD therapy Flashcards
What do all IBD therapies have?
anti inflammatory effect
What are the therapy options for UC?
5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy
What are the therapy options for Crohn’s?
Steroids
Immunosuppressants
Anti-TNF therapy
Smoking Cessation
What are the side effects of 5ASA?
diarrhoea
idiosyncratic nephritis
What is the mechanism of action of oral 5ASAs?
Anti-inflammatory effects
Prodrugs
pH dependent release
delayed release
What characteristics of topical 5ASAs?
suppositories - inserted into anus
enemas
What are some forms of 5ASAs?
Sulphasalazine (sulphapyridine/5-ASA) Balsalazide (5-ASA inert carrier) Mezavant (5-ASA matrix carrier) Mesalazine pH release (Asacol) Delayed release (Pentasa)
How does 5ASA topical medication work for enemas?
Reflex contraction aids proximal spread of foam or liquid enemas
How does 5ASA topical medication work for suppositories?
Suppositories coat <20cm, but have better mucosal adherence than enemas
Name some corticosteroids used to treat IBD?
oral Prednisolone
topical Budesonide
What is the role of corticosteroids in IBD?
Systemic anti-inflammatory properties
to induce remission
short course
high dose initially, reducing over 6 - 8 weeks
What are the side effects of steroids?
Musculoskeletal - Avascular necrosis - Osteoporosis Gastrointestinal Cutaneous - Acne - Thinning of skin Metabolic - Weight gain - Diabetes - hypertension Neuropsychiatric Cataracts Growth failure
When is immunosupression used in UC?
steroid-sparing agents
When is immunosupression used in Crohn’s?
maintenance therapy
Give an example of an immunosuppresive drug?
azathioprine / mercaptopurine
methotrexate
What are the characteristics of Azathioprine?
Slow onset of action (16 weeks)
TPMT activity contributes to toxicity
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required
What are the side effects of Azathioprine?
Pancreatitis
Leucopaenia
Hepatitis
Small risk of lymphoma, skin cancer
What is Tumour Necrosis Factor alpha(TNF)?
pro-inflammatory cytokine
Name some anti-TNFalpha drugs? and their characteristics?
chimeric (infliximab; IV infusion)
humanised (adalimumab; S/C injection)
Promote apoptosis of activated T- lymphocytes
Rapid onset of action
What are possible negative outcomes of anti TNFalphas?
infusion reactions infection Cancer: - Lymphoma - Solid tumours
When are anti-TNF alphas used in IBD?
as part of long term strategy immune suppression Crohns surgery supportive therapy refractory / fistulising disease (exclude current infection / TB)
What are biosimilar anti TNFs?
Produced by different company once drug patent expired
Infliximab/Remicade biosimilars:
‘Inflectra’ , ‘Remsima’ now approved for use
1/3 of the cost of Infliximab
When is emergency surgery indicated in IBD?
Failure to respond to medical therapy
small bowel obstruction
abscess
fistulae
When is elective surgery indicated in IBD?
Failure to respond to medical therapy
Dysplasia of colon mucosa
Is surgery for Crohn’s curative or not?
NOT
Is surgery for UC curative or not?
Curative
Option of permanent ileostomy
OR
Restorative proctocoloectomy and pouch
