IBD Treatments Flashcards
Treatment of ulcerative colitis
5-ASA, steroids, azathioprine/6-mercaptopurine, cyclosporine, infliximab, surgery - curative
Treatment of Crohns
5-ASA, steroids, azothioprine/6-mercaptopurine, methotrexate, infliximab, non-curative surgery
Which drug is the first line in treatment of UC to induce and maintain remission and prevent colonic cancer?
ASA’s ie mesalazine (minimal use in Crohn’s)
Mechanism of action of ASA’s?
Anti-inflammatory, anti-folate (inhibit synthesis of inflammatory mediators like prostaglandins, thromboxane, platelet activating factor), scavenger of oxygen radicals
Which was the first ASA on the market?
Sulfasalazine
SE’s of sulfasalazine?
Rash fever, leucopenia, agranulocytosis, male infertility, male infertility, orange discolouration of bodily fluids
What is the commonest ASA used? Name 2 others
Mesalazine - use orally or topically. Others include olsalazine and balsalazide
SE’s of ASA’s?
Diarrhoea, headache, nausea, rash, monitor renal function
What does corticosteroids do in IBD?
Induces remission, potent anti-inflammatory
What effects does ACTH have?
Affects water and electrolyte balance via mineralocorticoids. Affects protein and carb metabolism via glucocorticoid function (anti-inflammatory and immunosuppressive). Inactivates NF-KB and AP-1; prevents stimulation of prostaglandins, leukotrienes, cytokines, platelet activating factor
Prescribing issues with corticosteroids?
Not for long term use, do not stop suddenly, give bone protection (calcium and bisphosphanates)
Examples of corticosteroids?
Prednisolone, budesonide, beclometasone, hydrocortisone (IV), hydro and pred can be used topically
Immunosuppressants used in IBD (3)?
Azothioprine, ciclosporin, methotrexate
Examples of thiopurines?
Azothioprine, 6-mecraptopurine
When are thiopurines used?
When 5-ASA not well tolerated; in severe relapsing disease; when 2 or more corticosteroid treatments were need in 12 months or relapsing disease below 15mg steroid or within 6 months of stopping steroid, following ciclosporin
What is azothioprine metabolised to?
6-mercaptopurine which can be used on its own to avoid some of the side-effects. Is also steroid-sparing
SE’s of thiopurines?
Allergic, bone marrow suppression, leukopenia, hepatotoxicity
What metabolises thiopurines and why is this relevant?
Thiopurine methyltransferase (TPMT). TPMT deficiency patients at higher risk of bone marrow suppression
What does ciclosporin do?
Calcinuerin inhibitor (prevents expansion of T-cell subsets)
Which condition is ciclosporin used in?
Ulcerative Colitis
When would you consider colectomy?
If no response to IV steroid after colitis
How would you prescribe ciclosporin?
2mg/kg daily IV or 5-6mg/kg daily PO
SE’s of ciclosporin?
HT, infection renal impairment, increase risk of seizures if IV, if they have low cholesterol or magnesium; gum hypertrophy and hirsuitism
How does methotrexate work?
Anti-inflammatory; inhibits cytokine and eicosanoid synthesis. Induces and maintains remission in CROHN’S disease. 2nd line immunosuppressive after AZA
SE’s of methotrexate?
GI - nausea, vomiting, diarrhoea (give folic acid weekly), hepatotoxicity, blood dyscrasias
How is methotrexate given?
Weekly 2.5mg tablets. Can be given IM or SC as more effective but oral more convenient. Monitor LFT’s and FBC
What does infliximab do
Chimeric anti-tnF antibody, targets membrane-bound TNF and kills host cell by complement induced lysis, ant-inflammatory
Indications for infliximab?
Severe active crohn’s or where ciclosporin cannot be used in UC
How would you prescribe infliximab?
IV, 5mg/kg in 250ml normal saline over 2hrs, weeks 0, 2 and 6, then every 8 weeks.
SE’s of infliximab?
Delayed hypersensitivity, chest infections
MoA of adalimumab?
Targets TNF-alpha
Indications for adalimumab?
Severe active crohn’s disease
How is adalimumab given?
Subcut 80mg to 40mg
Which antibiotics would you use for infectious complications?
Metronidazole or ciprofloxacin
Indications for metronidazole and ciprofloxacin in IBD?
Infectious complications, perianal CD, prevention of postoperative recurrence of CD, pouchitis in UC
Treatment in active ulcerative colitis?
5-ASA and corticosteroids, then ciclosporin and inliximab, then colectomy
Maintenance treatment in UC?
5-ASA and azathiprine if needed
Treatment in active crohn’s?
Corticosteroids, then azathioprine and monoclonal antibodies
Maintenance treatment in Crohn’s?
Azathioprine, methotrexate and monoclonal antibodies if all else fails
