Management of IBD

Question 1

5-ASA

• use
• examples
• route of administration
• mechanism of action
• side effects

Answer 1

First line for UC, long term
eg: mesalazine, sulfasalizine (co-administer folic acid), pentasa
Administration route: topical or oral
- topical; suppositories, enemas (at night)
- oral; prodrugs, direct the drug to the correct part of GIT and then the drug is released
MOA: anti-inflammatory properties act on bowel surface
SE: diarrhoea, nephritis

Question 2

Corticosteroids

• use
• examples
• route of administration
• mechanism of action
• side effects

Answer 2

Use: Crohn’s, UC for acute flare up
eg: Prednisolone, budesonide
Administration route: oral (crohn’s), topical (UC)
MOA: systemic anti-inflammatoy properties, used to induce remission, short course (6-8 weeks)
Side effects: Steroid dependence, acne, weight gain

Question 3

Immunosuppression

• use
• examples
• MOA

Answer 3

Use: Crohn’s, UC when pts are unresponsive to steroids
- crohn’s (maintenance therapy)
- UC (steroid sparing agent)
eg: azathioprine, methotrexate
MOA: Inhibit T ell function
azathioprine: give it on a weight basis, slow onset of action

Question 4

Anti TNF therapy

• use
• examples
• MOA

Answer 4

Use: part of a long term management plan only if no other treatment options work
eg: infliximab, adalimumab
MOA: promotes apoptosis of activated T cells, mucosal healing

Question 5

Surgery indications

Answer 5

If Medication doesn’t work

If complications arise

Question 6

Ileostomy

Answer 6

Usually RHS abdo
Hard
Spout
Walnut whip, closed rose

Question 7

Colostomy

Answer 7

Usually LHS abdo
Soft, squashy
Flush with skin
Open rose

Question 8

Emergency crohn’s

Answer 8

resection

Question 9

Elective crohn’s

Answer 9

Resection

Question 10

Emergency UC

Answer 10

Sub total colectomy

Question 11

Elective UC

Answer 11

Proctocolectomy with end ileostomy or a pouch

Question 12

Pouch

Answer 12

Take intestines etc out until dentate line

Alternative to an ileostomy (stoma bag)