IBD - Therapy - Pharma

Question 1

describe the changes that need to occure in the diet of someone with IBD

Answer 1

low residue (fibre) diet
elemental diet (e.g. Modulen)
strict gut rest (e.g, parenteral nutrition)

Question 2

steroid suffix

Answer 2

• one

Question 3

RECALL

MOA differences between NSAID + Steroids

Answer 3

Question 4

RECALL

EFFECTS ON THE BODY NSAIDs + steroids

Answer 4

Question 5

steroids side effects

Answer 5

Question 6

when are steroids used in IBD? + name of commonest used

Answer 6

used as a bridge to mainenace therapy OR step up if changing treatment

+ rapid induction of remission of acute flares

NOT a LT maintenance therapy

METHYLPREDNISOLONE

Accrete D3 for bone protection while taking steroids

Systemic anti-inflammatory properties
**Methylprednisolone / Hydrocortisone: intravenous
IV requires in-patient admission for 5 days then oral switch
**Prednisolone: **oral / topical
Outpatient therapy
Budesonide: oral / topical
Outpatient therapy

Question 7

THERPEUTIC pyramid of IBD

Answer 7

Question 8

which class of drugs from the therpeutic pyramid in IBD is ONLY used for UC

Answer 8

5-ASA, 5-Aminosalicylic acids

Question 9

which class of drugs from the therpeutic pyramid in IBD are NOT used in Crohns

Answer 9

5-ASA, 5-Aminosalicylic acids

Question 10

5- ASA MOA + side effects + what do you need to monitor when you administer

5-Aminosalicylic acids

Only used in ulcerative colitis
Topical effect

Answer 10

**Anti-inflammatory properties
**decreases cyclooxygenase & lipoxygenase pathways
reduces formation of pro-inflammatory prostaglandin and leukotriene molecules

Side effects:
diarrhoea, idiosyncratic nephritis

monitor:
Renal function monitoring

Reduces risk of colon cancer

Question 11

main 5-ASA used + others

Answer 11

Mezavant / Mesalazine

Question 12

What do I need to know about Thiopurine metabolism? (AZA / 6-MP/MTX)

Answer 12

METABOLISM of 6-mp has 2 routes
1. active pathway, suppressing the immune systep to help cntrol IBD, but also suppresses bone marrow (g-TGN metabolite)

2. inactive pathway - metabolites not working against IBD

balance is key, too many/too few 6-TGN

TEST AGAINST tpmt enzyme activity to help presidt how well you will tolerate the drug

Question 13

aza + 6mp side effects + what you need to monitor

Answer 13

pancreatitis
leucopenia
hepatitis
skin cancer / lymphoma

monitor: FBC / LFTs

Question 14

name 2 anti-TNFa therapies

Answer 14

infliximab
adalimumab

rescue therapy in acute in patient presentations
maintenacne therapy

Question 15

name a rescue therapy in acute in patient presentations in both UC + Crohns

also can be used for
maintenacne therapy

Answer 15

anti-TNFa

Question 16

side effects of anti-TNFa

Answer 16

cancer : lymphoma + solid tumors

reactivation of TB

BBV

demyelination reaction

Question 17

name biologics licensed for both UC + Crohns

Answer 17

JAK inhibitors
tablet, quick acting

Question 18

what do you need to monitor with JAKi

Answer 18

Monitor
CVS risk (lipid profile)
Thromboembolic events (DVT/PE)
Infections (Herpes zoster)
Teratogenicity
Renal / liver / FBC monitoring