Pharm - IBD Flashcards
clinical and pathological features of UC
the ones bolded by Letassy are starred
- continuous distribution
- RARELY ileal and transmural involvement
- crypt abscesses VERY common
- NO cobblestone appearance
- uncommon: malaise, fever, abd pain
- rare: aphthous/linear ulcers, strictures, fistulas
- rectal involvement is common
clinical and pathological features of CD
the ones bolded by Letassy are starred
- discontinuous distribution
- ileal involvement VERY common
- Transmural involvement common
- crypt abcesses RARE
- cobblestone appearance common
- common: malaise, fever, abd pain, strictures, fistulas, aphthous/linear ulcers
- rectal involvement is rare
proctitis
-UC disease confined to the rectum
proctosigmoiditis
-UC disease extending to the sigmoid colon only
distal disease (left-sided colitis)
-UC disease that only reaches to the splenic flexure
extensive disease (pancolitis)
-extends to entire colon
What classifies a UC patient as mild
- <4 stools/day +/- blood
- no systemic complications
- normal ESR (0-30 mm/h)
What classifies a UC patient as moderate
- > 4 stools/day with blood
- minimal systemic complications
What classifies a UC patient as severe
- > or equal to 6 stools/day with blood and cramps
- evidence of systemic complications as indicated by:
- fever (>37.5 C)
- tachy (>90 BPM)
- anemia (<10.5 g/dl)
- ESR > 30 mm/hr
What classifies a UC patient as fulminant
- > 10 stools/day with continuous bleeding, toxicity, abd pain and tenderness, distension, fever, anorexia, may require transfusions
- pts are at risk of progressing to toxic megacolon and bowel perf
Crohn’s disease classification: asymptomatic remission
-note: CDAI = Crohn’s disease activity index)
- CDAI <150
- pts who are asymptomatic either spontaneously or after a medical/surgical intervention
- pts requiring steroid to remain asymptomatic are NOT considered to be in remission but are referred to as “steroid-dependent”
Crohn’s disease classification: mild/moderate
- CDAI: 150-219
- ambulatory pts able to tolerate diet w/o manifestation of dehydration, systemic toxicity, abd tenderness, painful mass, intestinal obstruction or >10% weight loss
Crohn’s disease classification: moderate/severe
- CDAI: 220-450
- pts that fail to respond to tx for mild/moderate dz or have more prominent sx of: fever, weight los, abd pain/tenderness, intermittent N/V (w/o obstruction) or anemia
Crohn’s disease classification: severe/fulminant
- CDAI: >450
- presence of persistent sx despite outpatient corticosteroid or biologic tx OR evidence of systemic toxicity: high fevers, persistent vomiting, intestinal obstruction, significant peritoneal signs, presence of cachexia or abcess
what are the goals of tx for CD and UC?
- resolve the acute/active inflammatory process (induce clinical remission)
- resolution of local and systemic complications
- maintain remission
- surgical palliation or cure
- improve quality of life
In which disease is surgery NOT curative?
- CD
- however may be used to manage dz
In which disease IS surgery curative?
- UC
- indicated when dz is uncontrolled on optimized medical therapy or for management of complications
class: 5-ASA (aminosalicylic acid) derivative
- list the drugs (4)
- sulfasalazine
- mesalamine
- olsalazine
- balsalazide
class: corticosteroids
- list drugs (6)
- hydrocortisone
- prednisone
- budesonide (CIR)
- budesonide-MMX
- hydrocortisone IV
- methylprednisolone IV
class: immunosuppressants
- list drugs (4)
- azathioprine
- 6-mercaptopurine
- cyclosporine
- methotrexate
class: biologics (TNF-alpha inhibitors)
- list drugs (3)
- infliximab (remicade)
- adalimumab (humera)
- certolizumab (cimzia)
class: anti-integrin abs
- list drugs (2)
- natalizumab (tysabri)
- vedolizumab (entyvio)
what is the preferred 5-ASA derivative?
mesalamine (better tolerated than sulfasalzine)
oral vs topical mesalamine
- oral: used for extensive disease
- topical: used for distal disease or proctitis
mesalamine drug interactions
avoid:
- antiacids
- H2RAs (ranitidine/famotidine)
- PPIs
-safe to use in pts w/ sulfa allergy
sulfasalazine MoA
- combo of sulfapyridine and mesalamine
- it is cleaved into those 2 products, mesalamine being the active one
- but true MoA is not well understood