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PHARM 345 - Other > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

What is IBD

A

Refers to two chronic inflammatory diseases of the GI tract
- Ulcerative Colitis
- Crohn Disease

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2
Q

Who is affected more by IBD

A

Females

Late Teens/20’s or 60’s/70’s

North America

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2
Q

Why is IBD common in Canada

A
  • Industralized Nation
  • Northern Hemisphere
  • City
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3
Q

Crohn’s Colitis

A

Disease involoving only colon

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4
Q

Crohn’s Ileitis

A

Disease involving only ileum

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5
Q

Crohn’s Ileocolitis

A

Disease involving both ileum and ileocolitis

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6
Q

What increases risk of IBD
- Inflammatory

A
  • Pro-inflammatory cytokines
  • Epithelial barrier
  • Loss of tolerance
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7
Q

What increases risk of IBD
- Non Immune

A
  • Triggered by bacteria
  • Reactive oxygen species
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8
Q

What decreases risk of IBD
- Diet

A
  • Whole foods
  • Omega 3
  • Fibre
  • Vitamin D
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9
Q

What decreases the risk of IBD
- Physical Health

A
  • Sleep
  • Exercise
  • Healthy Weight
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10
Q

What decreases the risk of IBD
- Mental Health

A
  • Sleep
  • Stress Reduction
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11
Q

What decreases the risk of IBD
- Medications

A
  • Limiting NSAIDs
  • Avoiding antibiotics in kids
  • Smoking (Is protective in UC)
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12
Q

Toxic Megacolon
- Risks

A
  • Antidiarrheals
  • Anticholinergics
  • Opioids
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13
Q

Ulcerative Colitis
- Areas of Inflammation

A

Only in Colon
- Ileum is involved in backwash ileitis

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14
Q

Crohn Disease
- Areas of Inflammation

A

Anywhere in GI tract (mouth to anus)
- Most common = Terminal Ileum

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15
Q

Ulcerative Colitis
- Depth of Inflammation

A

Mucosal/Submucosal Layers

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16
Q

Crohn Disease
- Depth of inflammation

A

Transmural

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17
Q

Ulcerative Colitis
- Distribution of Lesions

A

Continuous

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18
Q

Crohn Disease
- Distribution of Lesions

A

Discontinuous (Skip)

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19
Q

Ulcerative Colitis
- Other Features

A
  • Abscesses of Crypts of the mucosa
  • Pseudopolyps (Ulcers surround mucosa masses)
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20
Q

Crohn Disease
- Other Features

A
  • Granulomas (Tiny clump of WBC)
  • Fibrosis (Excessive connective tissue)
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21
Q

Ulcerative Colitis
- Symptoms

A
  • Abdominal Pain
  • Frequent bowel movements
  • Mucous in stools
  • Blood in stools
  • Tenesmus (Feeling of going to the bathroom)
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22
Q

Crohn Disease
- Symptoms

A
  • Abdominal Pain (Lower right quadrant most common)
  • Frequent bowel movements
  • Mucous in stools
  • Blood in stools (Less common than UC)
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23
Q

Ulcerative Colitis
- Severe Symptoms

A

Systemic Symptoms
- Fever
- Weakness
- Dehydration (Electrolyte Abnormalities, Tachycardia)

24
Crohn Disease - Severe Symptoms
Systemic Symptoms (More common than Ulcerative Colitis) - Fever - Weakness - Dehydration (Electrolyte abnormalities, Tachycardia)
25
Ulcerative Colitis - Local Complications
- Hemorrhoids, Anal Fistulas, Perirectal Abscesses - Toxic megacolon - Intestinal stricture (Colonic Stricture) - Colorectal Cancer (depends on the duration and extent of involvement)
26
Crohn Disease - Local Complications
- Small bowel strictures that cause bowel obstruction - Fistulas (Most common in anal and rectal) - Abscesses (Pocket of pus) - Sinus tract infections
27
Ulcerative Colitis - Systemic
- Malnutrition, Malabsorption (Severe Disease) - Anemia (Iron Deficient)
28
Crohn Disease - Systemic
- Malnutrition, Malabsorption (More common than UC) - Folate, Vitamin A, Vitamin B12, Vitamin D, Ca, Mg, Fe, Zn - Anemia (Iron Deficient Anemia) - VTE - Osteoporosis (From Malnutrition, Steroids, Inflammation) - Growth stunts in kids
29
Extraintestinal Manifestations of UC and CD
Arthritis / Arthralgia Hepatobiliary Dermatologic Ocular
30
Extraintestinal Manifestations Categories
Inflammatory process at distal sites Associations with other immune mediated disease Complications of systematic inflammation AE of Drug Therapy
31
Extraintestinal Manifestations - Inflammatory process at distal sites
Oral manifestations Scleritis Uveitis
32
Extraintestinal Manifestations - Associations with other immune mediated disease
Multiple Sclerosis Myocarditis Bronchicctasis
33
Extraintestinal Manifestations - Complications of Systematic Inflammation
Fatigue VTE Anemia Stroke
34
Extraintestinal Manifestations - AE of IBD Therapy
Pancreatitis Pericarditis Osteoporosis
35
IBD Lab Values - What to look for in diagnosis
High: - Fecal Calprotein (>250 ug/g) - C-Reactive Protein - White Blood Cell Low: - Hb - Iron - B12 - Folate
36
IBD - Diagnosis Imaging
Endoscopy - CD: Cobblestone Biopsy - Histology Barium Radiographic Contrast Study - Contraindicated severe UC (Risk of toxic megacolon)
37
Crohn Disease - Various Fistulas?
- Intestinal - Perianal - Bladder - Vaginal
38
Ulcerative Colitis - Classification Mild
Stools Per Day - <4 Blood in Stools - ? Systemic Symptoms - None ESR/CRP - Normal
39
Ulcerative Colitis - Classification Moderate
Stools Per Day - 4-6 Blood in Stools - ? Systemic Symptoms - None ESR/CRP - Normal
40
Ulcerative Colitis - Classification Severe
Stools Per Day - >6 Blood in Stools - Present Systemic Symptoms - Present ESR/CRP - Elevated
40
Crohn Disease - Classification Mild-Moderate
- Ambulatory, can tolerate oral intake - No dehydration, fever, abdominal tenderness, painful mass, weight loss
41
Crohn Disease - Classification Moderate-Severe
- Failed mild-moderate treatment OR - Fever, Weight Loss, Abdominal Pain, Nausea, Vomiting, Anemia
42
Crohn Disease - Classification Severe-Fulminant
- Persistient symptoms despite steroids as outpatient OR - High fever, persistient vomiting, intestinal obstruction, rebound tenderness, Cachexia, Abscess
43
Monitoring Effectiveness
Symptoms - Reduced fatigue - Consistient stools - Less or no cramping - Improved nutrition - Improved muscle mass Lab Values - CRP - Fecal Calprotein - Colonscopy should show reduced inflammation - HB normalizing, platelets decreasing
44
Monitoring Safety
Symptoms: - Fatigue/brain fog - Nausea, mouth sores - Sunburn - Alcohol Lab Values - ALT/Albumin (Ensure proper liver function) - Serum Creatinine - CBC - Test for exposure to Hep B and C
45
Biosimilars vs Generic
Generics are identical to reference product Biosimilars are highly similars (have some variation due to the complex nature of cells) - One clinical study comparing biosimilar to reference product is needed
46
Interchangeability
Expected to produce the same clinical response in the same patient - Financial decision
47
Substitutability
Expected to produce similar clinical outcomes - Formulary/Coverage decision
48
Can you interchange/substitute a biosimilar
You can but, Health Canada recommends against it
49
Biologics and Infections
- Hold biologics until 48 hours after antibiotic completion or symptom resolution - Vaccinate 4 weeks before biologic initiation, - Avoid live vaccines
50
Biologics and Perioperative
- Hold biologics pre and post operation to decrease risk of infection
51
Biologics and Pregnancy
TNFi - 1st and 2nd Trimester is safe - 3rd Trimester can increase risks of infection Plan last injection: - Adalimumab 1-3 weeks - Infliximab 4-10 weeks Other Biologics - Lack of evidence, leans towards harm
52
IBD Medications and Pregnancy - Aminosalicylates
Can use in pregnancy - Ensure folic acid supplementation
53
IBD Medications and Pregnancy - Prednisone
Can use in pregnancy - Use cautiously in first semester (Very low risk of cleft palates) - Weigh risk to benefits
54
IBD Medications and Pregnancy - Azathioprine
Can use in pregnancy
55
IBD Medications and Pregnancy - Methotrexate
Avoid use in pregnancy - Discontinue 3 months before trying to get pregnant
56
IBD Medications and Pregnancy - JAK Inhibitors
Avoid use in pregnancy - Discontinue 4-6 weeks before trying to get pregnant
57
IBD Medications and Pregnancy - SP-1 Modulators
Avoid use in pregnancy - Discontinue 3 months before trying to get pregnant

PHARM 345 - Other (36 decks)

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