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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
Q

What lab results are specific to UC and used to distinguish from CD?

A

Decreased Hgb/HCt and Albumin

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26
Q

What is Proctitis UC?

A

Localized to the bottom

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27
Q

What is Left-Sided Colitis?

A

Localized to the bottom up to the splenic flexure

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28
Q

What is Pancolitis UC?

A

Extensive to the entire GI

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29
Q

70% of CD is found where?

A

Distal Ileum and Right Colon

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30
Q

What is classified as MILD UC?

A

<4 stools/day (+/-blood)
NO systemic complications
NORMAL ESR

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31
Q

What is classified as MOD UC?

A

> 4 stools/day (+blood)
MINIMAL systemic complications

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32
Q

What is classified as SEVERE UC?

A

> 6 stools/day (+blood)
FEVER, TACHYCARDIA, ANEMIA systemic complications
ESR >30

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33
Q

What is classified as FULMINANT UC?

A

> 10 stools/day (continuous bleeding)
TOXIC vitals/symptoms
Abdominal Tenderness, Colonic Dilation
NEED TRANSFUSION

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34
Q

What is classified as MILD/MOD CD?

A

Ambulatory
NO Alarm Symptoms

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35
Q

What are the alarm symptoms of CD?

A
  1. Dehydration
  2. Systemic Toxicity
  3. Weight Loss
  4. Abdominal Tenderness
  5. Mass/Obstruction
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36
Q

What is classified as MOD/SEVERE CD?

A

Fever, Weight Loss, Abdominal Pain, Tenderness, Vomiting, Obstruction, or Anemia
FAILING to respond to treatment for mild/mod

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37
Q

What is classified as SEVERE/FULMINANT CD?

A

PERSISTANT Symptoms
Systemic Toxicity despite outpatient oral corticosteroids
SEVERE Weight Loss
Rebound tenderness, intestinal obstruction, or abscess

38
Q

What are Non-Pharmacologic Management Options for IBD?

A
  1. Nutrition
  2. Surgery
39
Q

What are nutrition considerations for IBD?

A
  1. Patients commonly malnourished
  2. Eliminate foods exacerbating conditions
40
Q

Surgery is what in UC and CD?

A

UC: surgery = CURATIVE –> prophylaxis against cancer
CD: surgery = NOT curative

41
Q

What are pharmacologic considerations in IBD?

A

Active, MD, Supportive, and Adjunctive

42
Q

Agents MODULATE disease process of IBD, NOT Curative and the target is to what?

A

Relieve Inflammation

43
Q

What dictates the route and formulation of the product picked for therapy?

A

Location and Severity of Disease

44
Q

What are adjunctive therapies?

A
  1. Antidiarrheals/Antispasmodics
  2. Nicotine ONLY in UC
45
Q

What are the 5-Aminosalicyclic Acid drugs?

A
  1. Sulfasalazine
  2. Mesalamine
  3. Olsalazine
  4. Balsalazide
46
Q

What are the considerations of Sulfasalazine?

A

CI for Sulfa Allergy
Improvement takes 4+ weeks

47
Q

What are AEs of Sulfasalazine?

A

GI upset, aplastic anemia, rash, HA

48
Q

What are counseling points of Sulfasalazine?

A

Impairs folic acid absorption
Take with food

49
Q

What is the indication of Sulfasalazine?

A

UC and CD
Active and MD Dosing

50
Q

What is the SOA of Sulfasalazine?

A

COLON

51
Q

What are the considerations of Mesalamine?

A

Alternative to sulfasalazine
DDIs: antacids/H2RAs/PPIs

52
Q

Oral vs Topical Mesalamine are used for what?

A

Oral = Extensive Disease Pancolitis
Topical = Distal Disease or Proctitis

53
Q

Mesalamine Cap SOA and Indication

A

Jejunum, Ileum, Colon
UC, CD

54
Q

Mesalamine Suppository SOA and Indication

A

Rectum
UC, reserved Proctitis

55
Q

Mesalamine Enema SOA and Indication

A

Rectum and Distal Colon
UC, Distal Diseases and Proctitis

56
Q

Mesalamine Suppository/Enema may have what effect?

A

May stain clothing/undergarments

57
Q

Mesalamine Tablet SOA and Indication

A

Distal Ileum and Colon
UC, CD

58
Q

Olsalazine AEs

A

Significant dose-dependent secretory diarrhea

59
Q

Balsalazide AEs

A

HA and Abdominal Pain

60
Q

What is the SOA and Indication of Olsalazine and Balsalazide

A

Colon
UC,CD

61
Q

Mesalamine Suppository SOA

A

Rectum

62
Q

Mesalamine Enema SOA

A

Distal Colon

63
Q

Corticosteroids MOA

A

Modulate immune system and inhibit production of cytokines and inflammatory mediators

64
Q

Corticosteroids is used for ACUTE management ONLY, where does each form work?

A

Rectal = Distal Disease
PO = Extensive disease not responding to oral 5-ASA
IV = Systemic complications and severe disease

65
Q

What corticosteroid combo is preferred for FIRST line therapy for Mild-Mod CD CONFIDED to the TERMINAL Ileum and/or ASCENDING Colon?

A

Controlled release BUDESONIDE or a tapering course of PREDNISONE w or without AZATHIOPRINE

66
Q

What corticosteroid therapy is preferred for patients with DIFFUSE diarrhea?

A

Managed by a tapering course of prednisone with or without azathioprine

67
Q

What is important to note about Corticosteroids?

A

MUST TAPER after 2 weeks of therapy

68
Q

What are counseling points for corticosteroids?

A

Take with food, do not stop abruptly

69
Q

Hydrocortisone ENEMA Indication

A

UC, Proctitis or Distal Disease

70
Q

Prednisone PO Indication

A

UC, CD 40-60 mg/day

71
Q

Budesonide PO Controlled Release Indication

A

CD, confined to the ileum and/or right colon

72
Q

Hydrocortisone IV Indication

A

UC,CD

73
Q

Methylprednisolone IV Indication

A

UC,CD

74
Q

What is an AE of corticosteroids?

A

HPA Axis Suppression, increased risk of infection

75
Q

What are the Immunosuppressant indications?

A
  1. Steroid dependent patients
  2. Patients not responding to steroids
  3. Attaining remission with inadequate response to 5-ASA derivates
76
Q

Immunosuppressants are used for what type of therapy?

A

NOT for acute relief
MAINTAING REMISSION ONLY

77
Q

What are the Immunosuppressant Drugs?

A
  1. Azathioprine
  2. Mercaptopurine
  3. Cyclosporine
  4. Methotrexate
78
Q

Azathioprine MOA

A

Mercaptopurine precursor antagonizes purine metabolism, synthesis of DNA, RNA, proteins, cellular metabolism = reducing proliferation of WBC/immune attacking agents

79
Q

Azathioprine and Mercaptopurine Indication

A

UC, CD

80
Q

What is something to note about Azathioprine and Mercaptopurine?

A

TMPT genotype or phenotype and should be performed prior to therapy

81
Q

What are the DDIs of Azathioprine and Mercaptopurine?

A
  1. TNFa inhibitors
  2. Natalizumab
  3. Azathioprine
  4. Allopurinol
  5. Febuxostat
82
Q

What is the MOA Mercaptopurine?

A

Purine antagonist which inhibits DNA and RNA synthesis; acts as false metabolite and is incorporated into DNA and RNA inhibiting synthesis

83
Q

Cyclosporine MOA

A

Inhibits release of IL-2 resulting in reduced T-cell function

84
Q

What are AEs Cyclosporine

A
  1. Hypertrichosis
  2. Hyperglycemia
  3. HTN
  4. Hepatotoxicity/Nephrotoxicity
85
Q

Cyclosporine Indication and Dose

A

UC, CD
IV 4mg/kg/day

86
Q

Methotrexate MOA

A

Folate antimetabolite that inhibits DNA synthesis

87
Q

Methotrexate Indication

A

CD
Use after mercaptopurine or cyclosporine

88
Q

What antibiotics are used in CD?

A
  1. Metronidazole
  2. Ciprofloxacin
89
Q

MOA of antibiotics and indication in CD?

A

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
Q

What are the AEs of Metronidazole?

A
  1. Metallic-Taste
  2. Disulfram-Like Reaction
91
Q

What are the counseling points of Metronidazole?

A

Disulfram like reactions with alcohol

92
Q

What are the counseling points of Ciprofloxacin?

A

Avoid taking with Ca2+ products, iron supplements, vitamins, dairy

GI/Rheumatology Module (18 decks)

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