Ulcerative Colitis and Crohn's Disease Flashcards
What is IBD?
chronic, idiopathic, relapsing inflammatory disorders
What is UC?
mucosal inflammatory condition of the GI tract limited to the rectum and colon
What is CD?
transmural inflammatory condition that can affect any part of the GI tract from mouth to anus
What age is UC typically diagnosed?
20-25
What age is CD typically diagnosed?
before 30
What is the etiology of IBD?
Infection
Foods (alcohol and red meat)
Smoking*
Genetic factors
Immunological
Smoking has actually shown to improve which IBD?
UC
1st degree relatives have how much of an increased risk of developing IBD?
13 fold
UC or CD has a bigger genetic role?
CD
What are the presenting symptoms of IBD?
Diarrhea
Abdominal pain/ cramping
Fever
Rectal bleeding
Weight loss
What is the mucosal appearance of UC?
Edema
Mucopus
Erosions
Continuous lesions
What is proctitis?
UC with only rectum involved
What is distal colitis?
extends from the rectum to the left splenic flexure
What is extensive colitis?
involves areas of the colon beyond the left splenic flexure
What is the mucosal appearance of CD?
ulcers
strictures (scarring)
fistulas
discontinuous and segmented lesions (cobblestone appearance)
Where can CD lesions occur? Where do they most commonly occur?
anywhere in the GI tract, mostly colon and ileum
What is mild UC?
< 4 stools/ day with or without blood
NO systemic disturbance
What is moderate UC?
4-6 stools/day with or without blood
Minimal systemic disturbance
What is severe UC?
7-10 stools/ day with blood
Systemic disturbance
What is systemic disturbance?
Fever
HR>90
anemia
abdominal tenderness
bowel wall edema
ESR>30mm/h
What is fulminant UC?
> 10 stools/ day continuous bleeding (may require transfusion)
marked systemic disturbance
What is mild-moderate CD?
ambulatory
tolerates PO
absence of fever, dehydration and abdominal tenderness
nonsignificant weight loss (<10%)
What is moderate-severe CD?
Failed treatment for mild-mod OR
fever, abdominal pain, N/V, dehydration, significant weight loss and anemia
What is severe/fulimant CD?
Symptoms persist with corticosteroids OR
high fever, vomiting, reboound tenderness, cachexia, evidence of intestinal obstruction / abcess
Which IBD has a higher risk of cancer?
UC
The risk of cancer starts to increase how many years after IBD diagnosis?
8 years
What are fistulas?
Abnormal communication between 2 organs or organ and exterior (intestines and bladder) usually areas of worst inflammation
Which IBD are fistulas more common?
CD
What is toxic megacolon?
severe inflammation, no peristalsis, emergency
What drugs increase the risk of toxic megacolon?
anticholinergics
antispasmodics
opioids
other drugs that decrease peristalsis
What agents are used for induction and maintenance of IBD?
Aminosalicylates
Budesonide
Remicade
What agents are used only for IBD maintenance?
Thiopurines
What agents are used only for IBD induction?
Corticosteroids
What is a CI to Aminosalicylates?
Aspirin, salicylate allergy
What Aminosalicylate should be avoided in patients with a sulfa allergy?
Sulfasalazine
What are dose related ADEs with Sulfasalazine?
GI disturbance, headache, arthalgia
What are ADEs that happen at any dose of Sulfasalazine?
rash, fever, hepatotoxicity, nephrotoxicity, bone marrow suppression, discoloration of skin, urine,and other secretions
What needs to be monitored while taking Aminosalicylates?
LFTs, renal function (CrCl, SCr, BUN), CBC with differential
What is the only Mesalamine dosage form that has effects on the small intestine and colon?
Pentasa ER capsules
Mesalamine should be used with caution in patients with what?
renal or liver insufficiency
Which Aminosalycilate does not require caution in patients with renal/ liver insufficiency?
Olsalazine
What oral corticosteroids are used for IBD?
Prednisone
Budesonide
What are contraindications to corticosteroid use?
Systemic fungal infections
LIVE vaccines
What corticosteroids are used IV?
Hydrocortisone
Methylprednisolone
What corticosteroids are used topically?
Hydrocortisone
Budesonide
What is the only corticosteroid that can be used up to 3 months?
Budesonide
What must be done if Budesonide is stopped after being used for >2 weeks?
Taper to avoid withdrawal
Why can Budesonide be used for a longer period of time?
extensive first-pass metabolism; decreased systemic exposure
What agents require genotype/ phenotype testing prior to initiation to properly dose and determine enzyme (TPMT) activity responsible for drug metabolism?
Thiopurines (Mercaptopurine and Azathioprine)
What agents should be used with caution when taking thiopurines?
5-ASAs can inhibit TPMT, the enzyme responsible for thiopurine drug metabolism
What ADEs are seen with thiopurines?
Bone marrow suppression
Anemia
Thrombocytopenia
Hepatotoxicity
Renal toxicity
Pancreatitis
N/V/D
rash
When is cyclosporine used?
Severe UC flares not responding to IV corticosteroids
What BBWs are seen with thiopurines?
chronic immunosuppression;
increased risk of malignancy and hematologic toxicities
What BBWs are seen with Janus Kinase (JAK) inhibitors?
Serious bacterial, fungal, viral, and opportunistic infections
Higher rate of all-cause mortality including sudden CV death
Higher rate of MACE
Increased risk of thrombosis (PE, DVT, arterial thrombosis)
Increased risk of lymphomas/ other malignancies
What can be given with TNF inhibitors to decrease infusion reactions?
APAP
diphenhydramine
corticosteroid
