Ulcerative colitis and crohns Flashcards
INFLAMMATORY BOWEL DISEASE:
What is first second and third line treatment of crohns/UC?
1st: aminosalicylates
2nd azathiprine or mercaptopurine
3rd Monoclonal antibodies
(smoking cessation- crohns)
what is crohns?
What is ulcerative colitis?
Crohns: is a long-term condition where the gut becomes inflamed.
UC:Ulcerative colitis is inflammation of the lower end of your digestive system, including your large bowel and rectum.
INFLAMMATORY BOWEL DISEASE:
What are symptoms?
abdominal pain
diarrhoea
rectal bleeding
weight loss
AMINOSALICYCLATES:
What are they indicated for?
1st line in UC (mainly sulfasalazine)
(with or without corticosteroids)
sulfasalazine- used in rheumatoid arthritis (used as DMARD)
AMINOSALICYCLATES:
what are important side effects?
GI upset
blood abnormalities
renal impairment
Sulfasalazine; oligospermia, hypersensitivity reaction( including liver abnormalities)
AMINOSALICYCLATES:
What are they contraindicated in?
aspirin hypersensitivity
AMINOSALICYCLATES:
what are prominent side effects?
orange/yellow staining of body fluids
including tears and therefore contacts
sulfasalazine may colour urine red - harmless
MONOCLONAL ANTIBODIES
What are they indicated for?
Immune mediated disorders;
rheumatoid arthriti, psoriasis, psoriatic arthritis, IBD
Allergic disorders; eczema, rhinitis, asthma
Cancer
Long term treatment conditions; osteoporosis, migraine, sickle cell disease.
MONOCLONAL ANTIBODIES
How do they work?
Made by immunising animals with target proteins.
Specific to receptors, binding to their target inhibits or activates.
MONOCLONAL ANTIBODIES
What are common indications?
immediate or delayed hypersensitivity reactions
Immune imbalance; immunosuppression, increased risk of severe infection or cancer.
MONOCLONAL ANTIBODIES
What is an important warning?
Active and latent infection;
Hep B or C
TB
Interacts with live vaccines, risk of severe generalised infection.
MONOCLONAL ANTIBODIES;
How are they given?
prescribed at 2-4 weekly intervals or longer
Adalimumab- 40mg every 4 weeks
Denosumab every 6 months
Not taken orally only sub cut as digested by gastric proteases and large and poorly permeable.
AZATHIOPRINE AND MERCAPTOPURINE:
What are indications?
Crohns
Rheumatoid arthritis
eczema
Myasthenia gravis
1-3mg/kg
AZATHIOPRINE AND MERCAPTOPURINE:
What are important interactions and how are they overcome?
Allopurinol
Manufacturer advises reduce dose to one-quarter of the usual dose with concurrent use of allopurinol
AZATHIOPRINE AND MERCAPTOPURINE:
What is the most common side effect?
Bone marrow depression (dose-related); increased risk of infection; leucopenia; pancreatitis; thrombocytopenia
AZATHIOPRINE AND MERCAPTOPURINE:
What are important side effects and how can they be managed?
Nausea- take with food
hypersensitivity -immediate withdrawal
neutropenia/thrombocytopenia- neutropenia dose dependent
AZATHIOPRINE AND MERCAPTOPURINE:
What are monitoring requirements?
Monitor full blood count weekly (more frequently with higher doses or if severe renal impairment) for first 4 weeks (manufacturer advises weekly monitoring for 8 weeks but evidence of practical value unsatisfactory), thereafter reduce frequency of monitoring to at least every 3 months.
AZATHIOPRINE AND MERCAPTOPURINE:
What are cautions?
Avoid in pregnancy, fine in breastfeeding use if benefits outweighs the risks.
Contraindications;
Absent thiopurine methyltransferase (TPMT) activity; very low thiopurine methyltransferase (TPMT) activity
