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Week 142 - IBD > Treating IBD > Flashcards

Treating IBD Flashcards

0
Q

What are the 4 main groups of pharmacotherapies for the treatment of IBD?

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biological therapy

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1
Q

What are the 3 key principles behind treating IBD?

A

1) induce remission
2) maintain remission
3) prevent secondary effects

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2
Q

What is the main therapeutic quality of corticosteroids and aminosalicylates?

A

They are anti-inflammatories

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3
Q

What is considered the first line treatment for Ulcerative Colitis?

A

Aminosalicylates

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4
Q

What 3 therapeutic effects do aminosalicylates have in the treatment of UC?

A

Induce remission
Maintain remission
Prevent colonic cancer

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5
Q

What is currently the first line aminosalicylate prescribed in UC?

A

Mesalazine

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6
Q

What two methods of administration are used for mesalazine?

A

Oral and PR (pr can be more effective in rectal limited UC)

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7
Q

What are the 3 main brand names for mesalazine?

A

Asacol
Pentasa
Mezavant

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8
Q

Why might Pentasa be selected for prescription in UC over Asacol?

A

It has a pH independent coating and so is released more slowly, working throughout the GI tract and not just in ileum and proximal colon

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9
Q

How do aminosalicylates (Asacol and Pentasa) have their anti-inflammatory impact?

A

By inhibiting the synthesis of inflammatory mediators:

  • prostaglandins
  • thromboxane
  • platelet-activating factor
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10
Q

What was the first aminosalicylate on the market?

A

Sulfasalazine

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11
Q

What side effects does sulfasalazine have?

A

Allergic reactions - rash, fever, leukopenia, agranulocytosis
Male infertility
Orange bodily fluid secretions
(Hence not first line - mesalazine is far better tolerated)

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12
Q

If aminosalicylates alone are found to be ineffective what might you add to them?

A

Corticosteroids

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13
Q

What is the main aim of treating IBD with corticosteroids?

A

To induce remission (NOT used for maintenance as significant side effects if used long term)

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14
Q

What is the mechanism of action behind corticosteroids?

A

Potent anti-inflammatory agent

Inhibit inflammatory processes (immunosuppressant)

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15
Q

How do steroids immunosuppress?

A

Inactivate pro-inflammatory transcription factors: NF-KB and AP-1

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16
Q

What inflammatory mediators do steroids suppress?

A

Prostaglandins
Leukotrienes
Cytokines
Platelet activating factor

17
Q

What is the main steroid we produce naturally in our adrenal cortex which contributes to the immune response?

A

Cortisol (a glucocorticoid - a natural anti-inflam and immunosuppressant)
(Aldosterone is the principle mineralcorticoid produced in the adrenal cortex; androgens are anabolic steroids both of which are not involved in immunity)

18
Q

List some steroid side effects.

A
  • Cushing’s-like symptoms: thinning skin, easy bruising, moon face with red cheeks, poor wound healing, increased abdominal fat /obesity
  • HTN; Euphoria; Cataracts; increased appetite
  • Osteoporosis (inc. osteoclastic activity, dec. osteoblastic activity)
  • Increased susceptibility to infection
19
Q

What would you prescribe alongside steroids as prophylactic treatment for osteoporosis?

A

Bisphosphonates

Calcium / Vit D

20
Q

Why must you NOT withdraw corticosteroids suddenly after several weeks use?

A

Your body stops releasing ACTH in response to the additional steroids so you need to give it time to being production again - risk ‘cortisone crisis’

21
Q

What are the 3 main oral corticosteroids?

A

Prednisolone (at moment most commonly used)
Budesonide (CD, mucosal anti-inflam. Not as well absorbed)
Beclometasone (beginning to be used more in UC now)

22
Q

What 2 forms does hydrocortisone come in?

A

IV and topical (suppository)

23
Q

What group of drug would be recommended if aminosalicylates are ineffective or not tolerated or if a patients UC was becoming steroid dependent (requiring 2 or more courses in 12 month period) - despite not being licensed for use in IBD?

A

Thiopurines (Azathioprine or 6-mercaptopurine

Used in CD remission maintenance as 1st line also

24
Q

What MUST be measured before treatment with Thiopurine begin?

A

TPMT (Thiopurine methyltransferase) as deficiency puts people more at risk of bone marrow suppression (a more serious side effect of Thiopurines)

25
Q

If IV steroid therapy is unaffective in treatment of active UC after 7 days what rescue therapy would you use?

A

Cyclosporin

26
Q

How do cyclosporine act?

A

They immunosuppress by preventing expansion of T cell subsets - in so doing they induce remission in Ulcerative Colitis

27
Q

If you are giving an infusion of a ciclosporin for longer than a period of 6 hrs what sort of ‘giving set’ should you use?

A

A non PVC one as it interacts with PVC

28
Q

Why should cyclosporin not be given alongside macrolides (the -mycin antibiotics)?

A

Because they (macrolides) are enzyme inhibitors and so would inhibit the metabolism of cyclosporin thereby increasing the dose that the patient was getting

29
Q

What are Azathioprine and Methotrexate used for in the treatment of Crohn’s?

A

1st and 2nd line treatment (respectively) for maintenance of remission

30
Q

What is methotrexate classed as pharmacologically?

A

An anti-inflammatory; inhibiting cytokine & eicosanoid synthesis

31
Q

When is it used in the Tx of Crohn’s?

A

When Azathioprine is not tolerated or resistance to it is evident

32
Q

Why is Folate generally prescribed weekly alongside methotrexate?

A

Because its GI side effects (vomiting and diarrhoea) mean a patient is likely to poorly absorb folate

33
Q

What is the MOST important thing to remember when prescribing methotrexate?

A

To always prescribe a weekly dose no matter what it is treating. On a drugs chart ensure you cross through any days they are not supposed to have the drug.

34
Q

What two things should you monitor when someone is on methotrexate?

A

FBC
Liver function tests
(Report any signs of liver toxicity and blood disorders early!)

35
Q

What are Infliximab and Adalimumab?

A

Humanised monoclonal antibodies

Ectopically produced anti-TNF (anti-immune stimulating) antibody

36
Q

How do Infliximab and Adalimumab act?

A

Target membrane-bound TNF and kill host cell by complement-induced lysis (anti-inflammatory action)

37
Q

How must Infliximab be administered?

A

In hospital, IV, combined with paracetamol and antihistamines as has a delayed hypersensitivity reaction (must have anaphylaxis at hand)

38
Q

Why should patients be screened for TB before being administered Infliximab?

A

It is known to relapse latent TB

39
Q

Subcutaneous Adalimumab is used for what?

A

Severe active Crohn’s

40
Q

At what stage of therapy are monoclonal antibodies (Infliximab and Adalimumab) used in the Tx of Crohn’s?

A

As a last resort in either severe active Crohn’s or remission maintenance before opting for a surgical approach

41
Q

What is first line treatment for active Crohn’s?

A

Corticosteroids (Prednisolone, Budesonide or IV hydrocortisone)

Week 142 - IBD (1 decks)

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