Lecture 6 - Pharmaceutical care in inflammatory bowel disease Flashcards
what is IBD?
chronic inflammatory conditions of the GIT
there are two main types of IBD; ulcerative colitis and crohns disease
ulcerative colitis affects the mucosa of the large bowel whereas crowns disease can effect any part of the GIT.
the third type of IBD is IBD-U or indeterminate colitis. this is when inflammation only affects the colon and it is difficult to differentiate between CD and UC
what are the causes of inflammatory bowel disease?
not yet fully understood.
1) genetic or family history of IBD
2) environmental triggers - viruses, bacteria, diet, certain medicines and stress
3) an abnormal reaction of the immune system to certain bacteria on the intestines
what are symptoms of IBD?
abdominal pain
change in bowel habit/ urgency. diarrhoea often with rectal bleeding, mucus and sometimes, pus.
fatigue/loss of appetite/ weight loss
feeling generally unwell/pyrexia
mouth ulcers
periods of flares and remission
what are complications of IBD?
extra-intestinal manifestations - IBD patients can develop conditions affecting the joints, bones yes or skin. often occurs during active disease, but can develop during remission or before any signs of bowel disease
Risks on fertility/pregnancy.
Impact on mental health, education, work and relationships.
Increased colorectal cancer, developing kidney stones/gallstones and increased two-fold risk of developing blood clots. PR bleeding is not a contraindication to blood thinners
Risk of side effects, failure of treatment+/-surgery, disease relapse.
Risk of life-threatening complications (e.g. Fistulas, abscesses, stricture, perforation).
what is annual cost of IBD to NHS
more than $72 million pa
descried ulcerative colitis
Inflammation and ulceration of the inner lining of the rectum and colon.
Estimated to affect about one in every 420 people in the UK.
More common in urban areas in northern, developed countries although, numbers are increasing in developing nations.
More common in white Europeans.
Affects women and men equally.
Tends to develop more frequently in ex/non-smokers (risks of smoking outweigh benefits so smoking is strongly discouraged).
UC can only be cured after a total colectomy and stoma formation.
what are the different types of colitis?
proctitis - involves only the rectum
proctosigmviditis involves the rectum and sigmoid colon
distal colitis involves only the left side of the colon
pancolitis involves the entire colon
describe crohns disease
Most likely to develop in ileum or colon.
Inflammation can occur in all layers of the bowel wall.
Estimated to affect 1 in every 650 people in the UK.
More common in urban areas in northern, developed countries although, numbers are increasing in white people of European descent.
Appears to be slightly more common in women.
More likely to occur in people who smoke. Stopping smoking can reduce the severity of Crohn’s. SMOKING CESSATION
No cure for Crohn’s disease.
what are types of crowns disease ?
A. terminal ill and ileocaecal
(B) Small bowel
(C) Colonic/Crohn’s colitis
(D) Gastroduodenal
(E) Peri-anal (around the anus).
Fissures – tears/splits in the lining of the anal canal causing pain/bleeding
Skin tags - small fleshy growths around the anus
Haemorrhoids/piles – small blood vessels in or around the anus and rectum which may bleed.
Abscesses – swollen/painful collections of pus in the area around the anus. Can cause fever or lead to a fistula.
Fistulas – narrow tunnels between the gut and the skin or another organ.
(F) Oral Crohn’s disease
what is the treatment goal for IBD
Reduce symptoms
Control flare-ups and achieve remission
Maintain remission
Many drugs are taken for many years (e.g. mesalazine/azathioprine); others are taken for short periods (e.g. steroids).
what is the main drug treatment of IBD and what drugs are used?
The main aim of drug treatment is to reduce inflammation.
The main types of drugs are:
Aminosalicylates (5-ASAs)
Corticosteroids
Immunosuppressants
(thiopurines, methotrexate, biologic agents)
describe the use of Aminosalicylic acids (5-ASA)
Licensed to treat UC and Crohn’s colitis (not for ileal Crohn’s).
Reduces inflammation in the lining of the intestine, allowing damaged tissue to heal.
Treatment of mild to moderate acute attacks and to maintain remission (higher doses used in acute flares).
Examples include mesalazine, olsalazine, sulphalazine and balsalazide.
The mechanism of action of mesalazine is not yet fully understood. Thought to be a more local effect on the inflamed intestinal tissue rather than a systemic effect.
what are brand names of the drug Aminosalicylic acids (5-ASA) sold as and their release like?
Asacol®, Octasa®, Salofalk®: Enteric coated so dissolve at a certain pH in the gut. They begin to release the drug at last part of small bowel and the beginning of the colon.
Pentasa®: Coated micro-granules enter the duodenem and the drug is continuously released throughout the GIT in any pH condition.
Mezavant®: Releases the drug as they pass through the large intestine
Aminosalicylates are chemically related to aspirin so should be avoided in patients with salicylate hypersensitivity
what are monitoring requirement of Aminosalicylic acids (5-ASA)
Orally: tablet/capsule/granule.
Topically: suppository, liquid or foam enema.
“Top and tail” approach when a patient is flaring.
Renal function before starting, 3 months after starting then annually.
Potential side effects: Nausea, vomiting, diarrhoea, headache.
See GP if unexplained bruising/bleeding, skin rash, sore throat, fever, purpura (may indicate bleeding disorder).
describe the use of immunosuppressants
Licensed for moderate to severe disease.
“Weaken” immune system to stop it attacking the gut thereby reduce inflammation but increase risk of infections/cancers.
Patients should not take immunosuppressants if they are unwell/on antibiotics
Try to avoid close contact with people with infections. Greater risk of becoming seriously ill from chickenpox, shingles, measles, coronavirus etc.
Examples in IBD include corticosteroids, thiopurines, methotrexate and biologic medicines.
Can take months to work to full effect-may need to “bridge” with steroids if symptomatic.
