Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Module 3: Crohns Disease Dr. Covert > Flashcards

Module 3: Crohns Disease Dr. Covert Flashcards

Dr. Covert EXAM V

1
Q

IBD Etiology

A

-not fully understood

-a combination of:
Immunology factors: autoimmune activity against the linage of the GI tract -> Immunosuppressants
Infection

Genetics: tends to run in the family, some genes discovered

Infection: pro-inflammatory microflora in patients with IBD (theory)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Differences Crohn’s Disease vs. Ulcerative Colitis

A

-Crohn’s disease: patchy areas of inflammation (Cobblestone appearance) in the Gi (also from mouth to anus), Illeal involvement more common, transmural involvement (deep in the layer of the GI mucosa)

-Ulcerative colitis:
continuous area of inflammation primarily in the colon (large intestine), rectal involvement more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which symptoms are more common in Crohn’s disease?

A

-Fatigue, malaise
-abdominal pain
-rectal bleeding (also seen sometimes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which symptoms are more common in Ulcerative Colitis?

A

-rectal bleeding
-abdominal (also seen sometimes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common Complications in Crohn’s Disease

A

-Strictures (narrowing of the affected GI organ e.g small intestine)
-Fistulas (e.g. tunnel between small and large intestinal loop)
-Ulcers
-Malnutrition (bc of a higher percentage of inflammation in Crohn’s disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Common Complications in Ulcerative Colitis

A

-Crypt Abscesses
-Toxic Megacolon
-Colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Staging of Crohn’s disease

A

Mild: is the patient ambulatory?, able to take PO, afebrile?

Moderate: failed mild therapy or more fever, weight loss, abdominal pain, tenderness

Severe: failed corticosteroids and biologics (mABs), high fever, persistent N/V, obstruction, abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which drug to use in Mild to moderate IBD?

A

Aminosalicylates (induction or maintenance of remission)
-more in UC than in CD (oral and rectal depending on the area of inflammation - endoscopy or colonoscopy check)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Counseling points/ Caution in 5-ASA

A

-allergies to Salicylates and Sulfasalazine/Sulfonamides

-take after a meal (better absorption)

-do not crush (bc they are XR, DR and it would release too early)

-may initially worsen IBD

-may take 4-6 weeks for symptom resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ADR of 5-ASA

A

-headache
-rash
-N/VD

-severe ADR: hepatoxicity (not common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to identify the area of inflammation

A

-Endoscopy
-Colonoscopy

-important bc different drugs work in SPECIFIC parts of the GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which drugs work where

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which drug to use to induce remission?

A

Steroids

systemic steroids: 40-60 mg PO or IV Prednisone daily
-taper when on for > 10 days
-no response after 3-7: poor prognosis
-high dose hydrocortisone for severe disease: 100 mg IV 3-4x daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Topical steroid

A

Budesonide for mild Chrohns disease, less side effects since topical

-Entocort EC: capsule released only in the distal part of the GI tract

-Uceris: rectal form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which agents can be used for Induction and Maintenance

A

Biologics

-take almost 2 weeks -> consider steroids to “bridge”

-Infliximab (Remicade), Infliximab-dyyb (Inflectra)
-Adalimumab (Humira), Adalimumab-atto (Amjevita)
-Certolizumab (Cimzia)
-Natalizumab (Tysabri)
-Vedolizumab (Entyvio)
-Ustekinumab (Stelara)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which Anti-TNF agents (bilogics) are commonly used when oral agents failed in UC and CD?

A

-Adalimumab (SC)
-> when failed:

-Infliximab (IV) + thiopurine

17
Q

Which biologic is reserved for Crohn’s disease?

A

Certolizumab (SQ)

18
Q

What are the side effects of anti-TNF agents?

A

Black box warnings:
-Tuberculosis infection (they need a negative Tb test)

-Hepatic malignancy (HSTCL)

-also for:
anaphylaxis
worsening of HF
Hep B reactivation
Pancytopenia

19
Q

What are the second-line biologics

A

-Integrin receptor antagonists (for patients who failed anti-TNF)

-Vedolizumab (Entyvio) -> more often used
CD and UC
IV infusion
Minimal PML risk (crosses the brain less)

-Natalizumab (Tysabri) - crosses the brain more
CD only
IV infusion
Progressive multifocal leukoencephalopathy (PML)
-> brain damage in those who had a John Cunningham virus

20
Q

What to screen for when using Natalizumab?

A

John Cunningham virus (JC virus)

21
Q

Last line antibitotic

A

Ustekinumab (Stelara®): Maintenance of
Remission

-MOA: IL-12 and IL-23 antagonist
-SubQ q 4-12 weeks
-used when other biologics fail
-ADR: infections, malignancy

22
Q

Immunomodulators

A

Monotherapy or Combination with biologic, Thiopurines preferred

-Thiopurines (Azathioprine, 6-Mercaptopurine)
CD and UC
PO
ADR: Bone marrow suppression, hepatotoxicity

-Methotrexate
CD
IM, SQ
ADR: Bone marrow suppression

23
Q

Which Immunomodulator should be avoided?

A

Methotrexate, especially in combination with TNF inhibitor -> HSTCL cancer

24
Q

Which antibiotic should only be used in Fistulizing Crohn’s disease?

A

-Fistula: connection between parts of bowels that are normally not connected -> bacteria moving in areas where they are not supposed to be

-gram-negative and anaerobe coverage
-Metronidazile 500 mg IV q8h +
Cipro 400 mg IV q 12h

25
Q

How to induce remission

A

-5-ASA +/- Budesonide PO
-continue Budesonide for 8-12 weeks then taper
-Maintenance: 5-ASA

26
Q

What to do if the patient does not respond/ or moderate/ severe Crohn’s disease?

A

-5-ASA with 60 mg Prednisone/equivalent (higher steroid dose)
-if they respond: taper the steroid -> continue 5-ASA

27
Q

What if they still don’t respond?

A

-add steroid back OR
-add immunomodulator OR
-add TNF inhibitor OR
vedolizumab (integrin receptor antagonist) +/- immunomodulator (thiopurine)
-> Remove 5-ASA

if response: taper steroid after 2-4 weeks, continue biologic +/- immunomodulator (thiopurine)

28
Q

What if they still don’t respond?

A

add immunomodulator (thiopurine) if not already OR
consider Ustekimumab

29
Q

What agent to consider in severe or Fistula Crohns disease?

A

-Hydrocortisone IV 100 mg q 6-8h
-consider infliximab (TNF-inhibitor) + immunomodulator (thiopurine)

Fistula: same + antibiotics (gram negative + anaerobe coverage)
-Hydrocortisone IV 100 mg q 6-8h
-consider infliximab (TNF-inhibitor) + immunomodulator (thiopurine) + antibiotics

30
Q

Non-pharmacologic therapies

A

Nutrition:
-Elimination of exacerbating foods
-Probiotic use
-Nutrition support (gain and maintain weight)

Fecal microbiota transplants: more data needed

GI (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions