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GI_EB > IBD Treatment > Flashcards

IBD Treatment Flashcards

1
Q

List specific goals of IBD therapy

A

a. Establishing and maintaining symptom control (clinical remission)
b. Controlling inflammation
c. Prevent flare-ups of disease (maintain remission)
d. Reducing complications
e. Reducing the need for surgery
f. Improving quality of life
g. In children facilitating normal growth

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2
Q

Describe the purpose of induction therapy

A

Rapidly induce a treatment response and achieve clinical remission.

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3
Q

What drugs can be used for IBD induction therapy

A 
Aminosalycilates
Antibiotics
Corticosteroids
Immunomodulators
Anti-TNF Agents
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4
Q

What is the purpose of IBD maintenance therapy?

A

prevent relapses and maintains patients in clinical remission
meds have slower onset of action
also called corticosteroid sparing therapy

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5
Q

List drug options for maintenance therapy

A

Aminosalycilates
Immunomodulators
Anti-TNF Agents

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6
Q

Differentiate between mild, moderate, and severe fulminant Crohn disease

A
  • Mild to moderate: patient is ambulatory and able to eat and drink without weight loss, high fever, painful masses, or obstruction
  • moderate to severe: either not responding to treatment or more pronounced symptoms- fever, weight loss, abdominal pain, significant anemia, NV
  • severe fulminant: failure of outpatient steroids or persistent vomiting, intestinal obstruction, cachexia, rebound tenderness, abscess
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7
Q

Differentiate between mild, moderate, severe, and fulminant ulcerative colitis

A

mild: fewer than four stools daily +/- blood, minimal signs of toxicity, normal ESR
moderate: more than four stools/ day but minimal signs of toxicity
severe: more than 6 bloody stools daily and evidence of fever, tachycardia, anemia, elevated ESR
fulminant: >10 stools per day, continuous bleeding, abdominal distention, colonic dilation, need for blood transfusion

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8
Q

What is the mechanism of action of aminosalicylates?

A

Split into active mesalamine form by bacteria in the colon

possible mechanism: interruption of the lipoxygenase and cyclooxygenase pathways, decreased production of IL-1, IL-2, and TNF in the colonic mucosa

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9
Q

What uses are appropriate for aminosalicylates?

A

induction and maintenance of mild to moderate UC and CD

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10
Q

________ are also effective in treated rheumatoid arthritis

A

Aminosalicylates

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11
Q

What are side effects of aminosalicylates?

A

headache, nausea

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12
Q

List two immunomodulators that are used to treat IBD

A

azothioprine, methotrexate

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13
Q

What is the mechanism of action of azothioprine?

A

These are purine analogs that become incorporated into DNA and inhibit DNA synthesis.
They interfere with nucleic acid metabolism and cell growth and exert cytotoxic effects
on lymphoid cells

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14
Q

What are appropriate uses of azothioprine?

A

Maintenance therapy for moderate UC and CD

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15
Q

What are side effects of azothioprine?

A

pancreatitis, increased LFTs, bone marrow suppression

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16
Q

What is the mechanism of action of methotrexate?

A

folate analog that interferes with DNA synthesis

At low doses, apoptosis of activated T-cells is one potential mechanism for immunomodulatory effects

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17
Q

What are appropriate uses of methotrexate?

A

Maintenance therapy of moderate Crohn disease

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18
Q

What are side effects of methotrexate therapy?

A

liver toxicity, bone marrow suppression, pulmonary toxicity

contraindicated in pregnancy

19
Q

________ is contraindicated in pregnancy due to possibility of congenital malformations, growth retaration

A

Methotrexate

20
Q

______ is a drug that is only used as maintenance therapy for Crohn disease

A

Methotrexate

21
Q

What are “biologics” that are used to treat IBD?

A

genetically engineered medications made from living organisms and their products, such as proteins, genes, and antibodies

Interfere with inflammation by targeting specific molecules such as cytokines so have only selective immune suppression

22
Q

List classes of drugs that are considered biologics

A

TNF inhibitors

anti-adhesion drugs

23
Q

List four TNF inhibitors

A

infliximab, adalimumab, golilumab, certolizumab

24
Q

What is the mechanism of action of TNF inhibitors?

A

bind to TNF and inhibit activity resulting in reduced inflammation

25
Q

What are appropriate uses of TNF inhibitors?

A

Induction and maintenance for severe UC and CD

26
Q

What are side effects of TNF inhibitors?

A

Reactivation of latent TB, HBV

27
Q

List two anti-adhesion drugs

A

natalizumab and vedolizumab

28
Q

What is the mechanism of action of anti-adhesion drugs?

A

binding to integrin (VCAM1) subunits and affecting leukocyte trafficking.
By inhibiting leukocyte trafficking it blocks inflammatory cells from entering the intestine and decreasing inflammation

29
Q

_______ works in both the CNS and GI system, where as _________ works only in the GI system

A

natalizumab, vedolizumab

30
Q

What are appropriate uses of anti-adhesion therapy?

A

Maintenance for severe CD and UC

31
Q

What are side effects of natalizumab?

A

CNS infects- risk of progressive multifocal leukoencephalopathy (demyelination with reactivation of JC virus)

32
Q

What are side effects of vedolizumab?

A

nasopharyngitis

NO risk for PML

33
Q

What is the mechanism of action of steroids

A

decrease inflammation by inhibiting arachidonic acid and cytokine release, inhibition chemotaxis and phagocytosis

34
Q

What are appropriate uses of steroids in IBD?

A

Induction therapy for UC and CD

NOT for maintenance therapy

35
Q

What are side effects of steroids?

A

hyperglycemia, acne, insomnia, anxiety, cataracts, osteoporosis

36
Q

The highest likelihood for surgery for CD is in patients with _______

A

ileocolitis

37
Q

_________ surgeries are preferred over resection whenever possible in Crohn disease

A

small bowel sparing

38
Q

What is the advantage of strictureplasty in Crohn disease management?

A

can open up short, tight areas without removing any small bowel

39
Q

For colonic involvement in Crohn disease, ________ is removed surgically

A

only the affected area

40
Q

In ulcerative colitis, _______ is removed surgically

A

the entire colon- even if disease is limited to only one part of the colon

41
Q

What are indications for total colectomy in UC?

A 
toxic megacolon
perforation
chronic anemia
severe fatigue 
severe hemorrrhage
lack of response to therapy
cancer
42
Q

In UC, total colectomy is ______ for all intestinal aspects of the disease

A

curative

43
Q

Patients with _____ after total colectomy usually have good control over defecation

A

ileoanal reservoir (pouch)

GI_EB (39 decks)

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