Pharmacology - IBD Flashcards
Crohn’s disease where
-anywhere in GIT from mouth to anus
Crohn’s cause
unknown
Crohn’s pattern
exacerbations and remission
Crohn’s disease what and how
- transmural (through wall) inflammation
- dense infiltration of lymphocytes and macrophages –> eating all way through wall –> fissuring ulceration –> submucosal fibrosis
Ulcerative colitis
- inflammation of mucosal layer only
- infiltration of inflammatory cells into mucus
- loss of goblet cells
- ulcerations
Crohn’s vs ulcerative colitis severity
Crohn’s more severe, colitis more superficial
Crohn’s symptoms
- diarrhoea
- pain
- fibrosis –> narrowing of gut lumen –? strictures, bowel obstruction
- abcess formation
- fistulisation to skin and internal organs
Stricutres
inflammation –> scar tissue formation –> narrowing of lumen –> pain, cramping, bloating –> risk of rupture
Fistulae
-inflammation –> ulcers –> develop into tunnels –> go between organs or to skin
Crohn’s disease consequences
- weight loss
- micro/macro nutrients
- fatigue
- protein-energy malnutrition in 20-80% paients
Ulcerative colitis symptoms
- severe diarrhoea, change in electrolytes
- blood loss
- loss of peristalic function
- toxic megacolon –> distension of colon, perforation, sepsis
Extra-intestinal inflammation
- joints, eyes, skin, mouth and liver
- forms of IBD
IBD treatment
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
5-aminosalicylate:
- inhibit LT & prostanoid synthesis, scavenge free radicals & decrease neutrophil chemotaxis effects on PPARγ receptors
- produg: sulfasalazine adn bacteria in colon–> mesalazine
TPMT enzyme consideration with azathioprine
- metabolise mercaptopurine
- great inter-patient variability in activity –> test for enzyme before treatment
- no activity: toxicity
- high activity: risk of resistance
Crohn’s nutrition considerations
elemental feeds: induce remission –> reduced steroid use
may require parenteral support
small bowel removal –> reduced absorption–> combination of methods for nutritional support
Probiotics effective?
-could be effective in ulcerative colitis (suggestion UC caused by pathogenic colonic bacteria)
Crohn’s treatment
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
Oral steroids counselling
- 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
5-ASA counselling
- 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
azathiopurine/mercaptopurine counselling
- test TMPT levels before therapy
- seek help if any symptoms (sore throat, vomiting, dark urine, abdominal pain etc.)
