IBD Treatment Flashcards
List specific goals of IBD therapy
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
Describe the purpose of induction therapy
Rapidly induce a treatment response and achieve clinical remission.
What drugs can be used for IBD induction therapy
Aminosalycilates Antibiotics Corticosteroids Immunomodulators Anti-TNF Agents
What is the purpose of IBD maintenance therapy?
prevent relapses and maintains patients in clinical remission
meds have slower onset of action
also called corticosteroid sparing therapy
List drug options for maintenance therapy
Aminosalycilates
Immunomodulators
Anti-TNF Agents
Differentiate between mild, moderate, and severe fulminant Crohn disease
- 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
Differentiate between mild, moderate, severe, and fulminant ulcerative colitis
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
What is the mechanism of action of aminosalicylates?
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
What uses are appropriate for aminosalicylates?
induction and maintenance of mild to moderate UC and CD
________ are also effective in treated rheumatoid arthritis
Aminosalicylates
What are side effects of aminosalicylates?
headache, nausea
List two immunomodulators that are used to treat IBD
azothioprine, methotrexate
What is the mechanism of action of azothioprine?
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
What are appropriate uses of azothioprine?
Maintenance therapy for moderate UC and CD
What are side effects of azothioprine?
pancreatitis, increased LFTs, bone marrow suppression
What is the mechanism of action of methotrexate?
folate analog that interferes with DNA synthesis
At low doses, apoptosis of activated T-cells is one potential mechanism for immunomodulatory effects
What are appropriate uses of methotrexate?
Maintenance therapy of moderate Crohn disease
What are side effects of methotrexate therapy?
liver toxicity, bone marrow suppression, pulmonary toxicity
contraindicated in pregnancy
________ is contraindicated in pregnancy due to possibility of congenital malformations, growth retaration
Methotrexate
______ is a drug that is only used as maintenance therapy for Crohn disease
Methotrexate
What are “biologics” that are used to treat IBD?
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
List classes of drugs that are considered biologics
TNF inhibitors
anti-adhesion drugs
List four TNF inhibitors
infliximab, adalimumab, golilumab, certolizumab
What is the mechanism of action of TNF inhibitors?
bind to TNF and inhibit activity resulting in reduced inflammation
What are appropriate uses of TNF inhibitors?
Induction and maintenance for severe UC and CD
What are side effects of TNF inhibitors?
Reactivation of latent TB, HBV
List two anti-adhesion drugs
natalizumab and vedolizumab
What is the mechanism of action of anti-adhesion drugs?
binding to integrin (VCAM1) subunits and affecting leukocyte trafficking.
By inhibiting leukocyte trafficking it blocks inflammatory cells from entering the intestine and decreasing inflammation
_______ works in both the CNS and GI system, where as _________ works only in the GI system
natalizumab, vedolizumab
What are appropriate uses of anti-adhesion therapy?
Maintenance for severe CD and UC
What are side effects of natalizumab?
CNS infects- risk of progressive multifocal leukoencephalopathy (demyelination with reactivation of JC virus)
What are side effects of vedolizumab?
nasopharyngitis
NO risk for PML
What is the mechanism of action of steroids
decrease inflammation by inhibiting arachidonic acid and cytokine release, inhibition chemotaxis and phagocytosis
What are appropriate uses of steroids in IBD?
Induction therapy for UC and CD
NOT for maintenance therapy
What are side effects of steroids?
hyperglycemia, acne, insomnia, anxiety, cataracts, osteoporosis
The highest likelihood for surgery for CD is in patients with _______
ileocolitis
_________ surgeries are preferred over resection whenever possible in Crohn disease
small bowel sparing
What is the advantage of strictureplasty in Crohn disease management?
can open up short, tight areas without removing any small bowel
For colonic involvement in Crohn disease, ________ is removed surgically
only the affected area
In ulcerative colitis, _______ is removed surgically
the entire colon- even if disease is limited to only one part of the colon
What are indications for total colectomy in UC?
toxic megacolon perforation chronic anemia severe fatigue severe hemorrrhage lack of response to therapy cancer
In UC, total colectomy is ______ for all intestinal aspects of the disease
curative
Patients with _____ after total colectomy usually have good control over defecation
ileoanal reservoir (pouch)
