Week 5 - UC + CD therapeutics Flashcards
What is the difference between ACUTE and MAINTENANCE therapy?
Acute therapy is the treatment of induce remission
Maintenance therapy is treatment to remain in remission / avoid relapse
How is the severity of UC measured?
Montreal classification - Extent + severity
Truelove + witts classification - used by nice - assesses no. of stools w blood , Hb levels, fever , tachycardia
Mayo score - measured using stool frequency and rectal bleeding
Describe first line treatment for mild to moderate ulcerative colitis - PROCTITIS
**Topical aminosalicylates for 4 weeks **
if remission still not occured then oral aminoslicylates
What happens when topical treatment isnt tolerated?
given oral aminosalicylates or short temporary oral corticosteroids
Describe the order of drug prescribed for onset of mild- moderate UC (Distal + Extensive)
- Topical aminosalicylates ( suppositories) at first presentation - 4 weeks
- If NO remission then ADD HIGH DOSE ORAL aminosalicylates
- > then Just high dose oral salicylates and short term corticosteroids
- > If aminosalicylates aren’t tolerated then then time limited topical or oral time limited corticosteroid
Name the therapy for moderate to severe UC
Oral corticosteroids
UC- Describe the drugs given for Moderate to severely active disease ( Name then too)
- Biologics + Janus Kinases ( AFTER conventional therapy failure)
- Infliximab, adalimumab, golimumab ( TNF alpha- antagonists).
- Vedolizumab - not responsive to conventional therapy + TNF alpha antagonits
- Tofacitinib (jak inhibitor) - inadequate response to conventional therapy + TNF alpha antagonists + biological
Name what therapoy is provided for acute severe- hospitalised UC
IV corticosteroids
-> if not tolerated IV Ciclosporin
if symptoms worsen or no improvent IV corticosteroids + IV ciclosporin
-> IF ciclosporin not clinically appropriate then infliximab is an option
What is the Maintainance therapy for mild to moderate UC (Proctitis)
- DAILY topical aminoslaicylates
- ## DAILY oral aminosalicylaytes + TOpical aminosalicylate
What is the maintenance therapy for mild -moderate( Left sided / extensive ) (UC)
Low dose oral aminosalicylates
What are drug therapy for maintenance remission for all areas (UC)
mercaptopurine / azathioprine
( if 2 or more inflmmatory exacerbation in 12 months then –>)
Systemic corticosteroids
According to the NICE guidelines what is the first line of therapy for CD
- gluticorticoisteroid ( 1 inflammatory exacerbation in 12 months)
- Prednisilone, methylprednisolone, hydrocoitisonoe (IV)
- If not severe CD or refusal to glucoicoticosteroids
- THEN budesonide
what is the second line treatment for CD ?
- glucocoitcoisteroid ( or budesonide) + azathiprine / mercaptopurine
- OR if azathioprine not tolerated then glucocoiticosteroid ( or budesonide) + methotrexate
When is inflixamab or adalimumab given ? ( for CD)
- Moderate/severe disease not repsonding to conventional therapy
- should be given as planned courese of treatment
- can be contuned if endoscopy shows ongoing disease
When is recommened for moderate to severe CD?
Ustekinumab - provided when conventionbal therapy + TNF - alpha inhibitor not worked or contraindicated
or Vendolizumab
