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Board Review > IBDFC > Flashcards

IBDFC Flashcards

1
Q

Inflammatory Bowel Disease pathophysiology and types

A

Group of inflammatory conditions of the colon and small intestine
Ulcerative colitis and Crohn’s disease

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2
Q

sx of ibd

A

Symptoms: cramping, bloody diarrhea, fever, weight loss; Crohn’s can also cause malabsorption and anal fissures

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3
Q

tx of ibd

A

Treatment goals is to suppress inflammation to reduce Symptoms

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4
Q

food triggers of ibd

A

Food triggers include beans, alcohol, lactosecontaining dairy products, cabbage, broccoli. NOT MEAT

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5
Q

Ulcerative Colitis (UC) def

A

Mucosal inflammation confined to the rectum and colon with superficial ulcerations

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6
Q

sx of UC

A

Symptoms: abdominal cramping, frequent bowel movements, weight loss, fever, tachycardia

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7
Q

Crohn’s Disease (CD) def

A

Transmural inflammation of the GI tract that can affect any part (from mouth to anus), although 2/3 of cases are in the ileum
bowel wall injury is extensive and the intestinal lumen is often narrowed

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8
Q

sx of croh’s

A

Symptoms: abdominal pain, frequent bowel movements, weight loss/malnutrition, malaise

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9
Q

tx of UC

A

Treatment
Antispasmodics my be useful in Mild UC (dicyclomine)
with acute flareups of either condition, short courses of oral or IV steroids are used
with more moderate Symptoms, aminosalicylates (sulfasalazine or mesalamine) are used to control inflammation

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10
Q

crohns tx

A

Crohn’s , in moderatesevere cases, may require a stronger immunosuppresive agent (thioprine, 6MP, methotrexate)

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11
Q

severe UC or crohns tx

A

In severe UC or Crohn’s cases TNFblockers (infliximab) may be needed

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12
Q

Antidiarrheals & Antispasmodic

A

Antidiarrheals: loperamide (Imodium), bismuth subsalicylate (PeptoBismol, BSS), diphenoxylate/atropine (Lomotil)
Antispasmodic: dicyclomine (Benyl)

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13
Q

when to use antidiarrheals and antispasmotides in IBD

A

used for Mild symptom control: diarrhea, cramping/GI spasms

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14
Q

Loperamide (Imodium) MOA

A

antidiarrheal moa unkonw

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15
Q

CI loperamide

A

CI: abdominal pain without diarrhea; children 2 days

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16
Q

SE loperamide

A

SE: abdominal cramping, constipation, nausea

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17
Q

dose loperamide for IBD

A

Dose: 4 mg after first loose stool, then 2 mg after each subsequent stool (Max: 16 mg/day)

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18
Q

Bismuth Subsalicylate (PeptoBismol, BBS) USE

A

antidiarrheal

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19
Q

ci of pepto

A

CI: children with viral infections due to risk of Reye’s; salicylate allergy; history of severe GI bleed or coagulopathy

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20
Q

se of pepto

A

SE: black tongue/stool, hearing loss, tinnitus (toxicity(

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21
Q

dose of pepto

A

Dose: 2 tbsp or 2 tabs every 3060 minutes (Max 8 doses/day & 2 days of therapy)

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22
Q

Diphenoxylate/Atropine (Lomotil) USE

A

antidiarrheal

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23
Q

CI of lomotil

A

CI: children < 2; C. diff.; obstructive jundice

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24
Q

se of lomotil

A

SE: sedation, constipation, urinary retention, tachycardia, blurred vision, xerostomia, dizziness, depression

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25
Q

dose of lomotil for ibd

A

Dose: 5 mg QID (Max 20 mg/day)

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26
Q

Dicyclomine (Bentyl) USE

A

Antispasmodic

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27
Q

CI of dicyclomine

A

CI: GI obstruction; severe ulcerative colitis; reflux esophagitis; narrowangle glucoma; myasthenia gravis; infants <6 months

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28
Q

se of dicyclomine

A

SE: (anticholinergic) dry mouth, blurry vision, urinary retention, constipation, dizziness, lightheadedness, drowsiness, xerostomia, confusion, tachycardia

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29
Q

dose of dicyclomine

A

Dose: 1020 mg QID (Max 160 mg/day)

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30
Q

when to take dicyclomine

A

Take 3060 minutes before meals

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31
Q

Steroids

A

Prednisone, budesonide (Entocort EC)

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32
Q

when to use steriuds for iBD

A

used to decrease severity of acute attack (use until acute flares resolve or weight is regained)

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33
Q

short term se of steroids

A

SE (shortterm): increased appetite/weight gain, fluid retention, emotional instability, insomnia, GI upset

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34
Q

longerm se of steroids

A

SE (longterm): adrenal suppression/Cushing’s syndrome, impaired wound healing, HTN, hyperglycemia, cataracts, osteoporosis

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35
Q

which steroid undergoes much first pass metabolism

A

Budesonide: undergoes extensive firstpass metabolism so lower systemic exposure; do not crush tablet; is preferred agent if disease is in ileum or ascending colon; 3A4 substrate. less side effects but less effective than prednisone. use for 8 weeks for active tx.

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36
Q

Maintenance Therapy for IBD

A

Aminosalicylates: mesalamine, 5ASA, sulfasalazine
Immunosuppressive Agents: azathioprine, 6mercaptopurine, methotrexate
Monoclonal antibodies to TNF: infliximab, certolizumab, adalimumab, natalizumab

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37
Q

moa mesalamine

A

aminosalicilate

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38
Q

Mesalamine brands and formulations

A

Asacol, Pentasa, Lialda, Canasa (suppository), Rowasa (enema)

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39
Q

mesalalamine

A

SE: headache GI upset, loss of appetitie, N/V/D, photosensitivity > 10% chance of rash.

40
Q

mx for mesalamine

A

Monitor: renal function, CBC, Symptoms of IBD

41
Q

what meds to avoid with mesalamine

A

Best to avoid concomittant use with antiacids, H2RAs, or PPIs

42
Q

whu use mesalamine over sulfasalazine

A

Better tolerated that sulfasalazine

43
Q

can you crush or chew mesalamine?

A

Swallow caps whole

44
Q

Sulfasalazine brands

A

Azulfidine, SulfazinAzulfidine ENtabs

45
Q

ci of sulfasalazine

A

CI: sulfa or salicylate allergy; GI or GU obstruction

46
Q

se of sulfasalazine

A

SE: headache, rash, anorexia, dyspepsia, GI upset, oligosperia, folate deficiency; arthalgia, crystalluria can cause skin/urine to turn yelloworange

47
Q

mx for sulfasalazine

A

Monitor: CBC, LFTs, Symptoms of IBD

48
Q

Azathioprine brand

A

Azasan, Imuran

49
Q

bbw of azathioprine

A

BBW: chronic immunospuppresion can increase risk of neoplasia; hematologic toxicities and mutagenic potential

50
Q

se of azathioprine

A

SE: GI upset, rash, increase LFTs, hematologic toxicities

51
Q

mx azathioprine

A

Monitor: LFTs, CBC, renal function

52
Q

what deficiency is important in azathioprine

A

Genetic deficiency of thiopurine methytransferase (TPMT) will be more sensitive to myelosupprssive effects

53
Q

6Mercaptopure

A

Purinethol

54
Q

6MP bbw

A

BBW: chronic immunospuppresion can increase risk of neoplasia; hematologic toxicities and mutagenic potential

55
Q

se of 6mp

A

SE: GI upset, rash, increase LFTs, hematologic toxicities

56
Q

mx 6mp

A

Monitor: LFTs, CBC, renal function

57
Q

deficiency important in 6mp

A

Genetic deficiency of thiopurine methytransferase (TPMT) will be more sensitive to myelosupprssive effects

58
Q

Methotrexate brand

A

Rheumatrex, Trexall

59
Q

mtx bbw

A

BBW: renal; pneumonitis; bone marrow suppression; mucositis/stomatitis; dermatologic reactions

60
Q

ci of mtx

A

CI: pregnancy; alcoholism; chronic liver disease; blood dyscrasias

61
Q

se of mtx

A

SE: nausea, diarrhea, mucositis/stomatitis, skin reactions

62
Q

mx of mtx

A

Monitor: CBC, LFTs, renal function

63
Q

antidote of mtx

A

Antidote: leucovorin or levoleucovorin

64
Q

Infliximab brand

A

Remicade

65
Q

MOA of infliximab

A

CHIMERIC monoclonal antibody to TNF (adlimubam and azathioprine are fully HUMANIZED so less antibody production)

66
Q

bbw of infliximab

A

BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy

67
Q

ci of infliximab

A

CI: doses >5mg/kg in moderatesevere HF

68
Q

warnings of infliximab

A

Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections

69
Q

se of infliximab

A

SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis

70
Q

mx of infliximab

A

Monitor: vitals, TB test, S&S of infection, CBC, LFTs, HBV, HF, malignancies

71
Q

how to infuse infliximab

A

Should be infused within 3 hours of reconstitution; 2 hour infusion (requires a filter) (IV only)

72
Q

Certolizumab brand

A

Cimzia

73
Q

moa of certolizumab

A

PEGlinked HUMANIZED Monoclonal antibody to TNF

74
Q

bbw of certolizumab

A

BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy

75
Q

warnings of certolizumab

A

Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections

76
Q

se of certolizumab

A

SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis

77
Q

how to take certolizumab

A

Inject SQ into the abdomen or thigh

78
Q

how to store certolizumab

A

Vials refrigerated; reconstituted vial are good for 24 hours in refrigerator or 2 hours at room temp

79
Q

Adalimumab

A

Humira

80
Q

moa adalimumab

A

HUMANIZED Monoclonal antibody to TNF

81
Q

bbw adalimumab

A

BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy

82
Q

warning of adalimumab

A

Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections

83
Q

se of adalimumab

A

SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis

84
Q

mx of adalimumab

A

Monitor: vitals, TB test, S&S of infection, CBC, LFTs, HBV, HF, malignancies

85
Q

how to take adalimumab

A

Inject SQ into the abdomen or thigh

86
Q

how to store adalimumab

A

Store in refrigerator until use

87
Q

Natalizumab brand

A

Tysabri

88
Q

moa of natalizumab

A

HUMANIZED Monoclonal antibody that inhibits alpha4integrin

89
Q

bbw natalizumab

A

BBW: risk for progressive mulifocal leukoencephalopathy (PML)

90
Q

warning natalizumab

A

Warnings: hepatotoxicity, infection

91
Q

when to dc if nor response natalizumab

A

Discontinue if no response by week 12

92
Q

program to be enrolled in for natalizumab

A

Must be enrolled in manufacturer TOUCH prescribing programming

93
Q

when to administer natalizumab

A

Must be administered within 8 hours of preparation

94
Q

first line for ulcerative colitis

A

enema or rectal mesalamine suppositites for mild/mod dz

95
Q

what type of mesalamine for chron’s?

A

ORAL therapy with mesalamine or sulfasalizine

96
Q

mesalamaine rectal suspension is called

A

rowasa. store at room temp. therapy can be up to 6 weeks. may have a sulfite. state if sulfa allergy. administer at night since enema once daily.

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