Week 6- Pharmaceutical care considerations in IBD + Pharmaceutical care - Drugs used in IBD

Question 1

why do patients with IBD have a risk of getting infections?

Answer 1

• 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

Question 2

when using steroids for patients with IBD what is the aim and why?

Answer 2

-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

Question 3

when a patient is taking steroids what else should they be given to help monitor their bone health?

Answer 3

• calcium and vitamin D as it help with uptake of calcium

- should have calcium and vitamin D levels checked and risk of deficiency checked

Question 4

why is malnutrition common in IBD?

Answer 4

increased nutritional demand due to chronic inflammation and poor absorption due to inflammation or surgery

Question 5

what vitamin deficiencies are important to consider for the patient?

Answer 5

• magnesium
• calcium
• potassium
• vitamin D

Question 6

why do patients with IBD have iron defiency?

Answer 6

-due to excess excretion of iron and bleeding to to inflammation, decrease of intake of iron due to changes in diet

Question 7

what type of patients with IBD tend to smoke more?

Answer 7

crohns disease

Question 8

what are the risks of smoking as a patient with IBD?

Answer 8

Continuation of smoking is linked to worse disease course, higher risk of
surgery and worst outcomes after surgery

Question 9

what are some of the risk of using NSAIDs with IBD?

Answer 9

• May to lead to increase disease activity – esp. in Crohn’s colitis
• May precipitate a relapse

Question 10

what cancer is IBD a risk factor for?

Answer 10

bowel cancer

Question 11

what are some ways to reduce the risk of colorectal cancer in IBD patients?

Answer 11

• 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

Question 12

what are some issues with adherence for IBD patients?

Answer 12

• Chronic disease with long term medical treatment
• Remission
• Topical treatments
• Need for monitoring
• Adverse effects
• Patients beliefs

Question 13

what are the consequences of poor adherence to medication for IBD patients?

Answer 13

Worse patient outcomes – increased disease activity, relapse, loss of response,
higher morbidity and mortality, poor QOL, higher disability

Question 14

what are some other pharmaceutical considerations to make about IBD treatment and patients?

Answer 14

• 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

Question 15

what type of drug is the main treatment for UC?

Answer 15

aminosalicylates

Question 16

where is mezalazine in its unaltered form absorbed ?

Answer 16

small intestine

Question 17

what is the structure of sulfasalazine?

Answer 17

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

Question 18

where is sulfapyridine absorbed, metabolised and excreted?

Answer 18

in the colon, metabolised by the liver and excreted in the urine and is responsible for adverse effects

Question 19

what are some contraindications for the use of sulfasalazine?

Answer 19

-hypersensitivity to sulfasalazine/sulfonamides or 5-aminosalicylate/ salicylates

Question 20

what are some of the cautions for the use of sulfasalazine?

Answer 20

-History of asthma can cause 
cough
Risk of haematological toxicity
Renal and hepatic impairment
Glucose-6-dehydrogenase (G6PD) deficiency
Slow acetylator status

Question 21

what are some of the side effects of sulfasalazine?

Answer 21

-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

Question 22

what are some of the monitoring that occurs for the treatment of sulfasalazine?

Answer 22

-full blood count
-liver function test
-renal function
more intensely at the beginning of therapy

Question 23

what are some preparations that can be done to aminosalicylates to help release the drug to a certain area

Answer 23

-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

Question 24

how long is the delayed effect of thiopurines?

Answer 24

3-6 months

Question 25

what are some contradictions for thiopurines?

Answer 25

Hypersensitivity, serious infection, pancreatitis, impaired bone
marrow

Question 26

what are some cautions for thiopurines?

Answer 26

Reduce TPMT

Renal and hepatic impairment

Question 27

when should patients inform their doctors when using thiopurine?

Answer 27

ulceration of the throat, fever, infections, bruising, bleeding
= signs of myelosuppression

Question 28

what should be the dose if a patient is using allopurinol?

Answer 28

Interaction with allopurinol – reduce azathioprine dose to ¼ of the usual dose