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GI: Inflammatory Bowel Disease > Treatment > Flashcards

Treatment Flashcards

1
Q

summary treatment

A
  • IV fluids
  • IV steroids - only once infective/ischaemic colitis is ruled out
  • GI rest

If they fail to settle….
Rescue medical therapy - can get more potent immunosuppressants
Surgery - can remove the affected colon

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2
Q

what is the 1st step in the ladder of treatment for UC?

A

5ASA

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3
Q

what are the side effects of 5ASA

A

diarrhoea, idiosyncratic nephritis (have to check renal function before starting treatment)

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4
Q

what are two examples of 5ASA

A

sulfasaline and mesalazine

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5
Q

5 ASA is an ____ ______ drug

A

anti-inflammatory

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6
Q

what is the 2nd step in the ladder of treatment for UC?

A

steroids

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7
Q

examples of steroids

A

budesonide and prednisolone

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8
Q

Patients are given a short course which is tapered as the weeks go on - high dose initially
Why? ]

A

Why? Because some patients may become dependent on them

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9
Q

what are the musculoskeletal side effects of steroids

A

Osteoporosis
Avascular necrosis
Proximal myopathy

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10
Q

what are the GI side effects of steroids

A

nausea , vomiting and gastritis

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11
Q

what are the cutaneous side effects of steroids

A

acne and thinning of the skin

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12
Q

what are the metabolic side effects of steroids

A

Makes you want to eat all the time so can lead to weight gain, diabtes and hypertension

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13
Q

what are the neuropsychiatric side effects of steroids

A

Can get loads of energy and do manic things
Once off treatment patients can become depressed
Can disrupt sleep pattern

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14
Q

can also get ____ and ___ failure on steriods

A

cataracts, growth failure

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15
Q

immunosuppressants are thiopurine based medicines: azathioprine/mercaptopurine (6MP)
give and example

A

methotrexate

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16
Q

____ is a purine analogue that interferes with ____ synthesis and inhibits the proliferation of quickly growing cells, especially cells of the immune system like-_ and __ cells

A

This is a purine analogue that interferes with DNA synthesis and inhibits the proliferation of quickly growing cells, especially cells of the immune system like t and b cells

17
Q

During metabolism ____ converts 6-MP (azathioprine) to 6-TGN (which is active), while ____ converts 6-MP to 6-MMP which is inactive.
Need to be careful with some patients - those who have reduced ____ activity as 6-___ can accumulate and cause toxicity and myelosuppression

A

During metabolism HPRT converts 6-MP to 6-TGN (which is active), while TPMT converts 6-MP to 6-MMP which is inactive.
Need to be careful with some patients - those who have reduced TPMT activity as 6-TGN can accumulate and cause toxicity and myelosuppression

18
Q

what will always be measured before starting azathioprine treatment?

A

TPMT

19
Q

____ is not co-prescribed with azathioprine

A

allopurinol

20
Q

what are the side effects of azathioprine and immunosuppressants

A
  • pancreatitis
  • leukopaenia
  • hepatitis
  • small risk of lymphoma, skin cancer
21
Q

what is step 3 in the treatment of UC

A

immunosuppresants

22
Q

they have a slow onset of action

A

immunosuppressants

23
Q

what is step 4 in the treatment of UC

A

anti-TNF

24
Q

TNF alpha is a _____ ____

A

TNF alpha is a proinflammatory cytokine

25
Q

anti- TNF are antibodies to TNF alpha - they can be ______ (e.g. infliximab) or ____ (e.g. adalimumab)

A

anti- TNF are antibodies to TNF alpha - they can be chimeric (e.g. infliximab) or huma (e.g. adalimumab)

26
Q

when do TNF alpha work

A

anti-TNF (TNF alpha is a proinflammatory cytokine) work at the point where naive T cells are being presented with the antigen and will switch off the immune response at this point and prevent the drive of inflammation by causing apoptosis of activated T cells

27
Q

they have a rapid onset of action

A

Anti-TNF

28
Q

have to make sure there is no ___ before starting anti-TNF

A

TB

29
Q

what is the treatment ladder for crohns

A
    • steroids
  2. immunosuppressants
  3. anti-tnf
30
Q

when would you do an emergency surgery

A

Failure to respond to medical therapy
Small bowel obstruction
Abscess
Fistulae

31
Q

when would you do an elective surgery

A

failure to respond to medical therapy

32
Q

what are the surgery options for crohns

A

Surgery: resection, stricturoplasty, fistula repair

33
Q

what is the surgery for fistula

A

seton- cord passing through fistula tract to keep it open for draining

34
Q

surgery for ___ is curative

A

UC

35
Q

UC - surgery

what is a koch pouch ?

A

rectum is removed and internal small bowel pouch formed

36
Q

UC - surgery

what is a j pouch ?

A

J pouch - functions as ‘new rectum’

GI: Inflammatory Bowel Disease (5 decks)

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