Pharmacology - IBD

Question 1

Crohn’s disease where

Answer 1

-anywhere in GIT from mouth to anus

Question 2

Crohn’s cause

Answer 2

unknown

Question 3

Crohn’s pattern

Answer 3

exacerbations and remission

Question 4

Crohn’s disease what and how

Answer 4

• transmural (through wall) inflammation
• dense infiltration of lymphocytes and macrophages –> eating all way through wall –> fissuring ulceration –> submucosal fibrosis

Question 5

Ulcerative colitis

Answer 5

• inflammation of mucosal layer only
• infiltration of inflammatory cells into mucus
• loss of goblet cells
• ulcerations

Question 6

Crohn’s vs ulcerative colitis severity

Answer 6

Crohn’s more severe, colitis more superficial

Question 7

Crohn’s symptoms

Answer 7

• diarrhoea
• pain
• fibrosis –> narrowing of gut lumen –? strictures, bowel obstruction
• abcess formation
• fistulisation to skin and internal organs

Question 8

Stricutres

Answer 8

inflammation –> scar tissue formation –> narrowing of lumen –> pain, cramping, bloating –> risk of rupture

Question 9

Fistulae

Answer 9

-inflammation –> ulcers –> develop into tunnels –> go between organs or to skin

Question 10

Crohn’s disease consequences

Answer 10

• weight loss
• micro/macro nutrients
• fatigue
• protein-energy malnutrition in 20-80% paients

Question 11

Ulcerative colitis symptoms

Answer 11

• severe diarrhoea, change in electrolytes
• blood loss
• loss of peristalic function
• toxic megacolon –> distension of colon, perforation, sepsis

Question 12

Extra-intestinal inflammation

Answer 12

• joints, eyes, skin, mouth and liver

- forms of IBD

Question 13

IBD treatment

Answer 13

5-aminosalicylate:

• questionable in Crohn’s
• some effect in ulcerative colitis

Steroids:
ex: oral prenisolone, budenoside (poor absorption, less systemic effects)

Immunosuppressants:
MTX
Azathioprine –> mercaptopurine (inhibit purine synthesis)
Cyclosporin (inhibit IL-2 induce gene expression)

TNF-α blockers:
neutralise inflammatory sytokine TNF-α implicated in Crohn’s
infliximab-infusion
adalimumab-injection

Question 14

5-aminosalicylate:

Answer 14

• inhibit LT & prostanoid synthesis, scavenge free radicals & decrease neutrophil chemotaxis effects on PPARγ receptors
• produg: sulfasalazine adn bacteria in colon–> mesalazine

Question 15

TPMT enzyme consideration with azathioprine

Answer 15

• metabolise mercaptopurine
• great inter-patient variability in activity –> test for enzyme before treatment
• no activity: toxicity
• high activity: risk of resistance

Question 16

Crohn’s nutrition considerations

Answer 16

elemental feeds: induce remission –> reduced steroid use

may require parenteral support

small bowel removal –> reduced absorption–> combination of methods for nutritional support

Question 17

Probiotics effective?

Answer 17

-could be effective in ulcerative colitis (suggestion UC caused by pathogenic colonic bacteria)

Question 18

Crohn’s treatment

Answer 18

Monotherapy:
-conventional steroid or alt. budenoside / 5-ASA

After remission induced….

Add-on therapy:

• first line: azathiopurine/mercaptopurine directly
• second line: MTX

Severe active Crohn’s:
-infliximab / adalimumab

Question 19

Oral steroids counselling

Answer 19

• best as single dose in morning, after food
• always carry steroid treatment card if taking for >3 weeks
• do not stop abruptly, wean off
• adequate Ca2+ intake and good nutrition
• normal body weight
• smoking cessation
• moderate alcohol consumption
• physical exercise

Question 20

5-ASA counselling

Answer 20

• report any bleeding, bruising, fever etc.
• swallow enteric-coated whole
• may colour tears yellow and urine orange, normal
• may stain soft contact lenses, use glasses

Question 21

azathiopurine/mercaptopurine counselling

Answer 21

• test TMPT levels before therapy

- seek help if any symptoms (sore throat, vomiting, dark urine, abdominal pain etc.)