Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

604 > IBD (UC/Crohns) > Flashcards

IBD (UC/Crohns) Flashcards

1
Q

IBD Definition

A

Chronic inflammatory disease of GI tract
- edema, ulceration, tissue destruction
Relapsing/remitting nature
- flare tx
- maintenance tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

IBD presentation

A

Diarrhea
Blood in stool
Abdominal pain
Cramping
Weight loss
Fatigue
Change in daily activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosing IBD

A

Symptoms - pt age 15-30
Labs
- increased ESR and CRP (nonspecific inflammatory)
Stool studies
- increased WBC (lactoferrin, calprotectin)
Endoscopy - colonoscopy
CT scans and MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ulcerative colitis

A

starts in rectum, spreads upwards
Proctitis = rectum only
Left sided/distal = rectum + sigmoid + descending
Extensive: past the splenic flexure
Confined to mucosa (superficial)
Continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Crohn’s disease

A

Mouth to anus, terimnal ileum especially
Deep penetration
patchy, cobblestone
Perianal involvement (fistulas and fissures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Compications of Crohn’s disease

A

Malnutrition
Vitamin deficiency
Strictures
Fistulas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of Ulcerative Colitis

A

Toxic megacolon/sepsis
Colon cancer
Colectomy (curative)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Crohn’s disease classification

A

Remission
Mild-moderate
Moderate-severe
Severe-fulminant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CD: remission

A

Asymptomatic, no sequelae, CDAI<150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CD: remission treatment

A

Flares: perianal fissures
- Antibiotics (Flagyl TID or Cipro BID)
- surgery
- infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CD: mild-mod

A

CDAI 150-200
no fever
significant pain/obstruction
less than 10% weight loss
some diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CD: mild-mod treatment

A

Local steroid: PO budesonide (Entocort) x 8 weeks

IF COLONIC involvement –> Sulfasalazine (5-ASA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CD: mod-severe

A

CDAI 220-450
failed mild-mod tx
FEVER >38F
weight loss more than 10%
abdominal pain
NV, no obstruction
ANEMIA (low hgb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CD: mod-severe treatment

A

when Budesonide fail after 2-4 weeks
-> Systemic oral GC + AZA
- PO prednisone + AZA

OR
Biologic therapy + AZA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CD: Severe-Fulminant

A

CDAI > 450
Persistent sx despite mod-severe tx
OFTEN needs to be in HOSPITAL
HIGH fever >39F
PERSISTENT N/V
Cachexia - can’t eat
Intestinal ABCESSES
SEVERE abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CD: severe-Fulminant

A

SURGERY - resect disease/obstruction

  • IV steroids (hydrocortisone, methylprednisolone)

OR

  • IV infliximab

+ supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Maintenance therapy for Crohn’s disease

A

If used steroid –> give AZA for remission
If used biologic –> give biologic + AZA
if Perianal disease: abx, surgery, infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

UC: remission

A

Asymptomatic
Formed stools (not diarrhea)
NO blood
Hbg normal
Normal ESR and CRP
Fecal calprotectin 100-200

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

UC: mild treatment

A

Distal disease
1) Active (combo of ASA is best)
»Topical 5-ASA mesalamine (rectum = suppository; left sided = enema)
»Oral 5ASA
2) Maintenance:
»Topical 5ASA & PO 5ASA

Extensive (entire GI)
1) Active:
»PO 5ASA +/- Budesonide (uceris) x 8 weeks
2) Maintenance
»PO 5ASA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

UC: mild

A

<4 stools/day
intermittend blood in stool
Hgb normal
ESR normal
CRP ELEVATED
FP ELEVATED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

UC: mod-severe

A

> 6 stools/day
FREQUENT blood
Hgb<75% of normal
ELEVATED
- ESR
- CRP
- FP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

UC: mod-severe treatment

A

Active
1) Local steroid: Budesonide (Uceris) +/- AZA x 8 weeks
2) Systemic steroid: Prednisone 40-60 mg +/- AZA
3) Biologic: Infliximab +/- AZA

Maintenance
- if used steroid: AZA
- if used biologic: same biologic +/- AZA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

UC: fulminant

A

> 10 stools/day
CONTINUOUS blood
hgb < 8 (pt needs transfusion)
ELEVATED
- ESR/CRP/FP

24
Q

UC: fulminant treatment

A

Active
1) IV steroids x 3 days (hydrocortisone/methylprednisolone)
2) IV infliximab (UC only)
3) IV cyclosporine

Surgery - colectomy

Maintenance
- Steroid: AZA
- Biologic: same biologic +/- AZA
- Cyclosporine: AZA or vedolizumab

25
Q

5-ASA drugs

A

Sulfasalazine - sulfa carrier
Mesalamine
Olsalazine
Balsalazide - inert carrier

26
Q

Mesalamine forms

A

Pentasa - wide GI coverage
Rowasa and Canasa - Rectal
Used more for ulcerative colitis (lower colonic)

27
Q

Immunomodulator drugs

A

Maintain remission
Azathioprine -workhorse
6-mercaptopurine
Methotrexate - crohns only (IM/SQ =>PO)
Cyclosporine - fulminant UC

28
Q

Azathioprine (AZA)

A

prodrug m6p
Takes 3 months to work
Steroid sparing (use less steroid)
Improve biologic efficacy (decrease ADA)

29
Q

Azathioprine (AZA) monitoring

A

CBC Q 3 months
LFT - hepatotoxicity
Pancreatic enzymes - pancreatitis

30
Q

Azathioprine (AZA) BBW

A

Lymphoma risk
Increased risk w/ biologic therapy use

31
Q

Corticosteroids

A

Induction therapy
Predisone = PO
Methylpred, HC = IV
Budesonide = PO (CD maintenance)
- Enterocort = CD; terminal ileum
- Uceris = UC; colon

32
Q

CD: enteric gram-negative/anaerobe abx

A

Metronidazole
Ciprofloxacin
3rd gen cephalosporins

33
Q

Infliximab

A

Remicade
IV = infusion center

34
Q

Adalimumab

A

Humira
SQ, use at home, better QoL

35
Q

Biologic drugs

A

Infliximab IV
Adalimumab SQ
Certolizumab
Golimumab

36
Q

Biologic drug BBW

A

Infections (TB, fungal, bacteria, viral, etc)
PPD, chest X-ray, screen for HBV, HCV, HIV at baseline
Malignancies - lymphoma

37
Q

Integrin inhibitors

A

Natalizumab
Vedolizumab

38
Q

Natalizumab BBW

A

progressive multifocal leukoencephelopathy w/ reactivation of john cunningham virus

REMS program

39
Q

interleukin inhibitors

A

Ustekinumab (IL12, IL23) - stelara
Risankizumab (IL23) - skyrizi

40
Q

non- biologics

A

Tofacitinib PO (JAKi)
Upadacitinib PO (JAKi)
Ozanimod PO (S1P)
Limited to TNFa failure

41
Q

Jak inhibitor BBW

A

Cancer
Cardiac (MACE)
thrombosis
infections
death

42
Q

Infusion-related reactions

A

IV products
- Methylprednisolone, hydrocortisone - both
- Infliximab - both
- Cyclosporine - full UC

43
Q

SQ better QoL

A

Adalimumab - Both
Certolizumab - CD
Golimumab - UC

44
Q

Which 5ASA also used for CD, what kind?

A

Sulfasalazine for colonic involvement

45
Q

Methotrexate and tacrolimus used in which IBD?

A

Crohns

46
Q

What are metronidazole and Cipro for in IBD?

A

CD fissure/fistulas
use with infliximab and surgery

47
Q

How long for budesonide to work?

A

2-4 weeks

48
Q

How long is budesonide therapy?

A

PO, 8 weeks

49
Q

Jak stat inhibitors are used in which IBD?

A

Ulcerative colitis

50
Q

Vedolizumab: what class and indication?

A

Integrin inhibitor, for ulcerative colitis maintenance after induction with cyclosporine

51
Q

When do we not use AZA for active UC?

A

Active fulminant
- use IV steroids x3 days, IV infliximab, IV cyclosporine
or surgery

52
Q

When do we not use AZA for active CD?

A

Mild-moderate cases
Severe-fulminant cases
- IV steroids, IV infliximab
or surgery

53
Q

5ASA MOA

A

acts topically to reduce inflammation (PG) locally
Decreases PG, LT, lipoxygenase, NFkB

54
Q

Pentsa (mesalamine)

A

PO jejunum

55
Q

Canasa (mesalamine)

A

Suppository, rectum

56
Q

Rowasa (mesalamine)

A

Enema, rectal + distal

57
Q

Comparing 5ASA options

A

Mesalamine: many doses
Sulfasalazine: cheap, lots of ADR
Osalazine: diarrhea, less frequent BID
Balsalazide: better tolerated, TID

604 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions