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NAPLEX Content > Inflammatory Bowel Dx (IBD) > Flashcards

Inflammatory Bowel Dx (IBD) Flashcards

1
Q

What’s used to treat acute exacerbation of IBD?

A

Short courses of oral and IV steroids

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2
Q

What’s used for maintenance therapy to control inflammation and reduce flare-ups of IBD?

A

Aminosalicylates

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3
Q

Which is the main Aminosalicylates used for maintenance therapy to control inflammation and reduce flare-ups of IBD?

A

Mesalamine

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4
Q

What’s used in pts with IBD refractory to Aminosalicylates and immunosuppressants?

A

Anti-TNF such as Infliximab

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5
Q

Should AB and probiotics be take at the same time?

A

No!

Separated by at least 2 hrs

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6
Q

Sorbitol and IBS?

A

Sorbitol is used as a sweetener as can cause considerable GI distress in some pts with IBD

Sorbitol also has laxative properties

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7
Q

Lactose and IBD?

A

If pt is lactose-intolerant may worsen IBD

Both sorbitol and lactose are used as excipients (binders) in tabs

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8
Q

List antidiartheal (agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Loperamide (Imodium)

Bismuth subsalicylate (Pepto-Bismol)

Diphenoxylate 2.5mg + Atropime 0.025mg (Lomotil)

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9
Q

Brand name of Loperamide? (antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Imodium

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10
Q

How long can pt self-treat Loperamide (Imodium)?

A

No more than 2 days

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11
Q

Brand name of Bismuth Subsalicylate? (antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Pepto-Bismol

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12
Q

SE of Bismuth subsalicylate (Pepto-Bismol)?

A

Black tongue/stop.

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13
Q

Brand name of Diphenoxylate 0.25mg + Atropine 0.025mg?

A

Lomotil

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14
Q

Which of the antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms is a controlled substance?

A

C V

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15
Q

List agents under Antispasmodic? (Used for mild sx control in IBD)

A

Dicyclomime (Bentyl)

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16
Q

Brand name of Dicyclomine (antispasmodic agent)?

A

Bentyl

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17
Q

SEs of Dicyclomine (Bentyl) - antispasmodic agent

A

Dizziness

Xerostomia

Nausea

Blurred vision

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18
Q

List oral steroids used for mild sx in IBD

A

Prednisone

Budesonide (Entocort EC)

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19
Q

What’s the brand name of Budesonide? Oral steroid used for mild sx of IBD

A

Entocort EC

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20
Q

Should u crush Budesonide (Entocort EC, Uceris) Oral steroid used for mild sx of IBD?

A

No!

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21
Q

Short-term SEs of oral steroids (Prednisone and Budesonide (Entocort EC))?

A

Increased appetite/wt gain

Fluid retention

Emotional instability (euphoria, mood swings, irritability)

Insomnia

GI upset

Higher doses - increase in BP and BG

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22
Q

Long-term SEs of oral steroids (Prednisone and Budesonide (Entocort EC))?

A

Adrenal suppression/Cushing’s syndrome

Impaired wound healing

HTN

Hyperglycemia

Cataracts

Osteoporosis

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23
Q

If oral steroids (Prednisone and Budesonide (Entocort EC)) are used long-term, what should be assesses? Supplement?

A

Bone density

Consider Bisphosphonates, optimize Ca and Vit. D intake

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24
Q

Budesonide (Entocort EC) and first-pass metabolism?

A

Budesonide (Entocort EC) undergo 1st-pass metabolism, so,lower systemic exposure may occur

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25
Q

How do u d/c if oral steroids (Prednisone and Budesonide (Entocort EC)) is used longer than 2 wks?

A

Must taper over 3-4 wks

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26
Q

When’s Budesonide (Entocort EC) preferred over prednisone in IBD?

A

If dx is in ileum or ascending colon

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27
Q

How do u use Prednisone and Budesonide (Entocort EC)?

A

Swallow whole - don’t crush, chew or break

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28
Q

List topical agents used in mild sx control of IBD

A

Hydrocortisone (Cortifoam, Cortenema)

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29
Q

T/F? Topical steroids (Hydrocortisone (Cortifoam, Cortenema)) have proven to be effective for maintenance of remission of IBD?

A

False!

They are not effective in maintenance of remission

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30
Q

Effect of potent inh (Ketoconazole, Itraconazole, Ritonavir etc) on Budesonide?

A

Budesonide may req dose reduction (3A4 substrate)

31
Q

Grapefruit and Budesonide?

A

Avoid Grapefruit in Budesonide

32
Q

List drugs used in maintenance therapy for IBD (Aminosalicylates)

A

Mesalamine (Asavo HD, Lialda - long acting orals)
(Canasa - suppository)
(Rowasa - enema)

Sulfasalazine (Azulfidine, Sulfazine)

Basalazide (Colazol, Glazo)

Olsalazine (Dipentum)

33
Q

What’s the brand name of Mesalamine? Suppository? Enema?

A

Asacol HD; Lialda

Canasa (suppository)

Rowasa (enema)

34
Q

Mesalamine and antacids, H2RAs or PPIs?

A

Avoid concomitant use of Mesalamine with antacids, H2RAs or PPIs

Interferes with absorption

35
Q

What’s most effective for Distal dx/ proctitis in UC?

A

Topical mesalamine

36
Q

CI to Sulfasalazine use? (Maintenance therapy in IBD)

A

Sulfa or salicylate allergy

37
Q

Se to Sulfasalazine use? (Maintenance therapy in IBD)

A

HA

Rash

Anorexia

Dyspepsia

GI upset (n/v/d)

Oligosoermia (reversible) all > 10%

Folate deficiency

38
Q

Sulfasalazine use and skin discoloration? (Maintenance therapy in IBD)

A

Sulfasalazine can cause YELLOW-ORANGE coloration of skin/urine

39
Q

Sulfasalazine use and folate? (Maintenance therapy in IBD)

A

Sulfasalazine impairs folate absorption

May give 1 mg/ day folate supplement

40
Q

In what Grp of is Balsalazide (Glazo) approved?

A

Males only

41
Q

SEs of Olsalazine (Dipentum) (Maintenance therapy in IBD)

A

Diarrhea

Abdominal pain

42
Q

Role of immunosuppressive agents in IBD?

A

Only for use if of fails maintenance therapy or used in combo with maintenance therap

43
Q

List Immunosuppresive agents used in IBD

A

Azathioprine (Azasan, Imuran)

6-Mercaptopurine (Purinethol)

Methotrexate (Rheumatrex, Trexail!

44
Q

SE of Azathioprine (Azasan, Imuran)?

A

GI upset (n/v)

Rash

Increased LFTs

Hematologic toxicities (leukopenia, thrombocytopenia)

45
Q

Which Grp of pt may be more sensitive to myelosuppressive effects and may req a lower dose of Azathioprine (Azasan, Imuran)?

A

Pts with genetic deficiency of thiopurine methyltransferase (TPMT)

46
Q

SE of Methotrexate (Rheumatrex; Trexail)?

A

N/v

Increased LFTs

Stomatitis

Alopecia

Photosensitivity

47
Q

Preg cat. of Methotrexate (Rheumatrex; Trexail)?

A

X

48
Q

Role of Monoclonal antibodies to TNF?

A

Last line… After everything else has failed

49
Q

List monoclonal antibodies to TNF agents used in IBD

A

Adalimumab (Humira)

Infliximab (Remicade)

Golimumab (Simponi)

Natalizumab (Tysabri)

Certolizumab (Cimzia)

50
Q

Brand name of Adalimumab? (monoclonal antibodies to TNF agents used in IBD)

A

Humira

51
Q

Brand name of Infliximab? (monoclonal antibodies to TNF agents used in IBD)

A

Remicade

52
Q

Brand name of Golimumab? (monoclonal antibodies to TNF agents used in IBD)

A

Simponi

53
Q

Brand name of Natalizumab? (monoclonal antibodies to TNF agents used in IBD)

A

Tysabri

54
Q

SEs of Adalimumab (Humira)?

A

Injection site rxns

55
Q

BBW of Infliximab (Remicade)? Similar to the others, except Natalizumab (Tysabri)

A

Serious infections (some fatal)

D/c tx if pt develops a severe inf; lymphomas and other malignancies; perform test for latent TB prior to starting therapy

56
Q

CI of Infliximab (Remicade)?

A

Doses > 5 mg/kg in moderate-severe HF (NYHA class III/IV)

57
Q

SEs of Infliximab (Remicade)?

A

Infusion rxns e.g.
Hypotension, fever, chills, pruritus (may pre-treat with APAP, antihistamine and/or steroids); inf, URT sx, HA, abdominal pain

58
Q

Monitoring of Infliximab (Remicade)?

A

TB test (prior to admin and annually)

CBC

LFTs

HBV (prior to initiation)

59
Q

Role of Infliximab (Remicade) in IBD?

A

Alternative 1st line in mod-severe Crohn’s or UC

60
Q

SEs of Golimumab (Simponi)?

A

Infection

Upper respiratory tract (URT) sx

Inj site rxns

61
Q

BBW of Natalizumab (Tysabri)?

A

Risk for progressive multifocal leukoencephalopathy (PML)

62
Q

SE of Natalizumab (Tysabri)?

A

Infusion rxns

HA

Fatigue

63
Q

What should be done if there’s no response to Natalizumab (Tysabri) after week 12?

A

D/c

64
Q

Which immunosuppressant is parts of a REMS program?

A

Natalizumab (Tysabri)

TOUCH prescribing program

65
Q

How should Mesalamine and Budesonide not be taken?

A

Don’t crush or chew

66
Q

Which of the meds for IBD may one see a ghost tablet in the feces?

A

Asacol HD

67
Q

T/F? Mesalamine is considered 1st line therapy for distal dx of IBD?

A

T

Note: oral therapy is NOT preferred for initial tx

68
Q

SE of long-term steroid use in IBD?

A

Poor wound healing

Fat distribution

Adrenal suppression

Peptic ulcers

69
Q

What dosage form does Infliximab (Remicade) come in?

A

IV ONLY

70
Q

Which tests should be done prior to staring Infliximab (Remicade)?

A

CBC

TB

HBV

71
Q

MOA of Infliximab (Remicade)?

A

Chimeric monoclonal antibody against TNF

72
Q

List SEs that may occur from using Infliximab (Remicade)?

A

Infusion-related rxns

Antibody induction

Hepatoxicity

Reactivation of latent TB

73
Q

Name major types if inflammatory bowel dx (IBD)?

A

Ulcerative colitis (UC)

Crohn’s dx

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