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Therapeutics Y2 Sem 2 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is included in the proximal large intestine

A

Ascending colon and transceding colon

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2
Q

What is included in the Distal large intestine?

A

Descending colon and sigmoid colon

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3
Q

What is UC?

A

It is chronic inflammatory condition characterized by episodes of infalmmation limited to the mucosal layer of the colon

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4
Q

What is CD

A

Chronic transmural inflammation with skip lesions, affecting mouth to perianal

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5
Q

What is the etiology of Crohn’s disease?

A
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6
Q

What is the etiology of Ulcerative colitis disease?

A
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7
Q

Where does UC being?

A

Rectum

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8
Q

Where does CD begin?

A

Anywhere

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9
Q

What are the risk factors of UC/CD

A
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10
Q

What is the prognosis of mortality rates?

A

1.4-5 times

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11
Q

What are the complications of UC?

A

Colectomy
Osteoporosis
Hypercoagulability
Anemia

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12
Q

What is the main symptoms of UC/CD?

A

Abdominal pain and diarrhea

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13
Q

What are the systemic effects that generally occur during a flair?

A

Fever
Sweats
Malaise
Arthralgia

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14
Q

What is the diagnosis of UC/CD?

A

Physical exam
lab exam (Stool testing, blood tests)
Imaging and endoscopy/coloncoscopy

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15
Q

What needs to be monitored with respect to UC/CD?

A

HG
Iron Indices
Nutrition
Growth
BMD
Colonoscopy

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16
Q

What is the goal of txtmnt?

A
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17
Q

What are the medicaitons used for treatment?

A

Corticosteroids
5-ASA
Immune modifiers

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18
Q

What are the dietary items we need to consider with CD/UC

A

Fiber
Reduce fat (Except Omega 3)
Consider trigger foods
Prevent malnutrition of specific nutrients

Multivitamin has a good role!

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19
Q

What role is their for probiotics?

A

Evidence is limiting, can be added on as therapy but should not be replaced

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20
Q

What are some other non-pharm treatments we should consider

A

Smoking cessation
Exercise

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21
Q

What is the principle of therapy for UC/CD?

A

Induce remission
Maintain remission
Minimize use of steroids

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22
Q

What is the definition of remission?

A
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23
Q

WIth respect to CS what are the benefits?

A

Highly effective agents for inducing remission

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24
Q

What are the dosage forms of CS and indication?

A

Orally for UC/CD and topical foams and enemas in UC

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25
Q

What are the indications of CS for UC?

A

Topical (Mild to moderate) induction

Oral: Moderate to severe induction

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26
Q

WHat is the indicaitions for CS?

A

Oral: mild to severe Crohns disease induction

Budesonide can be used for short term maintenance as well <3 months

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27
Q

What is the general dosing of prednisone for flare management?

A

40-60mg daily

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28
Q

What is the Budesonide entocort capasules generally target?

A

Ileal and ascending colon for CD only (9mg) daily

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29
Q

What is the Budesonide enocort enema generally used for?

A

Distal UC only 2mg qhs

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30
Q

What are the cortiment tablets used for?

A

UC, 9mg daily

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31
Q

What are the hydrocortisone 10% enemas/foams used for?

A

UC only QHS<but unavailable

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32
Q

What are the special administration instructions of CS?

A

Prednisone with food
Topicals: Life on left side and attempt to retain contents for as long as posible

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33
Q

What is the onset of CS for symptom imporvement?

A

As early as 2-3 days

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34
Q

What is the typical duration of therapy for corticosteroids?

A

Prednisione (4 weeks max recommended)
Budesonide: 8 weeks maze

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35
Q

What is the taper recommendations for budesonide?

36
Q

How long can budesonide capules be continued for after induction?

A

3 months at 6mg/day and then taper 8-3-0 over 2 weeks

37
Q

If switching from Prednisone to Budesonide

A

Done to reduce ADRs HPA-Axis supression or reduce disease recurrence

38
Q

Common side effects of CS?

39
Q

What are the serious side effects due to long term exposure of CS?

40
Q

What are the monitoring parameters of CS?

41
Q

If systemic toxicity is present what should be done?

A

Switch to budesonide or topicals if possible

42
Q

What are aminosalicylates?

A

Most commonly used agents in UC, but ahs questionable efficacy in acute CD

Topical and oral agents available

43
Q

What are the indications for 5-ASA?

A

Oral/topical therapy for mild UC

5-ASA + prednisone for moderate and severe UC

SSZ for induction of mild-moderate CD

44
Q

What is the maintenance dose of 5-ASA?

45
Q

What are the contraindications of Aminosaliclates?

46
Q

What is the MOA of Aminosalicylates?

A

Controls inflammation by inhibiting Cox pathways and blocks prostaglandin/leukotriene production in the colon

SSZ is convereted into 5-ASA in the colon

47
Q

What is the typical dosing of topical induction of UC? (3) with respect to ASA?

48
Q

What is the typical dosing of topical maintenance of UC? with respect to ASA

49
Q

What is the dosing for Mezacant (ASA)

A

2.4-4.78mg once daily, Very expensive

50
Q

What are the Aminosalicylates agents?

A

Asacol
Pentasa
Salofalk
Mezavant
Sulfasalazine

51
Q

What is the administration of the suppositories or enemas?

A

Must be able to retain enema contents for >30 minutes

52
Q

What is generally the onset of Aminosalicylates?

A

2-4 weeks to achieve remission

53
Q

What are the common side-effects of aminosalicylates

54
Q

What are the SSZ only side effects/

55
Q

What are the serious AE of Aminosalicylates?

56
Q

What should be monitored while on Aminosalicylates?

57
Q

What are the drug interactions of 5-ASA?

A

Antacids, PPis, H2RAs

Azathioprine/mercaptopurine toxicity increased

Digoxin decreased

58
Q

What are the pH dependant 5-ASA medicaitons?

A

Salofalk, Mesavant, Asacol

59
Q

What is the Clinical evidence for UC with the usage of aminosalicylates?

60
Q

What is the Clinical evidence for CD with the usage of aminosalicylates?

61
Q

What are the DI of SSZ?

62
Q

Which ASA has the greatest location of action?

63
Q

Take some time to review location of action for Aminosalicylates

64
Q

What are the immune modifieing aganets for CD/UC

A

Azathioprine and Mercaptopurine (Immunosuppressants)

65
Q

Which immune modifiers are indicated for maintenance of UC/CD?

A

Azathioprine and Mercaptopurine BUT

66
Q

What are the indications of the immune modifiers?

67
Q

What is the MOA of Azathioprine/Mercaptopurine?

A

Purine antagonists/Immune suppression

68
Q

What is the MOA of Vedolizumab?

A

Integrin receptor blockers

69
Q

What is the MOA of Ustekinumab?

A

Inhibits IL-12 and 23

70
Q

How is Mercaptopurine/Azathioprine dosed?

A

oral once daily dosing

71
Q

What is the onset of action of Mercaptopurine/Azathioprine?

A

3-6 months

72
Q

How long does biologics take to work?

73
Q

What is special about vedolizumab?

A

18-20 weeks

74
Q

What is the duration of therapy for the immune modifiers?

75
Q

What are the side effects of Mercaptopurine/Azathioprine?

A

Flu-Like symptoms
GI symptoms

76
Q

What are the Side effects of the biologics/

77
Q

What are the serious side effects of mercaptopurine or azathioprine?

78
Q

What should be monitored while on Mercaptopurine/Azathioprine?

79
Q

What should be monitored while on TNF-Inhibitors/

80
Q

What are the DI of Mercaptopurine/Azathioprine?

81
Q

What are generally the IBD biologic treatment?

A

TNF-inhibitors (Infliximab may have slight efficacy_

Vedolizumab is gut selective, but slow onset

82
Q

Is maintenance therapy always offered for patient?

A

UC yes
Crohns (Mild disease no), Consider if >2 or more exacerbations per year

83
Q

What is combo therapy appropriate for UC?

84
Q

When is combo therapy for CD appropriate?

Therapeutics Y2 Sem 2 (17 decks)

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