Inflammatory Bowel Disease Flashcards
What are the 2 types of IBD?
Crohns
Ulcerative Colitis
What are the characteristics of IBD?
Inflammation
Swelling
Ulceration of intestinal tissue
Chronic with periods of reumission
What are the symptoms of IBD?
Stomach pain
Weight loss
Diarrhoea
Bloody and mucus
Tiredness
*Joint pain
*Inflammed eyes
*Rashes
What is Ulcerative Colitis?
Only affects large bowel
Inflammation on inner lining
What is Crohns?
Can affect any area of GI tract
All layers of tissue can be inflammed
How to diagnose IBD?
Symptoms
Blood tests- anaemia, vitamin deficiencies, inflammatory markers
X-ray, CT, MRI
Sigmoidoscopy, colonoscopy
Diagnosis for Crohns?
Small bowel enema
Small capsule endoscopy
Causes of IBD?
Genetic links
Autoimmune disease
Environmental
Previous infection
Prevalence of IBD?
Late teens and early 20s
White ethnic groups
Women more than men
1 in 350 people
What are the 4 treatments of IBD?
Corticosteroids
Aminosalicylates
Cytokine modulators
Immunosuppresants
Steroid formulations?
Oral- MR and GR
Rectal- enema and foams
Examples of steroids?
Hydrocortisone
Beclomethasone
Budesonide
Prednisolone
What is the pharmacology of steroids?
Reduce inflammatory mediators directly
Have effects on expression of genes associated with inflammatory and anti-inflammatory proteins
Cautions of steroids?
Congestive heart failure
Hypothyroidism
Osteoporosis
Untreated infection
Side effects of steroids?
Insomnia
Dyspepsia
Cushing’s syndrome
Impaired healing
Adrenal suppression- long term
Interactions with steroids?
Grapefruit juice and budesonide
Steroids antagonise diuretics
Aminosalicylate formulations?
Oral- GR and MR caps/tabs, granules, suspensions
Rectal- foams, enemas and suppositories
Examples of aminosalicylates?
Balsalazine
Mesalazine
Olsalazine
Sulfasalazine
Aminosalicylate rare side effects?
Blood disorders- report unexplained bleeding, bruising, purpura, sore throat, fever, malaise
Renal function- checked before treatment then every 3 months
Salicylate sensitivity
Sulfasalazine side effects?
Colours urine
Colours lenses orange
Decrease digoxin concentration
Absorbs folate
What are cytokine modulators?
Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha
Stop expansion of activated T-cells by interrupting the calmodulin- calcineurin cascade
Examples of cytokine modulators and administration?
Subcutaneous
Infliximab
Adalimumab
Golimumab
Vedolizumab
What are immunosuppressants?
T-cell effects
Anticancer drugs with blood toxicity and liver toxicity therefore require regular monitoring (blood tests)
Immunosuppressant examples and administration?
Oral/ injection
Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate
What is methotrexate?
Weekly dose with folic acid
Only use 2.5mg tablets
Report sore throat, bleeding, bruising
FBC, renal and lier monitoring
Safety card
High risk drug
Non- drug treatment?
Smoking cessation
Attention to diet
Surgery- stoma operations, resection operations
