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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
Q

Balsalazide

A

Aminosalicylate
Less side effects
Brands: Colazzal and Giazo

26
Q

Olsalazine

A

Aminosalicylate
Site of action: Colon
Brand: Diprentum

27
Q

AminoSalicylate Mesalamine That have to be given based on antacids

A

Asacol/Delzicol, Asacol HD, Lialda and Apriso

28
Q

Rowasa Patient Counseling

A 
Rectal use only
Darken after opening
Stay in positive for at least 30 minutes 
Take at bedtime 
Keep in the 8 hours
29
Q

Canasa Patient Counseling

A

Rectal use only
Unwrap
1-3 hours or longer

30
Q

Corticosteroids Use

A

Acute treatment of moderate disease (oral), severe (IV) or proctitis and prosigmoiditis (topical)

31
Q

Prednisone Dose

A

40-60 mg PO QD

32
Q

Budesonide Uceris Dose

A

9 mg PO QD 8 week

33
Q

Budesonide Uceris vs Entocort EC

A

NOT interchangable

34
Q

Corticosteroids Drug Interactions

A 
Live vaccines (flu mist)
3A4 inhibitors
35
Q

Corticosteroid Counseling

A 
Avoid exposure to chicken pox or measles
Do not discontinue drug suddenly 
Take with food or milk
Glycemic control
Report unusual stuff
36
Q

Thiopurines Drugs and Dosing

A

Azathioprine (Azasan, Imuran) - GO TO drug
Mercaptopurine (Purinethol)
DOSED BY WEIGHT

37
Q

Thiopurines Monitoring

A

WBC less than 3.5 and platelets less than 150

38
Q

Allopurinol and Febuxostat Drug Interactions

A

Increase levels of TG (increase mylosuppresion)

39
Q

Immunodulator Classes

A

Thiopurines
Calcineurin Inhibitors
Methotrexate

40
Q

Calcineurin Inhibitor Drugs and dose

A

Cyclosporine (gengral, neoral, sandIMMUNE)
Infusion and PO
If no results by 5-7 days, then d/c

41
Q

Cyclosporine Use and AE

A

Acute, severe UC requiring hospitalization (refractory UC)

AE: Gingival hyperplasia

42
Q

Methotrexate General

A

Structural analog of folic acid
Steroid refractory/steroid dependent
Preg Cat X!!!!!
Used: refractory CD

43
Q

Methotrexate Dose and Monitoring

A

Qweekly with folic acid

Monitor: Chest XR, pulmonary function test and liver function test (2 weeks, 8 weeks and ten monthly)

44
Q

Methotrexate Drug Interactions

A

Adenosine receptor antagonists (theophyline)

Bone marrow suppresion

45
Q

Methotrexate Counseling Points

A

Once weekly
***Avoid pregnancy (males and females)
Avoid caffeine

46
Q

Biologic MOA

A

TNF alpha inhibitors

47
Q

**Remicade Dose

A

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
Q

Anti-TNF Biologics Drugs

A

Infliximab (remicade)
Adalimumab (humira)
Certolizumab pegol (cimzia)
Golimumab (Simponi)

49
Q

Anti-TNF Biologics CI adn BBW

A

Class III-IV heart failure (esp remicade)

BBW: Serious infection risk and malignancy

50
Q

Anti-Integrin Biologics Drugs

A

Natalizumab (Tysabri)

Vedolizumab (entyvio)

51
Q

Anti-Integrin Biologics doses and counseling

A 
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
Q

Antibiotic Use

A

Only id CD with fistura or something with a bacterial infection

53
Q

Antibiotics Drugs

A

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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