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GI Exam 3 > UC and CD > Flashcards

UC and CD Flashcards

1
Q

Define Extensive Ulcerative Colitis/ Pancolitis

A

Beyond the splenic flexure and may involve the entire colon

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2
Q

Define Distal Ulcerative Colitis

A

Extends as far as the splenic flexture

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3
Q

Define Ulcerative Proctitis

A

Limited to the rectum

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4
Q

Clinical Manifestations that Favor Crohn’s Disease

A 
Pallor
Cachexia (wasting of the body)
Ab mass or tenderness
Hematochezia
Perianal skin manifestation (fissures/fistulas/abscess)
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5
Q

Colon Cancer is more common with

A

UC

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6
Q

Diverticulitis is more common with

A

CD

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7
Q

Diagnosis of IBD

A

History and stool examinations

Biopsy is almost always recommended

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8
Q

Approach to Treatment of IBD

A 
Identify disease
Understand/communicate goals of therapy
Severity
Extent and location of disease
Pick drugs based on onset, formulation, effectiveness, side effects/CI
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9
Q

Mild Classification of UC

A

Less than 4 stools per day +/- blood
Normal ESR
No signs of toxicity

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10
Q

Moderate Classification of UC

A

Greater or equal to 4 stools/day

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11
Q

Severe Classification of UC

A

Greater than 6 bloody stools/day

Fever, tachycardia, anemia, +/-

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12
Q

Fulminant Classification of UC

A

Greater than 10 stools/day
Continuous bleeding
Abdominal tenderness, distention
Colonic dilation on xray

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13
Q

Proctitis Treatment Algorithm

A

Topical 5-ASA then oral if it is refractory

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14
Q

Mild-Moderate Distal UC Treatment Algorithm

A

5-ASA Foam/Enema or oral 5-ASA

Then you can treat as mild-moderate pancolitis in refractory

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15
Q

Mild-Moderate Pancolitis Treatment Algorithm

A

Oral 5-ASA or corticosteroids or 6MP/Azathiprine

Then infliximab or cyclosporine IV or surgery if it is refractory

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16
Q

Severe Pancolitis Treatment Algorithm

A

Severe and fulminant
IV corticosteroids then oral 5ASA or 6MP/Azathioprine + Infliximab
Then infliximab or cyclosporine IV or surgery if it is refractory

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17
Q

Remission CD Classification

A

CDAI less than 150
Asyptomatic
No inflammatory
Respond to acute medical/surgical intervention

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18
Q

Mild-Moderate CD Classification

A

CDAI 150-220
Ambulatory Tolerate PO
Signs of toxicity, dehydration
Less than 10% weight loss

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19
Q

Moderate-Severe CD Classification

A

CDAI 220-450
Unresponsive to previous treatment
More prominent symptoms
Significant weight loss

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20
Q

Severe-Fulminant CD Classification

A

CDAI greater than 450
Persistent symptoms
High fever, persistent vomiting
Evidence of obstruction or abscess

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21
Q

Mild-Moderate CD Algorithm

A

Sulfsalazine or oral mesalimine or ABX
Perianal: sulfasalazine or oral mesalamine +/- metronidazole
Small bowl: Oral mesalamine or metronidazole (budesonide)

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22
Q

Moderate-Severe CD Algorithm

A

Mild-Moderate Prednisone
Perinanal: add biologics +/- thiopurine
Small Bowel: Taper steroid after 2-4 weeks

23
Q

Severe Fulminant CD Algorithm

A

IV corticosteroids X 5-7 days
Perianal: cyclosporine IV or infliximab (if naive)
Small Bowel: Add thiopurine or methotraxate or integrin inhibitor

24
Q

Aminosalcicylates CI and AE

A

Sulfa or salicylate allergy
GI or GI obstruction
Porphyria

Extensive AE

25
Balsalazide
Aminosalicylate Less side effects Brands: Colazzal and Giazo
26
Olsalazine
Aminosalicylate Site of action: Colon Brand: Diprentum
27
AminoSalicylate Mesalamine That have to be given based on antacids
Asacol/Delzicol, Asacol HD, Lialda and Apriso
28
Rowasa Patient Counseling
``` Rectal use only Darken after opening Stay in positive for at least 30 minutes Take at bedtime Keep in the 8 hours ```
29
Canasa Patient Counseling
Rectal use only Unwrap 1-3 hours or longer
30
Corticosteroids Use
Acute treatment of moderate disease (oral), severe (IV) or proctitis and prosigmoiditis (topical)
31
Prednisone Dose
40-60 mg PO QD
32
Budesonide Uceris Dose
9 mg PO QD 8 week
33
Budesonide Uceris vs Entocort EC
NOT interchangable
34
Corticosteroids Drug Interactions
``` Live vaccines (flu mist) 3A4 inhibitors ```
35
Corticosteroid Counseling
``` Avoid exposure to chicken pox or measles Do not discontinue drug suddenly Take with food or milk Glycemic control Report unusual stuff ```
36
Thiopurines Drugs and Dosing
Azathioprine (Azasan, Imuran) - GO TO drug Mercaptopurine (Purinethol) DOSED BY WEIGHT
37
Thiopurines Monitoring
WBC less than 3.5 and platelets less than 150
38
Allopurinol and Febuxostat Drug Interactions
Increase levels of TG (increase mylosuppresion)
39
Immunodulator Classes
Thiopurines Calcineurin Inhibitors Methotrexate
40
Calcineurin Inhibitor Drugs and dose
Cyclosporine (gengral, neoral, sandIMMUNE) Infusion and PO If no results by 5-7 days, then d/c
41
Cyclosporine Use and AE
Acute, severe UC requiring hospitalization (refractory UC) | AE: Gingival hyperplasia
42
Methotrexate General
Structural analog of folic acid Steroid refractory/steroid dependent Preg Cat X!!!!! Used: refractory CD
43
Methotrexate Dose and Monitoring
Qweekly with folic acid | Monitor: Chest XR, pulmonary function test and liver function test (2 weeks, 8 weeks and ten monthly)
44
Methotrexate Drug Interactions
Adenosine receptor antagonists (theophyline) | Bone marrow suppresion
45
Methotrexate Counseling Points
Once weekly ***Avoid pregnancy (males and females) Avoid caffeine
46
Biologic MOA
TNF alpha inhibitors
47
****Remicade Dose
Infliximab 5 mg/kg IV Q8weeks Infused over 2 hours and used within 3 hours of making it - Infusion type reactions (pretreat with benadryl)
48
Anti-TNF Biologics Drugs
Infliximab (remicade) Adalimumab (humira) Certolizumab pegol (cimzia) Golimumab (Simponi)
49
Anti-TNF Biologics CI adn BBW
Class III-IV heart failure (esp remicade) | BBW: Serious infection risk and malignancy
50
Anti-Integrin Biologics Drugs
Natalizumab (Tysabri) | Vedolizumab (entyvio)
51
Anti-Integrin Biologics doses and counseling
``` T: Over 60 minutes; invert E: Over 30 minutes; swirl it Flush with NS after giving the drug ***Vaccines (no live) to prevent infections ***Skin test for TB ```
52
Antibiotic Use
Only id CD with fistura or something with a bacterial infection
53
Antibiotics Drugs
Metronidazole (flagyl) 10-20 mg/kg/day | Ciprofloxacin 1 g/day (only if CI to metro)

GI Exam 3 (9 decks)

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