IBD Treatment: Crohn's Flashcards
Severity levels of Crohn’s
Remission, mild-moderate, moderate-severe, severe-fulminant
Characteristics of remission
Asymptomatic
Characteristics of mild-moderate Crohn’s
Not in the hospital but not entirely asymptomatic
No fever or abdominal pain/tenderness
No obstructions
Weight loss is <10%
Characteristics of moderate-severe Crohn’s
Failed mild-moderate therapies Fever present >10% weight loss N/V Abdominal pain/tenderness Anemia No obstructions
Characteristics of severe-fulminant Crohn’s
Persistent symptoms despite steroids or biologic therapy
Often need to be treated in the hospital
Active therapy for mild-moderate Crohn’s
PO budesonide for 8 weeks- FIRST LINE!
Sulfasalazine in colonic involvement only
When can you extend budesonide treatment in mild-moderate therapy for Crohn’s
You can extend it for another 8 weeks if the patient improves but the symptoms come back after stopping it
When do you want to see an effect in mild-moderate Crohn’s active therapy?
2-4 weeks
When to use moderate-severe active therapy in Crohn’s
When patient has failed first-line treatment or presents with other symptoms
Active therapy for moderate-severe therapy in Crohn’s
Systemic PO steroid: prednisone
Biologic: INFLIXIMAB IS FIRST LINE (but can move to other biologics)
Can be used with or without azathioprine, methotrexate, or mercaptopurine
Active therapy for severe-fulminant therapy in Crohn’s
Surgery
IV steroids (hydrocortisone, methylprednisolone)
Infliximab (Remicade)
Supportive care (IV fluids, nutrition)
Therapy for perianal disease in Crohn’s
Surgery
ABX- metronidazole and ciprofloxacin +/- 3rd generation cephalosporin
Infliximab
Maintenance therapy for Crohn’s
6-MP/AZA/MTX- FIRST LINE!
Other options for maintenance therapy for Crohn’s
Budesonide can be used for another 3 months for maintenance but no more than 4 months consecutively
Can also continue on whatever biologic the patient was on
What should you not use in Crohn’s maintenance therapy?
5-ASA!
