Week 6- Pharmaceutical care considerations in IBD + Pharmaceutical care - Drugs used in IBD Flashcards
why do patients with IBD have a risk of getting infections?
- due to IBD treatment that can suppress the immune system and increase the risk
- to prevent infection they should get immunisation history and infection history
when using steroids for patients with IBD what is the aim and why?
-to use and slowly reduce till they can stop
-Prolonged steroid use is associated with: increased infection risk, osteoporosis,
adrenal suppression, diabetes, weight gain, cardiovascular disease
when a patient is taking steroids what else should they be given to help monitor their bone health?
- calcium and vitamin D as it help with uptake of calcium
- should have calcium and vitamin D levels checked and risk of deficiency checked
why is malnutrition common in IBD?
increased nutritional demand due to chronic inflammation and poor absorption due to inflammation or surgery
what vitamin deficiencies are important to consider for the patient?
- magnesium
- calcium
- potassium
- vitamin D
why do patients with IBD have iron defiency?
-due to excess excretion of iron and bleeding to to inflammation, decrease of intake of iron due to changes in diet
what type of patients with IBD tend to smoke more?
crohns disease
what are the risks of smoking as a patient with IBD?
Continuation of smoking is linked to worse disease course, higher risk of
surgery and worst outcomes after surgery
what are some of the risk of using NSAIDs with IBD?
- May to lead to increase disease activity – esp. in Crohn’s colitis
- May precipitate a relapse
what cancer is IBD a risk factor for?
bowel cancer
what are some ways to reduce the risk of colorectal cancer in IBD patients?
• Receive and take appropriate treatment to manage inflammation
• Regular specialist reviews – at least annually
• Regular colonoscopy – frequency dependent on presence of additional risk factors
(FHx) and specific disease characteristics (disease activity/presence of stricture)
• Usually 1-5 yearly
• Additional ways to reduce risk – physical activity, high fibre, reducing
red/processed meat, limiting alcohol, ?supplementing vitamin D if deficient
what are some issues with adherence for IBD patients?
- Chronic disease with long term medical treatment
- Remission
- Topical treatments
- Need for monitoring
- Adverse effects
- Patients beliefs
what are the consequences of poor adherence to medication for IBD patients?
Worse patient outcomes – increased disease activity, relapse, loss of response,
higher morbidity and mortality, poor QOL, higher disability
what are some other pharmaceutical considerations to make about IBD treatment and patients?
- stoma patient information
- ‘short gut syndrome’= lack of functioning small bowel maybe affect nutritional absorption
- drug consideration= magnesium giving diarrhoea, pain relief should only be paracetamol
- anxiety and depression
- pain and fatigue
what type of drug is the main treatment for UC?
aminosalicylates
where is mezalazine in its unaltered form absorbed ?
small intestine
what is the structure of sulfasalazine?
mesalazine bound t sulfapyridine via an azo bond, the presence of the Colonic bacterial azoreductase breaks the bond.
-The azo bond prevents absorption in the upper testinal tract
where is sulfapyridine absorbed, metabolised and excreted?
in the colon, metabolised by the liver and excreted in the urine and is responsible for adverse effects
what are some contraindications for the use of sulfasalazine?
-hypersensitivity to sulfasalazine/sulfonamides or 5-aminosalicylate/ salicylates
what are some of the cautions for the use of sulfasalazine?
-History of asthma can cause cough Risk of haematological toxicity Renal and hepatic impairment Glucose-6-dehydrogenase (G6PD) deficiency Slow acetylator status
what are some of the side effects of sulfasalazine?
-Headache, nausea, fever, rash, raised temperature,
reversible infertility in men, reduced WBC
-Pancreatitis
-Hepatitis, pneumonitis, skin reaction (i.e. Stevens-Johnson
syndrome), haemolysis, inflammation of the kidney
what are some of the monitoring that occurs for the treatment of sulfasalazine?
-full blood count
-liver function test
-renal function
more intensely at the beginning of therapy
what are some preparations that can be done to aminosalicylates to help release the drug to a certain area
-prepartions can be coated with an enteric coat with a specific agent to release at specific pH to prevent early disintergration in the stomach and upper GI
-wanting time dependant microspheres of mesalazine encapsulated in ethylcellulose semi-permeable
membrane = time and moisture dependent release (pH independent)
-multi-matrix, Mesalazine incorporated into lipophilic matrix and enterically coated (dissolution pH >7)
• Matrix swells to form a gel (potentiating slow diffusion) – terminal ileum and entire colon release
how long is the delayed effect of thiopurines?
3-6 months
what are some contradictions for thiopurines?
Hypersensitivity, serious infection, pancreatitis, impaired bone
marrow
what are some cautions for thiopurines?
Reduce TPMT
Renal and hepatic impairment
when should patients inform their doctors when using thiopurine?
ulceration of the throat, fever, infections, bruising, bleeding
= signs of myelosuppression
what should be the dose if a patient is using allopurinol?
Interaction with allopurinol – reduce azathioprine dose to ¼ of the usual dose
