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LC Gastroenterology Week 5 > Inflammatory bowel disease: Therapy > Flashcards

Inflammatory bowel disease: Therapy Flashcards

1
Q

What are the main aims in the treatment of IBD?

A

Control inflammation and heal the mucosa
Restore normal bowel habit
Improve the quality of life
Balance the effects of disease with side effects of treatment
Avoid long term complications

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2
Q

What different theaptutic strategies could you do?

A

Lifestyle advice
Drugs
Surgery

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3
Q

What lifestyle advice would you give to someone with IBD?

A

Crohns - STOP SMOKING, worse outcome, more rapid recurrence post-surgery

Diet - is not implicated in the pathogenesis but can influence some symptoms

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4
Q

What do all drug therapies for IBD have?

A

anti-inflammatory effects

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5
Q

What are the drug options for UC?

A

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

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6
Q

What are the drug options for Crohns disease?

A

Steroids
Immunosuppressants
Anti-TNF therapy

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7
Q

What is the mechanisms of action of 5ASA drugs used in UC?

A

Topical effect
Anti-inflammatory properties
Reduces risk of colon cancer

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8
Q

What are the side effects of 5ASA drugs?

A

Diarrhoea, idiosyncratic nephritis

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9
Q

Nav some examples of 5-ASA drugs?

A

Mesalazine
Sulphasalazine

Balsalazide

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10
Q

What can 5ASA drugs do in terms of mechanism of actions?

A

They have delayed release - pH dependent

Prodrugs

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11
Q

Describe the use of suppositories?

A

They coat <20cm but have better mucosal adherence than enemas do

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12
Q

Describe the use of enemas?

A

Reflex contration aids proximal spread of foam or liquid enemas

<10% of enemas remain in the rectum

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13
Q

Describe the use of corticosteroids?

A

systemic anti-inflammatory properties

Induces remission
Short course - high dose initially reduce over 6-8 weeks

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14
Q

Give some examples of corticosteroids?

A

Prednisolone

Budesonide

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15
Q

What are the side effects of steroids?

A

Osteoporosis
Weight gain

Diabetes
Hypertension
Cataracts
Acne

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16
Q

When do you need to use immunosuppression in IBD?

A

When more potent suppression of inflammation is required

17
Q

What are immuosuppresants used for in UC and Crohns?

A

UC - steroid sparing agents

Crohns - maintenance therapy

18
Q

Give some examples of immunosuppressants used?

A

Azathioprine

Methotrexate

19
Q

Describe azathioprine?

A

Immunosuppressant

Slow onset of action (16 weeks)
TPMT activity contributes to toxicity
Regular blood monitoring needed

20
Q

What are the side effects of azathriprine?

A

Pancreatitis
Leucopenia
Hepatitis
Small risk of lymphoma - skin cancer

21
Q

Describe anti-TNF therapy?

A

Tumour necrosis Factor alpha = pro inflammatory cytokine

Antibodies to TNF

Promotes apoptosis of activated T-lymphocutres

Rapid onset of action

22
Q

Give an example of anti-TNF therapy?

A

IV infliximab

23
Q

What does re-treatment of anti-TNF do?

A

Maintains mission
Reduces hospitalisation and need for surgery

(only used in UC mod-severe)

24
Q

When should you used Anti-TNF according to NICE guidelines?

A

As part of long terms strategy, including immune suppression, surgery(crohns) and supportive therapy

Refractory/fistulising disease

Make sure to recluse current infection/TB

25
Q

Describe emergency surgery in IBD?

A

Failure to respond to medical therapy, small bowel obstruction, abscess, fistulae

26
Q

Describe elective surgery in IBD?

A

Failure to respond to medical therapy

Dysplasia of colon mucosa

27
Q

Describe surgery in crohns?

A

Minimise amount of bowel resected
Not curative

Repeated resection of small intestine can result in ‘short gut syndrome’ and requirement of lifelong total parenteral nutrition (reduced life expectancy)

28
Q

Describe surgery for UC?

A

Curative

Option of permanent ileostomy OR restorative proctocoloectomy and pouch

29
Q

Describe the mechanism of Anti-TNF therapy - detail?

A

Anti-TNF therapy: a type of biological therapy; blocking the actions of TNF alpha, which is secreted by macrophages and dendrites during antigen presentation phase, preventing them from producing other inflammatory cytokines, does so by promoting apoptosis of effector T cells

LC Gastroenterology Week 5 (10 decks)

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