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MEDICATION > IBD Treatments > Flashcards

IBD Treatments Flashcards

1
Q

Treatment of ulcerative colitis

A

5-ASA, steroids, azathioprine/6-mercaptopurine, cyclosporine, infliximab, surgery - curative

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2
Q

Treatment of Crohns

A

5-ASA, steroids, azothioprine/6-mercaptopurine, methotrexate, infliximab, non-curative surgery

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3
Q

Which drug is the first line in treatment of UC to induce and maintain remission and prevent colonic cancer?

A

ASA’s ie mesalazine (minimal use in Crohn’s)

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4
Q

Mechanism of action of ASA’s?

A

Anti-inflammatory, anti-folate (inhibit synthesis of inflammatory mediators like prostaglandins, thromboxane, platelet activating factor), scavenger of oxygen radicals

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5
Q

Which was the first ASA on the market?

A

Sulfasalazine

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6
Q

SE’s of sulfasalazine?

A

Rash fever, leucopenia, agranulocytosis, male infertility, male infertility, orange discolouration of bodily fluids

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7
Q

What is the commonest ASA used? Name 2 others

A

Mesalazine - use orally or topically. Others include olsalazine and balsalazide

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8
Q

SE’s of ASA’s?

A

Diarrhoea, headache, nausea, rash, monitor renal function

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9
Q

What does corticosteroids do in IBD?

A

Induces remission, potent anti-inflammatory

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10
Q

What effects does ACTH have?

A

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

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11
Q

Prescribing issues with corticosteroids?

A

Not for long term use, do not stop suddenly, give bone protection (calcium and bisphosphanates)

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12
Q

Examples of corticosteroids?

A

Prednisolone, budesonide, beclometasone, hydrocortisone (IV), hydro and pred can be used topically

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13
Q

Immunosuppressants used in IBD (3)?

A

Azothioprine, ciclosporin, methotrexate

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14
Q

Examples of thiopurines?

A

Azothioprine, 6-mecraptopurine

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15
Q

When are thiopurines used?

A

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

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16
Q

What is azothioprine metabolised to?

A

6-mercaptopurine which can be used on its own to avoid some of the side-effects. Is also steroid-sparing

17
Q

SE’s of thiopurines?

A

Allergic, bone marrow suppression, leukopenia, hepatotoxicity

18
Q

What metabolises thiopurines and why is this relevant?

A

Thiopurine methyltransferase (TPMT). TPMT deficiency patients at higher risk of bone marrow suppression

19
Q

What does ciclosporin do?

A

Calcinuerin inhibitor (prevents expansion of T-cell subsets)

20
Q

Which condition is ciclosporin used in?

A

Ulcerative Colitis

21
Q

When would you consider colectomy?

A

If no response to IV steroid after colitis

22
Q

How would you prescribe ciclosporin?

A

2mg/kg daily IV or 5-6mg/kg daily PO

23
Q

SE’s of ciclosporin?

A

HT, infection renal impairment, increase risk of seizures if IV, if they have low cholesterol or magnesium; gum hypertrophy and hirsuitism

24
Q

How does methotrexate work?

A

Anti-inflammatory; inhibits cytokine and eicosanoid synthesis. Induces and maintains remission in CROHN’S disease. 2nd line immunosuppressive after AZA

25
Q

SE’s of methotrexate?

A

GI - nausea, vomiting, diarrhoea (give folic acid weekly), hepatotoxicity, blood dyscrasias

26
Q

How is methotrexate given?

A

Weekly 2.5mg tablets. Can be given IM or SC as more effective but oral more convenient. Monitor LFT’s and FBC

27
Q

What does infliximab do

A

Chimeric anti-tnF antibody, targets membrane-bound TNF and kills host cell by complement induced lysis, ant-inflammatory

28
Q

Indications for infliximab?

A

Severe active crohn’s or where ciclosporin cannot be used in UC

29
Q

How would you prescribe infliximab?

A

IV, 5mg/kg in 250ml normal saline over 2hrs, weeks 0, 2 and 6, then every 8 weeks.

30
Q

SE’s of infliximab?

A

Delayed hypersensitivity, chest infections

31
Q

MoA of adalimumab?

A

Targets TNF-alpha

32
Q

Indications for adalimumab?

A

Severe active crohn’s disease

33
Q

How is adalimumab given?

A

Subcut 80mg to 40mg

34
Q

Which antibiotics would you use for infectious complications?

A

Metronidazole or ciprofloxacin

35
Q

Indications for metronidazole and ciprofloxacin in IBD?

A

Infectious complications, perianal CD, prevention of postoperative recurrence of CD, pouchitis in UC

36
Q

Treatment in active ulcerative colitis?

A

5-ASA and corticosteroids, then ciclosporin and inliximab, then colectomy

37
Q

Maintenance treatment in UC?

A

5-ASA and azathiprine if needed

38
Q

Treatment in active crohn’s?

A

Corticosteroids, then azathioprine and monoclonal antibodies

39
Q

Maintenance treatment in Crohn’s?

A

Azathioprine, methotrexate and monoclonal antibodies if all else fails

MEDICATION (13 decks)

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