wk 5 5 GI IBD therapy

Question 1

the aims of therapy are to control inflammation/heal mucosa, restore normal bowel habit, improve quality of life, balance effects of disease with side effects, avoid long term complications.
in what 3 ways is this achieved

Answer 1

lifestyle advice
drugs
surgery

Question 2

t/f smoking aggravates ulcerative colitis

Answer 2

false
aggrevates crohns
- worse disease outcome, more rapid recurrence

Question 3

whats the difference in therapy options for ulcerativ and crohns

Answer 3

crohns

• steroids
• immunosuppressants
• anti-TNF therapy

ulcerative
same with 5ASA (mesalazine) added

Question 4

t/f 5ASA reduces risk of colon cancer

Answer 4

true

Question 5

likely side effects of 5ASA 2

Answer 5

diarrhoea

idiosyncratic nephritis

Question 6

there are many 5ASA drugs
-Sulphasalazine 
-Balsalazide
-Mezavant
-Mesalazine
-Asacol
-Pentasa
which one is pH release? delayed release?

Answer 6

Asacol

Pentasa

Question 7

advantages of using suppositories? enemas

Answer 7

suppositories
-smaller coat but better mucosal adherence

enemas
- less than 10% stays in rectum, reflex contraction aids spread

Question 8

give an example of a topical corticosteroid

Answer 8

Budesonide

Question 9

t/f steroids are required for lng term therapy

Answer 9

false
6-8 weeks, high dose then reducing
brdge to maintenance therapy

Question 10

side effects of corticosteroids

Answer 10

musculoskeletal

• avascular necrosis
• osteoporosis
• acne, thinning of skin

metabolic

• weight gain
• hypertension

Question 11

immunosuppression is required when inflammation is not reduced by corticosteroids, what type of drugs would be used for UC/crohns?

Answer 11

UC; steroid sparing agents (azathioprine, mercaptopurine)

Crohns - maintenance therapy (methotrexate)

Question 12

what should be avoided if azathioprine iis being prescribed

Answer 12

allopurinol (gout/kidney stones)

Question 13

tumour necrosis factor alpha is a proinflammatory cytokine,give 2 examples of anti-TNFalpha

Answer 13

infliximab - IV
adalimumab - S/C injection

promotes apoptosis of activated T cells

Question 14

t/f infliximab is approved for UC

Answer 14

true

mod-severe

Question 15

when is anti-TNF alpha used in IBD 2

Answer 15

long term strategy - inc immunosuppression, surgery (crohns), supportive therapy

for refractory/fistulising disease

Question 16

other than failing to respond to medical therapy, when would an eelective surgery in IBD be considered

Answer 16

if there is dysplasia of colon mucosa

Question 17

t/f surgery for UC is curative

Answer 17

true

Question 18

2 surgeries involved in UC

Answer 18

permanent ileostomy - small intestine diverted to hole in belly

restorative proctocolectomy and pouch - rectum +/- colon removed
- new pouch functions as rectum

Question 19

what is the therapy cascade in IBD

Answer 19

smoking cessation 
5-ASA (UC) 
steroids if reqd 
immunosuppression
anti-TNF