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GI/Rheumatology Module > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is Inflammatory Bowel Disease?

A

Inflammatory condition of the GI tract

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2
Q

What are the 2 primary conditions of IBD?

A
  1. Ulcerative Colitis UC
  2. Crohn’s Disease CD
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3
Q

IBS Irritable Bowel Syndrome does NOT cause inflammatory changes in bowel tissue and therefore?

A

Does NOT increase risk of colorectal cancer

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4
Q

UC is what?

A

MUCOSAL inflammation confined to the rectum and colon

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5
Q

CD is what?

A

TRANSMURAL inflammation affecting anywhere from the mouth to the anus

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6
Q

Between UC and CD, which one is more common?

A

UC

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7
Q

Crohn’s disease, is more common in what gender?

A

Female>Male

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8
Q

Ulcerative Colitis, is more common in what gender?

A

Male>Female

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9
Q

Smoking is seen as what in UC?

A

Smoking = PROTECTIVE
Nicotine patches can be used for symptomatic relief

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10
Q

Smoking is seen as what in CD?

A

Smoking ASSOCIATED with INCREAED frequency of CD

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11
Q

What medications can trigger flares in IBD?

A

NSAIDs

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12
Q

What is the pathophysiology of IBD?

A
  1. Lack of normal regulation of inflammatory cascade
  2. Pro-Inflammatory mediators overpower down-regulation
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13
Q

Abdominal pain is COMMON in which disease?

A

CD
UC-uncommon

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14
Q

Distribution in UC vs CD?

A

UC: continuous
CD: discontinuous

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15
Q

Aphthous or Linear Ulcers are COMMON in what disease?

A

CD
UC - rare

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16
Q

Rectal involvement is COMMON in what disease?

A

UC
CD - rare

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17
Q

Ileal involvement is VERY COMMON in what disease?

A

CD
UC - rare

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18
Q

Strictures, Fistulas, and Transmural Involvement are COMMON in what disease?

A

CD
UC - rare

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19
Q

Crypt Abscesses are VERY COMMON in what disease?

A

UC
CD - rare

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20
Q

Cobblestone Appearance is COMMON in what disease?

A

CD
UC - Absent

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21
Q

What are S/S of UC?

A
  1. Abdominal cramping
  2. Frequent BM +/- blood
  3. Weight loss
  4. Fever and tachycardia
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22
Q

What are the S/S of CD?

A
  1. Malaise and fever
  2. Abdominal pain
  3. Diarrhea
  4. Hematochezia = oozing blood
  5. Weight loss
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23
Q

Acute exacerbations followed by remission or symptom free intervals can be seen with what disease?

A

BOTH UC and CD

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24
Q

What lab results can be seen with both UC and CD?

A

Increased ESR and WBC

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25
What lab results are specific to UC and used to distinguish from CD?
Decreased Hgb/HCt and Albumin
26
What is Proctitis UC?
Localized to the bottom
27
What is Left-Sided Colitis?
Localized to the bottom up to the splenic flexure
28
What is Pancolitis UC?
Extensive to the entire GI
29
70% of CD is found where?
Distal Ileum and Right Colon
30
What is classified as MILD UC?
<4 stools/day (+/-blood) NO systemic complications NORMAL ESR
31
What is classified as MOD UC?
>4 stools/day (+blood) MINIMAL systemic complications
32
What is classified as SEVERE UC?
>6 stools/day (+blood) FEVER, TACHYCARDIA, ANEMIA systemic complications ESR >30
33
What is classified as FULMINANT UC?
>10 stools/day (continuous bleeding) TOXIC vitals/symptoms Abdominal Tenderness, Colonic Dilation NEED TRANSFUSION
34
What is classified as MILD/MOD CD?
Ambulatory NO Alarm Symptoms
35
What are the alarm symptoms of CD?
1. Dehydration 2. Systemic Toxicity 3. Weight Loss 4. Abdominal Tenderness 5. Mass/Obstruction
36
What is classified as MOD/SEVERE CD?
Fever, Weight Loss, Abdominal Pain, Tenderness, Vomiting, Obstruction, or Anemia FAILING to respond to treatment for mild/mod
37
What is classified as SEVERE/FULMINANT CD?
PERSISTANT Symptoms Systemic Toxicity despite outpatient oral corticosteroids SEVERE Weight Loss Rebound tenderness, intestinal obstruction, or abscess
38
What are Non-Pharmacologic Management Options for IBD?
1. Nutrition 2. Surgery
39
What are nutrition considerations for IBD?
1. Patients commonly malnourished 2. Eliminate foods exacerbating conditions
40
Surgery is what in UC and CD?
UC: surgery = CURATIVE --> prophylaxis against cancer CD: surgery = NOT curative
41
What are pharmacologic considerations in IBD?
Active, MD, Supportive, and Adjunctive
42
Agents MODULATE disease process of IBD, NOT Curative and the target is to what?
Relieve Inflammation
43
What dictates the route and formulation of the product picked for therapy?
Location and Severity of Disease
44
What are adjunctive therapies?
1. Antidiarrheals/Antispasmodics 2. Nicotine ONLY in UC
45
What are the 5-Aminosalicyclic Acid drugs?
1. Sulfasalazine 2. Mesalamine 3. Olsalazine 4. Balsalazide
46
What are the considerations of Sulfasalazine?
CI for Sulfa Allergy Improvement takes 4+ weeks
47
What are AEs of Sulfasalazine?
GI upset, aplastic anemia, rash, HA
48
What are counseling points of Sulfasalazine?
Impairs folic acid absorption Take with food
49
What is the indication of Sulfasalazine?
UC and CD Active and MD Dosing
50
What is the SOA of Sulfasalazine?
COLON
51
What are the considerations of Mesalamine?
Alternative to sulfasalazine DDIs: antacids/H2RAs/PPIs
52
Oral vs Topical Mesalamine are used for what?
Oral = Extensive Disease Pancolitis Topical = Distal Disease or Proctitis
53
Mesalamine Cap SOA and Indication
Jejunum, Ileum, Colon UC, CD
54
Mesalamine Suppository SOA and Indication
Rectum UC, reserved Proctitis
55
Mesalamine Enema SOA and Indication
Rectum and Distal Colon UC, Distal Diseases and Proctitis
56
Mesalamine Suppository/Enema may have what effect?
May stain clothing/undergarments
57
Mesalamine Tablet SOA and Indication
Distal Ileum and Colon UC, CD
58
Olsalazine AEs
Significant dose-dependent secretory diarrhea
59
Balsalazide AEs
HA and Abdominal Pain
60
What is the SOA and Indication of Olsalazine and Balsalazide
Colon UC,CD
61
Mesalamine Suppository SOA
Rectum
62
Mesalamine Enema SOA
Distal Colon
63
Corticosteroids MOA
Modulate immune system and inhibit production of cytokines and inflammatory mediators
64
Corticosteroids is used for ACUTE management ONLY, where does each form work?
Rectal = Distal Disease PO = Extensive disease not responding to oral 5-ASA IV = Systemic complications and severe disease
65
What corticosteroid combo is preferred for FIRST line therapy for Mild-Mod CD CONFIDED to the TERMINAL Ileum and/or ASCENDING Colon?
Controlled release BUDESONIDE or a tapering course of PREDNISONE w or without AZATHIOPRINE
66
What corticosteroid therapy is preferred for patients with DIFFUSE diarrhea?
Managed by a tapering course of prednisone with or without azathioprine
67
What is important to note about Corticosteroids?
MUST TAPER after 2 weeks of therapy
68
What are counseling points for corticosteroids?
Take with food, do not stop abruptly
69
Hydrocortisone ENEMA Indication
UC, Proctitis or Distal Disease
70
Prednisone PO Indication
UC, CD 40-60 mg/day
71
Budesonide PO Controlled Release Indication
CD, confined to the ileum and/or right colon
72
Hydrocortisone IV Indication
UC,CD
73
Methylprednisolone IV Indication
UC,CD
74
What is an AE of corticosteroids?
HPA Axis Suppression, increased risk of infection
75
What are the Immunosuppressant indications?
1. Steroid dependent patients 2. Patients not responding to steroids 3. Attaining remission with inadequate response to 5-ASA derivates
76
Immunosuppressants are used for what type of therapy?
NOT for acute relief MAINTAING REMISSION ONLY
77
What are the Immunosuppressant Drugs?
1. Azathioprine 2. Mercaptopurine 3. Cyclosporine 4. Methotrexate
78
Azathioprine MOA
Mercaptopurine precursor antagonizes purine metabolism, synthesis of DNA, RNA, proteins, cellular metabolism = reducing proliferation of WBC/immune attacking agents
79
Azathioprine and Mercaptopurine Indication
UC, CD
80
What is something to note about Azathioprine and Mercaptopurine?
TMPT genotype or phenotype and should be performed prior to therapy
81
What are the DDIs of Azathioprine and Mercaptopurine?
1. TNFa inhibitors 2. Natalizumab 3. Azathioprine 4. Allopurinol 5. Febuxostat
82
What is the MOA Mercaptopurine?
Purine antagonist which inhibits DNA and RNA synthesis; acts as false metabolite and is incorporated into DNA and RNA inhibiting synthesis
83
Cyclosporine MOA
Inhibits release of IL-2 resulting in reduced T-cell function
84
What are AEs Cyclosporine
1. Hypertrichosis 2. Hyperglycemia 3. HTN 4. Hepatotoxicity/Nephrotoxicity
85
Cyclosporine Indication and Dose
UC, CD IV 4mg/kg/day
86
Methotrexate MOA
Folate antimetabolite that inhibits DNA synthesis
87
Methotrexate Indication
CD Use after mercaptopurine or cyclosporine
88
What antibiotics are used in CD?
1. Metronidazole 2. Ciprofloxacin
89
MOA of antibiotics and indication in CD?
Reduce bacteria concentrations and endotoxin levels in the bowel. May also suppress cell mediated immunity -Useful for CD of the PERINEAL area or when fistulas/abscess present
90
What are the AEs of Metronidazole?
1. Metallic-Taste 2. Disulfram-Like Reaction
91
What are the counseling points of Metronidazole?
Disulfram like reactions with alcohol
92
What are the counseling points of Ciprofloxacin?
Avoid taking with Ca2+ products, iron supplements, vitamins, dairy

GI/Rheumatology Module (18 decks)

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