Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) Flashcards
Which drugs are used in chronic bowel disorders?
Sulfasalazine, sulfapyridine, mesalazine, balsalazide sodium, olsalazine sodium, MTX (w/ folic acid), monoclonal antibodies targeting TNF-alpha.
What are two common side effects of 5-aminosalicylic acid (5ASA) drugs?
Blood disorders and lupus-like syndrome.
Which cytokine modulating monoclonal antibodies can be used to treat inflammatory bowel diseases?
Infliximab, adalimumab, golimumab.
What type of disease is Crohn’s disease?
Chronic, inflammatory bowel disease.
What are the key features of Crohn’s disease?
Thickened areas of the GIT wall. Inflammation extending through all layers. Deep ulceration and fissuring of the mucosa. Presence of granulomas. Affected areas may be found anywhere in the GIT.
What are the symptoms of Crohn’s disease?
Abdominal pain. Diarrhoea. Fever. Weight loss. Rectal bleeding.
What complications are associated with Crohn’s disease?
Intestinal strictures (narrowing of the intestine). Abscesses in the GIT wall or surrounding structures. Fistulae. Anaemia. Malnutrition. Colorectal and small bowel Cx. Growth failure. Delayed puberty in children.
What extra-intestinal manifestations are associated with Crohn’s disease?
Extra-intestinal manifestations include arthritis and other abnormalities of the joints, eyes, liver, and skin.
In what proportion of patients with Crohn’s disease does fistulising Crohn’s disease occur?
1/4.
What are the aims of Crohn’s disease treatment?
Induction and maintenance of remission. Reducing symptoms and maintaining or improving quality of life, whilst reducing toxicity in both the short and long term. In fistulising Crohn’s Disease, surgery and medical treatment aim to close and maintain closure of the fistula.
What drugs are used for first line for monotherapy in acute Crohn’s disease?
Corticosteroids (prednisolone, methylprednisolone, and IV hydrocortisone).
When is budesonide considered for use as monotherapy in acute Crohn’s disease?
In distal ileal, ileocecal or right sided colonic disease, where conventional corticosteroids are contraindicated or unsuitable.
When should budesonide not be considered for monotherapy in acute Crohn’s disease?
In severe presentations or exacerbations.
When are aminosalicylates considered as monotherapy in acute Crohn’s disease?
In patients for whom corticosteroids are contraindicated or otherwise inappropriate.
When should aminosalicylates not be considered for monotherapy in acute Crohn’s disease?
In severe presentations or exacerbations.
When should add on therapy be considered for acute Crohn’s disease?
Add on treatment is prescribed if there are two or more inflammatory exacerbations in 12 months, or the corticosteroid dose cannot be reduced.
Which medications can be added to corticosteroid treatment to induce remission?
Azathioprine or mercaptopurine (unlicensed).
If azathioprine or mercaptopurine add-on treatment is not suitable for a Crohn’s patient, what can be used as an alternative?
Methotrexate.
Which TNF-alpha inhibiting monoclonal antibodies can be considered, under specialist supervision, for severe active Crohn’s disease?
Adalimumab or infliximab.
When would TNF-alpha inhibitors be considered in acute Crohn’s disease?
Following inadequate response to conventional treatment or contraindications.
Which monoclonal antibodies can be considered in place of adalimumab or infliximab when treatment with these drugs fails, is contraindicated, or not tolerated for the induction of remission in patients in Crohn’s disease?
Vedolizumab or ustekinumab.
Which symptoms of relapse should Crohn’s patients, who refuse treatment for maintenance of remission, be made aware of?
Unintended weight loss, abdominal pain, diarrhoea, general ill-health.
What should be put in place when a Crohn’s patient refuses treatment for maintenance of remission?
A suitable follow up plan should be agreed upon and information on access to healthcare should be provided in the case of relapse.
When used with corticosteroids to induce remission in patients with Crohn’s disease, which drugs can be used to maintain remission?
Azathioprine or mercaptopurine.
When can azathioprine or mercaptopurine be considered to maintain remission in patients with Crohn’s disease who have not received these drugs for induction of remission?
Particularly in those with factors such as early age of onset, perianal disease, corticosteroid use at presentation, severe presentations.
When can methotrexate be considered for maintenance of remission in patients with Crohn’s disease?
When it has been used to induce remission or treatment with azathioprine or mercaptopurine has failed, is not tolerated, or is contraindicated.
Which drugs should not be used to maintain remission in patients with Crohn’s disease?
Corticosteroids or budesonide.
What feature distinguishes Crohn’s disease and ulcerative colitis?
Crohn’s affects any part of the GIT and UC affects the colon only.
Give some examples of aminosalicylates.
Sulfasalazine, mesalazine, balsalazide, olsalazine.
What key side effect(s) should patient on aminosalicylates be aware of?
Blood disorders. Unexplained bleeding, bruising, purpura, sore throat, fever or malaise occurring during treatment. A blood count should be performed and drug stopped immediately if there is signs of blood dyscrasias.
