Wk 11: IBD (UC treatment + management)

Question 1

What is used for inducing remission in patients with mild-moderate proctitis?

Answer 1

• Topical aminosalicylate
• Add oral aminosalicylate to topical

Question 2

What is given when inducing remission to patients with mild-moderate proctitis who can’t tolerate aminosalicylate?

Answer 2

• Topical corticosteroid

OR

• Oral pred

Question 3

What is used for inducing remission in patients with mild-moderate proctosigmoiditis + left sided?

Answer 3

• 1st line: topical aminosalicylate
• High dose oral aminosalicylate
• High dose oral aminosalicylate w/ topical corticosteroid

Question 4

What is given for inducing remission in patients with mild-moderate proctosigmoiditis + left sided who can’t tolerate aminosalicylate?

Answer 4

Topical/oral steroid

Question 5

What is given to induce remission in patients with mild to moderate extensive disease?

Answer 5

• Topical aminosalicylate + high dose oral aminosalicylate
• Stop topical + give high dose of oral aminosalicylate w/ time limited oral corticosteroid

Question 6

How is tacrolimus prescribed?

Answer 6

Brand name only

Question 7

When is tacrolimus contraindicated?

Answer 7

Hypersensitivity to macrolides

Question 8

What are the monitoring requirements of tarcoliums?

Answer 8

• Drug levels
• BP
• ECG
• U+Es
• Liver function
• Coagulation
• Neurological parameters

Question 9

What are the counselling points for tacrolimus?

Answer 9

• Avoid exposure to UV light
• Affect driving
• Take 1 hrs before or 2-3 hrs after meal
• Avoid grapefruit/juice
• Report Bone marrow suppression
• Avoid pregnancy, contraception for 3 months after stopping

Question 10

What is used for inducing remission for severe UC?

Answer 10

1. IV CCS or ciclosporin if CI
2. IV ciclosporin w/ IV CCs
3. No improvement w/ 72hrs: biologics/surgery

Question 11

How is ciclosporin prescribed?

Answer 11

By brand

Question 12

What are the interactions of ciclosporin?

Answer 12

• Amiodarone
• Atorvastatin
• Carbamazepine
• Clarithromycin
• Dabigatran
• Diclofenac

Question 13

What are the monitoring requirements of ciclosporin?

Answer 13

• Serum cholesterol prior to starting
• BP

Weekly for 4 wks then 2 weekly for 3 months:
- Renal
- Liver
- Potassium + mg
- Drug levels

Question 14

What are the brands of budesonide?

Answer 14

Cortiment + MMX

Question 15

What is budesonide used for?

Answer 15

• Mid-mod active UC where 5-ASA is not sufficient
• Not for maintenance of remission

Question 16

What is used to maintain remission in proctitis + proctosigmoiditis?

Answer 16

Topical +/or oral aminosalicylates

Question 17

What is used to maintain remission in left sided + extensive UC?

Answer 17

Low dose oral aminosalicylate

Question 18

When should you use oral azathioprine or mercaptopurine to maintain remission?

Answer 18

• After 2/more exacerbations in 12 months requiring treatment with systemic corticosteroid
• Remission not maintained by aminosalicylate

Question 19

What is given after a single episode of acute severe UC?

Answer 19

• 1st line: Azathioprine or mercaptopurine
• 2nd line: oral aminosalidcylates

Question 20

Which vaccinations are considered for all patients with IBD?

Answer 20

• Flue annually
• Pneumococcal vaccine
• Hep b
• Human papillomavirus
• Varicella zoster