IBD (Chron's Disease & Ulcerative Colitis)

Question 1

Ulcerative colitis affects what region of the digestive tract?

Answer 1

Continuous lesion in colon and rectum

Question 2

Crohn’s Disease affects what region of the digestive tract?

Answer 2

Discontinuous lesions in any part of the GI tract

Question 3

Which is more likely to have nutritional deficiencies; CD or UC? Which is more likely to have colorectal cancer?

Answer 3

nutritional deficiencies-Crohn’s Disease

colorectal cancer - both but higher risk with ulcerative colitis

Question 4

Common IBD Symptoms and characteristics unique to CD

Answer 4

pain, cramping, nocturnal diarrhea, urgency, bleeding, fatigue, weight loss
CD-abdominal mass, pain, fistula, ulcers, abscess

Question 5

Which is more likely to relapse? CD or UC?

Answer 5

20% mild UC cases remiss within weeks with tx
vs
20% CD cases relapse annually

Question 6

Drug classes used for IBD

Answer 6

5-ASA( Sulfasalazine, mesalazine aka mesalamine)
Corticosteroids (Prednisone, budesonide)
Antibiotics (Antimycobacterial agents, metronidazole, ciprofloxacin)
For severe IBD when the above don’t work
Immunosuppressives ( Azathioprine, 6-mercaptopurine, methotrexate)
Biologics (Infliximab, adalimumab, certolizumab, natalizumab)

Question 7

Mesalazine aka Mesalamine products

Answer 7

Asacol tabs
Pentasa tabs
Salofalk Pentasa Enema or suppository

Question 8

Sulfasalazine products

Answer 8

tabs

Question 9

mild-mod UC tx

Answer 9

Recta 5-ASA>1g/day +/-
Oral 2-4.8g/day
If no response in 4-8 weeks add on oral or rectal corticosteroids

Question 10

CD tx

Answer 10

Mild
Sulfasalazine 3-6g/day or PO Meselamine 2.4-4.8g/day or metronidazole up to 10-20mg/kg/day
Moderate
add on prednisone 40-60mg/day

Question 11

Sulfasalazine S/E

Answer 11

nausea, headache, rash, hemolytic anemia,
hepatotoxicity
*most S/E are minor, dose related, and related to sulfapyridine not in 5-ASA preps
*may cross react w sulfonamide antibiotics

Question 12

Sulfasalazine vs Mesalamine chem, efficacy, safety

Answer 12

mesalamine (2 linked 5-ASA moieties)

sulfasalazine (a sulfapyridine linked to a 5-ASA moiety with an azo bond)

Question 13

Products that release in small bowel

Answer 13

Salofalk, Pentasa

Question 14

Products that release in the colon

Answer 14

Sulfasalazine, olsalazine, Asacol and Mezavant

Question 15

Mesalamine S/E

Answer 15

hypersensitivity (can rarely worsen sx), rarely renal toxicity

Question 16

Long term corticosteroid tx in IBD

Answer 16

Not recommended for maintenance of remission due to long term s/e like osteoporosis (Ca+VitD recommended)

Question 17

NSAIDs in IDB

Answer 17

Avoid bc linked to worsening sx and disease flares

Question 18

Can 5-ASA be d/c abruptly?

Answer 18

Not recommended, may result in relapse