Lecture 10 - Irritable Bowel Disease Flashcards

Question

Assessing TPMP phenotype prior to starting therapy....

Answer 1

pts who have low enzyme lvls increased risk of severe leukopenia if no active TPMP activity, don't initiate if intermediate TPMP activity, reduce start dose 25-50%

Answer 2

1. Limited role in UC, primarily used in CD 2. Long term SE, monitor WBC, RBC,PLT GI ulceration + bleed, hepatoxicity (ALT,ASLT, LFTs) Pulmonary fibrosis/pneumonitis

Answer 3

Primarily used in UC, typically not recommended for treatment of CD except for acute management of pts with severe fistulizng disease used in hospital, have to monitor levels, bunch of DI CYP3A4 SE: HTN, edema, tremor, nephrotoxicity

Answer 4

300-500 mg/ml for IV average response seen in 8 days

Answer 5

maintenance remission therapy due to long time to take to work

Answer 6

``` HA Abdominal pain Infections, URI, sinusitis Dyspnea Urticaria ``` fairly well tolerated overall

Answer 7

black box warning for inc risk of developing infections can reactivate latent TB infusion reactions are possible, typically pts have fever, chills, and or pruritus serum sickness with repeated doses are rare

Answer 8

fully homogenized, better tolerated Common: HA, rash, antibody development, inject site reactions, URI, sinusitis Less common: HTN, confusion, N/V/ab pain, serious infection

Answer 9

URI Increased LFTs Injection/dermatologic reactions

Answer 10

``` Infections: Latent TB activation Hep B react Secondary malignancy CHF exacerbations MS (demylenating disease) ```

Answer 11

Pegylated human anti-tnf similar efficacy to humira + infliximab SE: inc site reaction, cytopenias, Hep B reactivation, new or worsening HF

Answer 12

SE: rash, UTI, infection (flu), n, gastroenteritis, infusion related Black box: increased risk of PML, often fatal **REMS restricted, access through TOUCH program**

Answer 13

MOA: works on T cells Common SE: HA, arterialgia, nasopharyngitis Less common SE: Fatigue, skin rash, infection, UTI, increased LFTs

Answer 14

works on interleukins SE: Serious infections, C.diff, UTI, some cases carcinoma

Answer 15

MOA: inhibit JAK1/3, oral drug Txm adults with mod/sever active UC SE: influenza, nasopharyngitis, modest LDL/HDL inc Rare: serious infections ** FDA safety warning inc risk of VTE pts taking standard 10mg BID dose **

Answer 16

MOA: JAK1/3 inhib, also works on interleukin SE ( >5%): URI, CK + LFT elevation, Acne, Neutropenia, Rash

Answer 17

MOA: block lymphocyte egress from lymph node, reduce inflammation response Common SE: URI, LFT elevation, HA Serious SE: Infections (viral/fungal), Bradyarrhythmias + condition delays, HTN< Respiratory decline, Macular edema

Answer 18

1. similar amino acid sequences, but glycosylation differences between production can impact stability and immunogenicity Must have same strength, dose form, route of admin and indication

Answer 19

not used for much, very specific indications for a few such as Metronidazole and Ciprofloxacin

Answer 20

**Rectal (support + enema) mesalamine more effective than oral 5-ASA or topical steroids for distal disease** Combo oral + topical 5-ASAs more effective than either alone Mesalamine prep typically better tolerated than sulfasalazine, usually 1st line***

Answer 21

1. Corticosteroids (PO or IV), Burst therapy, taper over 6-8wks...2-4wk if tolerated 2. Budesonide MMX, alternative or addition to 5-ASA intolerant/non-responders PO+rectal combo better than solo AZA + 6-MP = limited role, poor risk/benefit, not recommended

Answer 22

1. lower oral doses of agents (1g/day of 5-ASA) 2. Oral+ topical formulations better than either alone 3. Corticosteroids and budesonide not indicated 4. Infliximab, AZA, 6-MP limited role, only in refractory pts

Answer 23

1. Oral 5-ASA (2g/day) 1st line, recommend against alternative 5-ASA for pts who fail to achieve remission on initial 5-ASA, higher doses not associated with better remission 2. oral steroids typically used pts dont respond to combo oral+rectal 5-ASAs 3. Infliximab effective pts steroid refractory or dependent

Answer 24

``` 1st = oral Sulfasalazine or other 5-ASA 2-2.4g/day 2nd = Oral corticosteroids or budesonide as an alternative 3rd = Infliximab ```

Answer 25

1. Lower dose 5-ASA ( sulfasalazine, olsalazine, mesalamine, balsalazide) 2. AZA or 6-MP maybe used 3. TNFi (infliximab pref) ** chronic oral corticosteroids not indicated **

Answer 26

1. Corticosteroid adjust can be considered | 2. early biologic therapy recommended, anti TNF

Answer 27

1. infliximab | 2. Vedolizumab

Answer 28

Ustekinumab and tofacitinib

Answer 29

Thiopurines or MTX + biologic is better than biologic monotherapy

Answer 30

1. give steroid 1a. no response = cyclosporine or infliximab - if remission continue therapy, if no remission Colectomy 1b. if remission = change to prednisone, add AZA/6-MP/infliximab or adalimumab and attempt withdrawal of steroid, continue if remission achieved

Answer 31

Systemic corticosteroids = prednisone w/ taper effective inducing remission Antibiotics - limited efficacy, insufficient data Controversial 1st line = Sulfasalazine (when involves colon) + Mesalamine ( targeting ill disease, better tolerated)

Answer 32

Controlled release budesonide (Entocort)

Answer 33

Taper oral corticosteroids anti-TNF used, combo more effective than mono Ustekinumab = treatment resistant pts AZA, 6-MP, Max = not effective short term Cyclosporine, mycophenolate, taco = controversial but generally not efficacious

Answer 34

1. rule out obstruction, mass, abscess 2. IV corticosteroids 1st line 3. Limited data supporting anti-TNFs

Answer 35

Anti-TNFs AZA, 6-MP Antibiotics

Answer 36

long term corticosteroids not recommended AZA, 6-MP preferred over MTX 5-ASA not effective/recommended