inflammatory bowel disease

Question 1

diagnosis of IBD

Answer 1

• blood tests for anaemia, vitamin deficiencies and inflammatory markers
• x-ray examination/CY + MRI scans
• sigmoidoscopy and colonoscopy

Question 2

ulcerative colitis

Answer 2

only affects the large bowel and the inflammation is on the inner lining

Question 3

crohn’s disease

Answer 3

affects any area of the GI system and all layers of tissue can be inflamed

Question 4

symptoms of IBD

Answer 4

• stomach pain
• weight loss
• diarrhoea (bloody/mucus)
• tiredness
• joint pain
• inflamed eyes
• rashes

Question 5

corticosteroids

Answer 5

• administered orally or rectally
• gastro-resistant or modified release or enemas/foams
• hydrocortisone, beclomethasone, budesonide, prednisolone

Question 6

steroids mechanism of action

Answer 6

• briefly reduce inflammatory mediators directly and also have effects on expression of genes associated with inflammatory/anti-inflammatory proteins

Question 7

steroids caution

Answer 7

• congestive heart failure
• hypothyroidism
• osteoporosis
• untreated infection

Question 8

steroid side effects

Answer 8

• insomnia
• dyspepsia
• cushing’s syndrome
• impaired healing
• adrenal suppression with long term use

Question 9

steroid interactions

Answer 9

• grapefruit juice increases plasma concentration of oral budesonide
• corticosteroids antagonise diuretic effects

Question 10

aminosalicylates

Answer 10

• administered orally/rectally
• modified release tablets/capsules, granules, suspensions or foam/suppository/ enemas
• balsalazide, mesalazine, osalazine, sulfasalazine

Question 11

aminosalicylates rare side effects

Answer 11

• blood disorders (unexpected bleeding, bruising, purpura, sore throat, fever, malaise)

Question 12

aminosalicylates interactions

Answer 12

sulfasalazine:
- colours urine and contact lenses orange
- decreases concentration of digoxin and absorption of folates

Question 13

cytokine modulators

Answer 13

• monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha
• briefly stop the expansion of activated T-cells by interrupting the calmodulin-calcineurin cascade
• subcutaneous administration
• infliximab, adalimumab, golimumab, vedolizumab

Question 14

immunosuppressants

Answer 14

• administered orally or by injection
• azathioprine, ciclosporin, mercaptopurine, methotrexate
• anticancer drugs with blood toxicity and liver toxicity so require regular monitoring of blood counts and organ function

Question 15

methotrexate

Answer 15

• weekly dosage
• follow up dose of folic acid to reduce side effects
• only use 2.5mg tablets
• patients must report sore throat, bleeding, bruising, mouth ulcers
• methotrexate safety card