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Pharm II > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

what are the two types of inflammatory bowel diz?

A

Ulcerative colitis

crohn’s dz

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2
Q

which condition is a transmural inflammation of the GI?

A

Crohn’s dz

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3
Q

bloody diarrhea and abdominal pain indicates what?

A

Ulcerative colitis

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4
Q

Diarrhea and abdominal pain indicates what?

A

Crohn’s dz

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5
Q

common complaints of crohn’s dz

A

weight loss
vomiting
fever
perianal discomfort

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6
Q

what 2 bacteria is there an increase in (pathogenic) with IBD?

A

Bacteroides

E. Coli

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7
Q

what types patients have a generalized impaired immune response? will have decreased blood flow to sites and decrease neutrophils and inter-leukin 8

A

Crohn’s Dz

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8
Q

what dz is smoking protect for?

A

Ulcerative colitis

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9
Q

smoking makes what dz worse?

A

crohn’s dz

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10
Q

what meds should be avoided w/ IBD

A

Opiates
NSAIDs (disrupt mucosal barrier)
Antidiarrheals (risk of megalocolon)

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11
Q

with IBD will result in fistulas?

A

Crohn’s Dz

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12
Q

does any diet improve or exacerbate UC?

A

No

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13
Q

What nutritional supplements can help UC?

A

Reduced fiber during exacerbation
folic acid
oral iron w/ considerable rectal bleeding
metamucil

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14
Q

when should someone with UC take folic acid?

A

When leafy veggies restricted or

sulfasalazine being used

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15
Q

what drugs can you start someone on with mild-moderate ulcerative colitis?

A

Sulfasalazine
Mesalamine
Aminosalicylate

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16
Q

If ulcerative colitis is more distal what drugs can you give?

A

Mesalamine enema/ suppository

corticosteroid enema

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17
Q

when someone is in remission for UC what can you do?

A

Reduce dose by 1/2 or

reduce enema/ suppository to q 1-2 days

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18
Q

what should you add to treatment for moderate to severe UC.

A

Add prednisone (high dose)

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19
Q

what must you do with the prednisone to discontinue it?

A

Taper the dose down

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20
Q

when someone goes into remission after having moderate to severe UC what should you do?

A

Taper prednisone

REduce sulfasalazine/ mesalamine after 1-2 months to half

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21
Q

For refractory UC what do you add? (Not responding to normal therapy)

A

Azathioprine or mercaptopurine (6-MP)

infliximab (antibody)

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22
Q

How do you treat severe or fulminant UC?

A

Hydrocortisone (IV)

if remission change to prednisone add sulfasalazine or mesalamine

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23
Q

If someone doesn’t respond to tx of severe or fulminant UC? (within 5-7 days)

A

cyclosporine IV

colectomy

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24
Q

only cure of UC

A

surgery

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25
what do you use for maintenance of UC? (takes all the time)
aminosalicylates and/or AZA or 6-MP | alternative infliximab q 8 weeks
26
What are beneficial nutritional measures for Crohn's?
Limit fiber w/ cramping and diarrhea decrease fat intake w/ steatorrhea multivitamin w/ minerals daily
27
how do you treat ileocolonic or colonic crohn's?
sulfsalazine | oral mesalamine
28
tx for perianal crohn's
sulfsalazine oral mesalamine metronidazole
29
small bowel tx of crohn's
oral mesalamine metronidazole budesonide
30
with mild-moderate crohn's dz you give them the same tx and add what?
Prednisone
31
If a person isn't responding to initial tx for Crohn's what do you add or fistulaing dz?
Infliximab
32
what are 3 other drugs to use if infliximab isn't working? for crohn's
Adalimumab Natalizumab Certolizumab
33
once the patient responds to tx for crohn's dz how do you treat?
Taper prednisone after 2-3 weeks | Add AZA, 6-MP or MTX
34
how do you tx severe fulminant crohn's?
hydrocortisone IV | if no response switch to cyclosporin
35
what drugs do you d/c for crohn's?
long term corticosteroids
36
what is the 1st line maintenance for crohns?
azathioprine / 6-MP infliximab methotrexate
37
name the 2 aminosalicylates
sulfasalazine | mesalamine
38
name 2 immunomodulators
azathiprine | 6-MP
39
Most commonly used for inducing and maintaining remission
Aminosalicylates
40
how long can response take with aminosalicylates?
2-3 weeks
41
what metabolizes sulfasalazine to 5-ASA and mesalamine?
intestinal bacteria
42
C/I to sulfasalazine
``` salicylate hypersensitivity renal impairment (monitor SrCr) ```
43
what needs to be monitored w/ sulfasalazine?
SCr
44
Main ADRs with sulfasalazine
blood disorders (anemia, thrombocytopenia, granulocytopenia) impair folic absorption low sperm counts
45
what are the idiosyncratic rxs with sulfsalazine (will go away once stop taking meds)
hepatocellular injury agranulocytosis lupus-like phenomena
46
MOA of mesalamine
unclear
47
ADRS with mesalamine
less than sulfasalazine local itching and mild rectal iritation idiosyncratic rxns
48
how should you presibe mesalamine?
based on location (oral/ supossitory)
49
what drugs has there idiosyncratic rxns pleuropericarditis, pancreatitis, nephrotic syndrome ?
mesalamine
50
MOA of corticosteroids
anit-inflammatory effects
51
name some corticosteroids
``` prednisone budesonide prednisolone hydrocortisone methyprednisolone ```
52
what corticosteroid is in syrup?
Prednisolone
53
when should you taper w/ a corticosteroid.
If a patient is on the corticosteroid for more than 7 days
54
if you can't taper the patient down without the patient getting sick again, what should you give?
amtimetabolite and/or infliximab
55
with long term use of corticosteroids what can happen?
glucose intolerance/ metabolic abnormalities | greater risk for adrenal insufficiency/ infection
56
if one corticosteroids for greater than 3 months what can develop?
osteoporosis | eye problems
57
what are 2 immunosuppressants
6-Mercaptopurine (6-MP) (pro drug) | Azathioprine
58
MOA of immunosuppressives
Antagonizes purine metabolism; inhibits DNA, RNA and protein synthesis
59
how long do immunosuppressives take to work?
weeks to months
60
ADRS with immunosuppressive drugs
Bone marrow suppression (dose related) Lymphoma (4 fold increase) pancreatitis
61
what infections can occur with immunosupressive drugs ? higher risk when on this and steroids
disseminated CMV, herpes zoster pneumonia, viral hepatitis Q fever occurs w/o leukopenia
62
what will the immunosupressions inhibit the metabolism of
Sulfasalazine, mesalamine Allopurinol Aspirin Furosemide
63
what drugs are an immunomodulator?
Methotrexate | tacrolimus
64
MOS of methotrexate
folic acid antagonist with anti-inflammatory effects
65
what does methotrexate reduce the need for?
steroid
66
what do you need to monitor with methotrexate?
LFTs
67
what category is methotrexate in pregnancy?
Category X
68
what is the most significant side effect of methotrexate?
Hepatic fibrosis
69
What is the MOA of cyclosporin?
inhibits production and release of IL-2 leads to inhibits activation of T-lymphocytes
70
what should you give while giving cyclosporin?
IV steroids
71
is cyclosporin alone able to maintain remission?
No, so you must switch over to AZA or 6-MP
72
Big ADRS with cyclosporin?
HTN electrolyte abnormalities kidney problems
73
MOA of tacrolimus
inhibits T-lymphocyte activation
74
when will the ADRs of tacrolimus go away
when you decrease the dose
75
Big ADRs of tacrolimus
Increased serum creatinine
76
Monoclonal antibody that binds to TNF-alpha | Inhibits inflammatory cytokines, inhibits leukocyte migration and activation of neutrophils
Infliximab
77
when is infliximab c/i?
``` NYHA class III/IV failure Hepatitis (will reactivate hep B) ```
78
what will your body develop against infliximab.
Antibodies. increased risk of infusion rx can lead to shorter duration of response
79
with most monoclonal antibodies there are higher rates of what?
TB with extrapulmonary involvement
80
what is a patient experiencing if they have these symptoms HA, dizziness, nausea, erythema at site, flushing, fever, chills, chest pain, cough, dyspnea, pruritis
Infusion rxn
81
when do delayed hypersensitivities develop to monoclonal antibodies?
3-13 days
82
how can you avoid delayed hypersensitivies w/ monoclonal antibodies
prednisone or methylprednisolone IV 30 minutes before
83
Toxicities w/ monocolonal antibodies
autoantibodies (lupus like) | malignancy and lymphomas
84
Only for crohn's dz. recombinant fully-human immunoglobulin-1 anti-tumor necrosis factor (TNF)-alpha monoclonal antibody
adalimumab
85
what type injection if adalimumab?
SQ
86
what is the black box warning for Adalimumab ?
TB, invasive fungal and or other opportunistic infections
87
for crohn's in pts with evidence of inflammation who have had inadequate response to, or are unable to tolerate conventional therapies. Patient must be in special program. originally for MS
Natalizumab
88
for crohn's recombinant immunoglobulin-4 monoclonal antibody. infused
recombinant immunoglobulin-4 monoclonal antibody
89
Major adverse effect with natalizumab?
progressive multifocal encephalopathy
90
used for Failure to respond to sulfasalazine, tx of ileocolitis or colitis.
metronidazole
91
ADRs with metronidazole
GI upset, metallic taste, paresthesias, antabuse-like rxn
92
what 2 drugs together is recommended for fistula or abscess.
combination with standard tx | Metronidazole + Ciprofloxacin
93
what can provide symptomatic relief of diarrhea. MOA- inhibits excessive GI motility and propulsion.
opiates
94
which patients should you avoid opiates in?
Ulcerative colitis
95
what drug can cause hypertrichosis?
Cyclosporin

Pharm II (16 decks)

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