Therapeutics of IBD Flashcards
To examine the management strategies for
Inflammatory Bowel Disease (IBD)
Aminosalicylates: These medications are used to reduce inflammation in the gut. They are often the first-line treatment for mild to moderate ulcerative colitis and Crohn’s disease.
Corticosteroids: These medications are used to reduce inflammation and suppress the immune system. They are typically used to treat moderate to severe IBD.
Immunomodulators: These medications suppress the immune system to reduce inflammation in the gut. They are often used in combination with other medications for long-term control of IBD.
Biologics: These medications target specific proteins in the immune system to reduce inflammation. They are typically used to treat moderate to severe IBD.
Diet and Nutrition: Diet and nutrition can play a significant role in managing IBD. Some general recommendations include:
Avoiding foods that trigger symptoms: Common triggers include fatty or greasy foods, spicy foods, caffeine, alcohol, and dairy products.
Eating a well-balanced diet: Eating a diet that is high in protein, low in fat, and rich in fruits, vegetables, and whole grains can help manage IBD symptoms.
Taking nutritional supplements: Supplements such as vitamin D, calcium, and iron can help manage nutritional deficiencies that may occur with IBD.
Lifestyle Changes: Certain lifestyle changes can help manage IBD symptoms, including:
Getting enough rest: Fatigue is a common symptom of IBD, so getting enough rest is important for managing symptoms.
Regular exercise: Exercise can help reduce stress and improve overall health, which can help manage IBD symptoms.
Stress reduction: Stress can trigger IBD symptoms, so stress reduction techniques such as yoga, meditation, and deep breathing can help manage symptoms.
Surgery: Surgery may be necessary for some people with IBD who do not respond to other treatments or who have complications such as intestinal blockages, abscesses, or fistulas. Surgery may involve removing part or all of the affected intestine.
To gain a knowledge of the different therapies
available for the treatment of Ulcerative Colitis (UC)
and Crohns Disease (CD)
Medications:
Aminosalicylates: These medications, such as sulfasalazine, mesalamine, and olsalazine, are often used to treat mild to moderate UC and CD.
Corticosteroids: These medications, such as prednisone and budesonide, are used to reduce inflammation in moderate to severe UC and CD.
Immunomodulators: These medications, such as azathioprine, 6-mercaptopurine, and methotrexate, are used to suppress the immune system and reduce inflammation in moderate to severe UC and CD.
Biologics: These medications, such as infliximab, adalimumab, and ustekinumab, are used to target specific proteins in the immune system that contribute to inflammation in moderate to severe UC and CD.
Surgery:
Colectomy: This surgery involves removal of the entire colon and rectum and is often used to treat severe UC.
Ileostomy: This surgery involves creating an opening in the abdomen for waste to pass through, which is then collected in a bag. This may be necessary if the colon and rectum are removed.
Strictureplasty: This surgery is used to widen a narrowed area of the small intestine in CD.
Lifestyle modifications:
Diet: Some people with UC and CD find that certain foods trigger symptoms, so they may need to modify their diet to avoid these triggers.
Stress management: Stress can worsen symptoms of UC and CD, so stress management techniques, such as yoga or meditation, may be helpful.
To develop an understanding of the rationale for the
selection of drugs used in IBD
Aminosalicylates: These drugs are often used as first-line therapy for mild to moderate UC and CD, as they have a good safety profile and are effective in reducing inflammation in the gut. They are typically used to induce and maintain remission, especially in patients with mild disease.
Corticosteroids: These drugs are used for the treatment of moderate to severe UC and CD, and are effective in reducing inflammation quickly. They are often used in short-term courses to induce remission, but long-term use is generally avoided due to the risk of side effects.
Immunomodulators: These drugs, such as azathioprine and 6-mercaptopurine, are used for the treatment of moderate to severe UC and CD, and are effective in reducing inflammation and maintaining remission. They work by suppressing the immune system, but their use can be limited by side effects, including an increased risk of infection.
Biologics: These drugs are used for the treatment of moderate to severe UC and CD, and are effective in reducing inflammation and inducing remission. They work by targeting specific proteins in the immune system that contribute to inflammation. Biologics are generally reserved for patients who do not respond to other treatments, or who cannot tolerate other medications.
Antibiotics: These drugs are sometimes used to treat IBD, particularly in patients with fistulas or abscesses. Antibiotics can help reduce bacterial overgrowth and prevent infections, but their use is generally limited due to the risk of antibiotic resistance.
How does IBD affect drug absorption
Altered mucosal barrier: The inflammation in IBD can lead to changes in the intestinal mucosal barrier, including the loss of tight junctions between cells, increased permeability, and reduced mucus production. This can result in increased absorption of some drugs, particularly those that are hydrophilic, as they can more easily penetrate the intestinal mucosa. For example, the antibiotic, ciprofloxacin, has been shown to have increased absorption in IBD patients.
Decreased surface area for absorption: The inflammation in IBD can also lead to a reduction in the surface area available for drug absorption. This can result in reduced absorption of some drugs, particularly those that are lipophilic, as they require a larger surface area for absorption. For example, the immunosuppressive drug, azathioprine, has been shown to have reduced absorption in IBD patients.
Altered gastric pH: The inflammation in IBD can affect the pH of the gastric environment, which can influence the absorption of drugs that are pH-dependent. For example, some drugs such as ketoconazole require an acidic environment for absorption, and the increased pH in IBD patients may result in reduced absorption.
Altered gut microbiota: The gut microbiota plays a critical role in drug metabolism and absorption. The changes in the gut microbiota seen in IBD can influence the absorption of some drugs. For example, the immunosuppressive drug, methotrexate, has been shown to have reduced absorption in IBD patients due to alterations in the gut microbiota.
