UC Flashcards
Ulcerative colitis
mucosal inflammation & ulcers restricted to colon and rectum
UC symptoms
~ blood diarrhoea (mucus / pus)
~ abdo pain
~ urgent need to defecate
~ acute flareups (mouth ulcers, arthritis, sore skin, weight loss, fatigue)
UC long term complications
~ colorectal cancer
~ secondary osteoporosis
~ VTE
~ Toxic megacolon
contra-indication in UC during acute flare ups
Loperamide / Codeine = avoid as paralytic ileus = increased risk of toxic megacolon
Extensive colitis is
inflammation affects ascending colon and transverse colon
==> oral tx needed
Left sided colitis
inflammation affects descending colon (distal)
==> enemas tx needed
Proctosigmoiditis
inflammation of rectum & sigmoid colon
==> foam preparations & suppositories easier to retain than liquid enemas
Proctitis
inflammation of rectum ===> suppositories tx
Extensive/left-sided colitis (UC) tx
1st line = high dose ORAL aminosalicylates
+
rectal aminosalicylates or ORAL beclomethasone
alternative = oral pred alone
Proctosigmoiditis/Proctitis tx
1st line = RECTAL aminosalicylates
2nd line = RECTAL steroids or ORAL pred
sub-acute (moderate-severe) UC xt
ORAL pred
2nd line = antibodies
if initial tx fails in all extents of acute mil-moderate UC
ORAL pred after 4/52 with aminosalicylates
ORAL tacrolimus if no response after 2-4 weeks
Severe acute UC
hospital
1st line = IV steroids / IV ciclosporin
maintaining remission in UC
~ AMINOSALICYLATES
Proctosigmoiditis/Proctitis ~ RECTAL alone or with oral
Extensive/left-sided colitis ~ low dose oral (single dose more effective, but more SE)
if 2+ acute flare-ups in 12m after steroids, or remission not maintained by aminosalicylates
oral Azathioprine or Mercaptopurine
Monoclonal antibodies
aminosalicylates MOA
reduce cytokine and free radical formation & inhibit prostaglandin synthesis
side effects of aminosalicylates
~ blood dyscarsias
— unexplained bleeding, sore throat, bruising, fever
~ Nephrotoxic
~ Sulfasalazine = colours urine yellow/orange
aminosalicylates interactions
Lactulose + Mesalazine
lactulose lowers stool pH in intestine = prevents sufficient release of active ingredient in E/C or MR preparations)
