Inflammatory Bowel Disease treatment Flashcards
In Crohn’s disease, what nutritional deficiencies are expected in jejunoileitis?
Anemia
Hypoalbuminemia
Hypocalcemia
Hypomagnesemia
Coaguolopathy
Hyperoxaluria with nephrolithiasis
Typical presentation of patient with Colitis in Crohn’s disease
Low grade fever Malaise diarrhea Crappy abdominal pain Sometimes hematochezia
These agents are effective at inducing and maintaining remission in Ulcerative Colitis, with limited role in inducing remission in CD but no clear role in maintenance in CD
5-ASA agents
Hypersensitivity reaction in sulfasalazine include? 8 manifestations
- Rash 2. Fever 3. Hepatitis 4. Agranulocytosis 5. Pancreatitis 6. Worsening of colitis 7. Hypersensitivity pneumonitis 8. Reversible sperm abnormalities
Which of the oral 5-ASA preparations exclusively deliver in the colon?
Sulfasalazine Balsalazide
Patients taking sulfasalazine are in danger of which nutritional deficiency?
Sulfasalazine can also impair folate absorption and should be given folic supplement
What are the common side effects of 5-ASA?
Headache Nausea Hair loss Abdominal pain
This is a new glucocorticoid for UC which is released entirely in the colon and has minimal to no glucocorticoid side effects.
Budesonide 9 mg/d for 8 weeks and no taper is required.
True or. false. topical 5-ASA is more effective than topical steroid therapy in the treatment of distal UC.
True.
True or False. Glucocorticoids are important in maintenance therapy of both UC and CD.
False.
Which antibiotic/s is/are effective in active inflammatory, fistulizing and perianal CD?
Metronidazole and Ciprofloxacin. However ciprofloxacin is associated with tendinitis and tendon rupture.
Which is the active end product of azathioprine and 6-mercaptopurine?
Thioinosinic acid (inhibitor of purine ribonucleotide synthesis and cell proliferation
Side effects of 6-MP and Azathioprine
Pancreatitis (completely reversible upon cessation of meds) Nausea, fever, rash, and hepatitis Bone marrow suppression (dose related)
What does methotrexate inhibit?
Dihydrofolate reductase which results in impaired DNA synthesis
Potential toxicities of Methotrexate
Leukopenia hepatic fibrosis Hypersensitivity Pneumonitis
Pharmacological effects of Cyclosporine
Blocks the production of IL-2 by helper T cells Indirectly inhibits B cell function by blocking helper T cells CSA binds to cyclophilin which inhibits CALCINEURIN (involved in activation of T cells)
Side effects of CSA
Renal toxicity Hypertension Gingival hyperplasia Hyper triceps is Paresthesias Tremors Headaches Electrolyte abnormalities
____________ is a macrolide antibiotic which is 100 times as potent as CSA but not dependent on bile or mucosal integrity for absorption
Tacrolimus.
First biological therapy approved for moderate to severely active CD and UC, IgG1 antibody against TNF-alpha
Infliximab
Which drug has similar mechanism of action to infliximab but with less immunogenicity?
Adalimumab
Which medication is a pegylated form of an anti-TNF Fab portion of an antibody administered SC once monthly?
Certolizumab pegol (effective for induction of clinical response in patients with active inflammatory CD)
What are the side effects of anti-TNF therapies?
Development of antibodies Non-Hodgkin’s lymphoma Hepatosplenic T-cell lymphoma Skin lesions (psoriasiform lesions) Infections (reactivation of latent TB)
Examples of anti-integrins
NVU (Nat Ved Us) Natalizumab Vedolizumab Ustekinumab
Anti-integrin not widely used for CD due to the risk of Progressive Multifocal Leukoencephalopathy
Natalizumab (recombinant humanized IgG4 antibody against alpha-integrin
