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Gastrology > Treatment of Inflammatory Bowel Disease > Flashcards

Treatment of Inflammatory Bowel Disease Flashcards

1
Q

Two dermopathies associated with inflammatory bowel disease

A

Pyoderma gangrenosim

Pyoderma nodosum

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2
Q

Mouth features in IBD

A

Oral facial granulomatous

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3
Q

Steroids for flare ups

A

Glucocorticoids

  • Iv hydrocortisone, methylprednisolone for hospital admissions
  • oral prednisolone - home

Rapidly induction of remission

Slow reducing course

  • prednisolone 40mg daily/1 week
  • reduce by 5mg/week
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4
Q

Side effects of steroids

A
  • immunosuppresion
  • impaired glucose tolerance
  • osteoporosis
  • weight gain
  • cushingoid appearances
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5
Q

Aminosalicylates (5-asa)

A
  • anti-inflammatory
  • ph dependent release/resin coated (Asacol)
  • time controlled release (pentasa)
  • Deliver by carrier therapys
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6
Q

Main role of aminosalicylates

A
  • maintenance of remission in UC
  • efficacy more related to complicance than delivery system
  • maintenace therapy may reducer cancer risk
  • little evidence to support use in crohn’s
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7
Q

Side affects of aminosalicylates

A

Sulphasalazine 10-45%
Mesalazine intolerance 15%

  • renal impairement (interstial nephritis ) is rare
  • diarrhoea, nausea, rarely pancreatitis, bone marrow problems
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8
Q

Thiopurines

A

Azathioprine and mercaptopurine (mercaptopurine is the active metabolite) however more expensive
-effective in active and maintenance therapy for UC and Crohns

Steroid sparing agent:

  • those requiring 2+ course steroids in a year
  • relapse on
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9
Q

Thiopurine mechanism of action

A
  • purine anti-metabolytes
  • essentially prevent T cell clonal expansion in response to antigenic stimuli
  • allow T cell apoptosis
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10
Q

Thiopurine dosing

A

Dose dependent on weight

  • 1.5mg/kg/day azathioprine
  • 1-1.5mg/kg/day mercaptopurine

Monitoring (overly immunosuppresion)
-weeekly FBC for 8/53 then at least every 3/12

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11
Q

Side effects of thiopurines

A
  • nause, vomitting
  • leucopenia
  • arthlagia
  • pancreatitis
  • hepatitis
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12
Q

Main enzyme for metabolising mecaptopurine

A

TPMT

  • thipurine methytransferase
  • genetically determined
  • absent/low/normal activity
  • predicts bone marrow suppression
  • checked prior to starting
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13
Q

Dosing of thipurines

A

checked with active metabolites

6-TGN

  • Active metabolite of thipurines
  • measurement allows dose escalation
  • also identifies non-compliance

meMP

  • metabolitie associated with hepatotoxicity
  • allows dose reduction to minisime risk

Give allopurinal + mecatopurine in low doses to even out levels of metabolities

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14
Q

Methotrexate

A
  • anti-metabolities
  • folate scavenger- need folate supplements
  • 15-25mg weekly
  • effective in crohns
  • little evidence in UC
  • widely used in inflammatory disease
  • serious teratogenicity
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15
Q

Adverse affects of methotrexate

A
  • highly teratogenic
  • hepatotoxic -liver fibrosis
  • pulmonary fibrosis
  • nausea, malaise, GI upset
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16
Q

Biologics

A

Infiximab

  • murine anti-TNF-alpha monoclonal antibody
  • severe or fistulating corhns
  • some beenefit in acute severe UC
  • 2 monthly intravenous infusion
  • loss of efficacy
  • allergic reactions
  • expensive

Adalumimab

  • humanised anti-TNF alpha monoclonal antibod
  • fortnightly SC injections
  • less reaction
  • less need for concomitant immunospurresion
  • arginally less expensive
17
Q

Acute severe colitis

A

patients who fail to respond o to optimal treatment

  • IV steroids
  • Liaison with colorectal surgeon
  • stool frequency ?8/day/CRP >45 on day 3 predicts colectomy in 85%
18
Q

Criteria for acute severe colitis

A

Truelove & Witts

Spilt into mild and severe

Bms/day 
Pr blood 
Temperatire 
Pulse 
Hb 
ESR
19
Q

Acute severe collitis investifations

A

Daily FBC, ESR, U&Es, CRP

  • stool cultures (including C.difficile)
  • daily AXR
  • Sigmoidoscopy
20
Q

Treatment for acute severe collitis

A

Prophylactic LMW heparin
IV hyrdrocortisone 100mg QDS

Treat for 72 hours

  • -improving then oral prednisiole-40mg
  • no improvement - rescue therapy
21
Q

Rescue therapy for acute severe colitis

A

Ciclosporin 2.g/kg/day IV
Infliximab 5mg/kg single dose
Surgery

If medical therapy doesnt work then surgery indicated

22
Q

Surgery for UC and Crohns

A

UC

  • surgery curative
  • ileo-anal pouch or ileostomy

Crohns

  • indicated for stricturing, perforation, fistulising disease
  • sparing as will come back
  • not curative

Gastrology (19 decks)

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