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PHAM01 > Wk 11: IBD (Crohn's treatment + management) > Flashcards

Wk 11: IBD (Crohn's treatment + management) Flashcards

1
Q

What is first line for inducing remission in a patient with Crohn’s disease?

A

Corticosteroids:

  • Glucocorticoid (pred, methyl pred, IV hydrocortisone)
  • People w/ 1st presentation or single inflammatory flare in 12 month period
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2
Q

What is given to induce remission in patients w/ one/more distal ileal or right sided colonic disease who can’t tolerate/CI glucocorticoid?

A

Budesonide

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3
Q

What are the early side effects of corticosteroids?

A
  • Mood disturbance
  • Insomnia
  • Acne
  • Dyspepsia
  • Glucose intolerance
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4
Q

What are the delayed effects of corticosteroids?

A
  • Osteoporosis
  • Osteonecrosis
  • Myopathy
  • Susceptible to infection
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5
Q

When is IV corticosteroids used?

A
  • Severe
  • Patient vomiting
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6
Q

What happens to the corticosteroid when a patient is undergoing illness, trauma or surgery?

A
  • Inc dose
  • If stopped, temp. reintroduce corticosteroid
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7
Q

What happens to patients on corticosteroids when undergoing surgery?

A

Avoid BP fall + adrenal suppression:

  • IV hydrocortisone prior to surgery
  • Continue 24-72hrs
  • Usual oral dose continued after surgery
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8
Q

What are the risks of steroid use post surgery?

A
  • Inc risk of infection
  • Inc risk of GI bleeding
  • Delayed wound healing
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9
Q

When are corticosteroids gradually withdrawn?

A
  • > 40mg pred for more than 1 wk
  • Repeated doses in evening
  • > 3 wks treatment
  • Repeated courses
  • Taken short course w/in 1 yr of stopping LT therapy
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10
Q

When are bisphosphonates given?

A
  • Steroids for >65 yrs
  • <65 but need steroids for >3 months
  • Stopped when steroids stopped
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11
Q

Alongside bisphosphonates, what else is given to help with osteoporosis?

A

Calcium + vit D

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12
Q

What is given to people who decline, cannot tolerate or where glucocorticoid steroid is contraindicated for a first presentation or single inflammatory exacerbation in 12 month period?

A

5-aminosalicylate:

  • Balsalazide
  • Mesalazine
  • Sulphasalazine
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13
Q

What is given as an add on to glucocorticoid or budesonide to induce remission if: 2/more exacerbations in a 12 month period or steroid dose cannot be tapered?

A
  • 1st line azathioprine
  • 6-mercaptopurine
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14
Q

What needs to be assessed before offering azathioprine or mercaptopurine?

A

TPMT

  • Offer lower dose if TPMT activity below normal
  • Don’t offer if TPMT activity is deficient
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15
Q

When is methotrexate given as an add on to glucocorticosteroid or budesonide to induce remission?

A
  • Can’t tolerate azathioprine/mercaptopurine
  • TPMT activity deficient
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16
Q

What is the complication of azathioprine?

A

Bone marrow suppression: infection, unexplained bleeding/bruising

17
Q

What are the interactions of azathioprine?

A
  • Allopurinol: inc toxicity
  • Warfarin: red INR (monitor)
  • Trimethoprim/co-trimoxazole: inc thrombocytopenia + neutropenia (avoid)
  • Clozapine: inc agranulocytosis (avoid)
18
Q

What is 6MP?

A
  • Metabolite of azo
  • Better tolerated
  • Same interactions, s/e + monitoring
19
Q

What is TPMT?

A

Thiopurine methyl transferase:

  • Metabolises azathioprine
  • Lack of TPMT = marrow suppression + death
20
Q

What is given if azathioprine/6MP is not effective or tolerated?

A

Methotrexate w/ folic acid 5mg weekly (2-3 days after MTX)

21
Q

What are the monitoring requirements of methotrexate?

A

FBC + LFTs before + every month

22
Q

What are the adverse effects of methotrexate?

A
  • Bone marrow suppression - w/draw if WCC or platelet fall
  • Liver toxicity - discontinue if abnormal function
  • Pulmonary toxicity - monitor symptoms, discontinue if pneumonitis
  • Gastro-intestinal toxicity - w/draw if stomatitis develops
23
Q

What increases the risk of bone marrow suppression when taking methotrexate?

A
  • Advanced age
  • Renal impairment
  • Use of anti-folate drug (trimethoprim)
24
Q

What signs do you report when on methotrexate?

A
  • Blood toxicity: sore throat, bruising, ulcers
  • Liver toxicity: nausea, vom + dark urine
  • Respiratory: SOB
25
Q

What drugs interact with methotrexate?

A
  • NSAIDs, ACE + diuretics
  • Anti-folate drugs: trimethoprim

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