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Pediatric Pharm Exam 3 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Inflammatory Bowel Disease

A

Family of closely related intestinal disorders

Also known as IBD

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2
Q

Ulcerative Colitis (UC)

A

Mucosal inflammatory condition confined to the rectum and colon

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3
Q

Crohn’s Disease (CD)

A

Transmural inflammation of the gastrointestinal tract that can affect any part

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4
Q

Etiology (7)

A
  1. Unknown
  2. Host susceptibilities and environmental triggers
  3. Infectious diseases
  4. Genetics (hereditary)
  5. Environmental
  6. Immune defects
  7. Psychologic factors
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5
Q 
Ulcerative Colitis:
Distribution of disease in GI tract
Fistula, abscess, stricture
Location
Histology
Risk of colon cancer
A
  1. Distribution of disease in GI tract – colon and rectum
  2. Fistula, abscess, stricture – uncommon
  3. Location – mucosal
  4. Histology – crypt abscess, cryptitis
  5. Risk of colon cancer – high
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6
Q 
Crohn's Disease
Distribution of disease in GI tract
Fistula, abscess, stricture
Location
Histology
Risk of colon cancer
A
  1. Distribution of disease in GI tract – mouth to anus
  2. Fistula, abscess, stricture – common
  3. Location – transmural
  4. Histology – tissue granuloma
  5. Risk of colon cancer – high
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7
Q

UC Disease Severity Mild (4)

A
  1. < 4 BM per day
  2. No or minimal blood
  3. No systemic symptoms
  4. Normal ESR
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8
Q

UC Disease Severity Moderate (3)

A
  1. > 4 BM per day
  2. Minimal blood
  3. Minimal systemic complications
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9
Q

UC Disease Severity Severe (7)

A
  1. > 6 BM per day
  2. Positive blood
  3. Evidence of systemic complications
  4. ESR > 30
  5. Hb <75% normal
  6. Abdominal tenderness
  7. Bowel wall edema
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10
Q

Fulminant (7)

A
  1. > 10 stools per day
  2. Continuous blood
  3. Evidence of systemic complications
  4. ESR > 30
  5. Transfusions required
  6. Abdominal pain
  7. Dilated colon
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11
Q

Treatment - Goal of Therapy (4)

A
  1. Reverse and prevent further destruction of inflammatory response
  2. Maintain disease remission
  3. Prevent malignancy
  4. Optimize quality of life
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12
Q

Treatment Pharmacological (3)

A
  1. Generally, consider treatment as immune modulating therapy
  2. Induce remission
  3. Maintain remission
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13
Q

Treatment Drugs for IBD (6)

A
  1. Aminosalicylates
  2. Corticosteroids
  3. Antibiotics
  4. Immunomodulatory Agents
  5. Immunosuppressants
  6. Biologics
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14
Q

Aminosalicylates MOA (3)

A
  1. Unknown
  2. Works topically to inhibit pro-inflammatory cytokines
  3. Inhibits inflammatory transcription of NF-kB to block prostaglandin and leukotriene production
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15
Q

Aminosalicylates Available Agents (6)

A

Mesalamine: Ascacol®, Pentasa®, Rowasa®
Sulfasalazine
Balsalazide

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16
Q

Aminosalicylates ADE (7)

A
  1. Headache
  2. Nausea
  3. Photosensitivity
  4. Diarrhea
  5. Colitis
  6. Pancreatitis
  7. Hepatitis
17
Q

Corticosteroids MOA for IBD (4)

A
  1. Unknown
  2. Decreases transcription of proinflammatory cytokines
  3. Prevents nuclear translocation of NF-kB
  4. Inhibits inflammatory response
18
Q

Corticosteroids Available Agents for IBD (3)

A

Topical – Hydrocortisone

Oral – Prednisone/prednisolone and Budesonide (Enterocort®)

19
Q

Corticosteroids

Place in Therapy for IBD (3)

A
  1. Moderate to Severe
  2. Remission (induction)
    60%-80% in moderate disease
    50%-60% in severe disease
  3. Ineffective for maintenance therapy (IV is used for acute flare)
20
Q

Corticosteroids ADE (8)

A
  1. Weight gain
  2. Glucose intolerance
  3. Hypertension
  4. Neuropsychiatric events
  5. Decreased linear growth
  6. Bone loss
  7. Kyphosis
  8. Adrenal suppression
21
Q

Antibiotics - Place in therapy for IBD

A

Mucosal inflammation and abscesses present

22
Q

Antibiotics Available Agents for IBD (2)

A
  1. Metronidazole
    - Active CD
    - UC maintenance
  2. Ciprofloxacin
    - CD (perineum)
    - UC
23
Q

Immunomodulators Available Agents (3)

A
  1. Azithioprine (Imuran®)
  2. Mercaptopurine (6MP)
  3. Methotrexate
24
Q

Immunomodulators MOA
Azathioprine and mercaptopurine (1)
Methotrexate (2)

A

Azathioprine and mercaptopurine
1. Inhibit inflammatory response (protein synthesis, nucleic acid metabolism, clonal expansion of lymphocytes)

Methotrexate

  1. Unknown
  2. Inhibits proinflammatory cytokins and down-regulates activated T-cells and neutrophils
25
Immunomodulators Place in Therapy (3)
1. Prevention of clinical relapse - Failed previous therapy - Weaned from other therapy and now require induction 2. Azathioprine and mercaptopurine - Induction of mucosal and clinical remission 3. Methotrexate - Second line to azathioprine and mercaptopurine
26
Immunomodulators ADE Azathioprine and mercaptopurine (7)
1. Neutropenia 2. Thrombocytopenia 3. Hepatotoxicity 4. Infection 5. Rash 6. Hypersensitivity 7. Malignancy
27
Immunomodulators ADE -- Methotrexate (5)
1. Neutropenia 2. Thrombocytopenia 3. Nausea 4. Nephropathy 5. Vasculitis
28
Immunomodulators Pearls (4)
1. Thiopurine methyltransferase deficiency 2. Caution with mercaptopurine 3. Risk of metabolite toxicity 4. Patients receiving methotrexate should receive folic acid
29
Immunosuppresants Available Agents (2)
1. Calcineurin inhibitors - Tacrolimus - Cyclosporine 2. Antimetabolites
30
Antimetabolites Available Agent
Mycophenolate mofetil (Cellcept®)
31
Antimetabolites Place in Therapy (2)
1. Suppresses T and B cell proliferation | 2. Decreases lymphocyte proliferation through inhibition of DNA synthesis
32
Antimetabolites MOA (2)
1. Alternative to mercaptopurine and azathioprine therapy | 2. Used in conjunction with other agents
33
Biologics MOA (2)
1. Neutralizes pro-inflammatory cytokine TNF | 2. Activates complement-mediated cytolysis of TNF-producing monocytes
34
Biologics Available Agents (2)
1. Humira - Adalimumab | 2. Remicade - Infliximab
35
Biologics ADE (4)
1. Infusion Related Reactions: Shortness of breath, Chest tightness 2. Hypersensitivity Reactions: Fever, Facial edema 3. Positive ANA titers 4. Infection
36
Biologics Pearls (4)
1. Patients may develop antibodies resulting in loss of response or infusion reactions - Pre-medicate with corticosteroids - Co-treat with corticosteroids 2. Smoking reduces response to infliximab 3. Limited data for use in pediatric patients with UC 4. CAUTION in heart failure patients
37
Adjunct Meds for IBS (3)
1. Loperamide (Imodium) - Useful for proctitis or diarrhea 2. Antispasmodics - Dicyclomine (Bentyl) - Propantheline (Pro-Banthine) - Hyoscyamine (Levsin) 3. Cholestyramine (Questran) - Bile-salt-induced diarrhea after ileal resection

Pediatric Pharm Exam 3 (11 decks)

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