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Pharm II > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

what are the two types of inflammatory bowel diz?

A

Ulcerative colitis

crohn’s dz

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2
Q

which condition is a transmural inflammation of the GI?

A

Crohn’s dz

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3
Q

bloody diarrhea and abdominal pain indicates what?

A

Ulcerative colitis

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4
Q

Diarrhea and abdominal pain indicates what?

A

Crohn’s dz

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5
Q

common complaints of crohn’s dz

A

weight loss
vomiting
fever
perianal discomfort

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6
Q

what 2 bacteria is there an increase in (pathogenic) with IBD?

A

Bacteroides

E. Coli

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7
Q

what types patients have a generalized impaired immune response? will have decreased blood flow to sites and decrease neutrophils and inter-leukin 8

A

Crohn’s Dz

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8
Q

what dz is smoking protect for?

A

Ulcerative colitis

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9
Q

smoking makes what dz worse?

A

crohn’s dz

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10
Q

what meds should be avoided w/ IBD

A

Opiates
NSAIDs (disrupt mucosal barrier)
Antidiarrheals (risk of megalocolon)

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11
Q

with IBD will result in fistulas?

A

Crohn’s Dz

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12
Q

does any diet improve or exacerbate UC?

A

No

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13
Q

What nutritional supplements can help UC?

A

Reduced fiber during exacerbation
folic acid
oral iron w/ considerable rectal bleeding
metamucil

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14
Q

when should someone with UC take folic acid?

A

When leafy veggies restricted or

sulfasalazine being used

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15
Q

what drugs can you start someone on with mild-moderate ulcerative colitis?

A

Sulfasalazine
Mesalamine
Aminosalicylate

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16
Q

If ulcerative colitis is more distal what drugs can you give?

A

Mesalamine enema/ suppository

corticosteroid enema

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17
Q

when someone is in remission for UC what can you do?

A

Reduce dose by 1/2 or

reduce enema/ suppository to q 1-2 days

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18
Q

what should you add to treatment for moderate to severe UC.

A

Add prednisone (high dose)

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19
Q

what must you do with the prednisone to discontinue it?

A

Taper the dose down

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20
Q

when someone goes into remission after having moderate to severe UC what should you do?

A

Taper prednisone

REduce sulfasalazine/ mesalamine after 1-2 months to half

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21
Q

For refractory UC what do you add? (Not responding to normal therapy)

A

Azathioprine or mercaptopurine (6-MP)

infliximab (antibody)

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22
Q

How do you treat severe or fulminant UC?

A

Hydrocortisone (IV)

if remission change to prednisone add sulfasalazine or mesalamine

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23
Q

If someone doesn’t respond to tx of severe or fulminant UC? (within 5-7 days)

A

cyclosporine IV

colectomy

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24
Q

only cure of UC

A

surgery

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25
Q

what do you use for maintenance of UC? (takes all the time)

A

aminosalicylates and/or AZA or 6-MP

alternative infliximab q 8 weeks

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26
Q

What are beneficial nutritional measures for Crohn’s?

A

Limit fiber w/ cramping and diarrhea
decrease fat intake w/ steatorrhea
multivitamin w/ minerals daily

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27
Q

how do you treat ileocolonic or colonic crohn’s?

A

sulfsalazine

oral mesalamine

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28
Q

tx for perianal crohn’s

A

sulfsalazine
oral mesalamine
metronidazole

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29
Q

small bowel tx of crohn’s

A

oral mesalamine
metronidazole
budesonide

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30
Q

with mild-moderate crohn’s dz you give them the same tx and add what?

A

Prednisone

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31
Q

If a person isn’t responding to initial tx for Crohn’s what do you add or fistulaing dz?

A

Infliximab

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32
Q

what are 3 other drugs to use if infliximab isn’t working? for crohn’s

A

Adalimumab
Natalizumab
Certolizumab

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33
Q

once the patient responds to tx for crohn’s dz how do you treat?

A

Taper prednisone after 2-3 weeks

Add AZA, 6-MP or MTX

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34
Q

how do you tx severe fulminant crohn’s?

A

hydrocortisone IV

if no response switch to cyclosporin

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35
Q

what drugs do you d/c for crohn’s?

A

long term corticosteroids

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36
Q

what is the 1st line maintenance for crohns?

A

azathioprine / 6-MP
infliximab
methotrexate

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37
Q

name the 2 aminosalicylates

A

sulfasalazine

mesalamine

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38
Q

name 2 immunomodulators

A

azathiprine

6-MP

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39
Q

Most commonly used for inducing and maintaining remission

A

Aminosalicylates

40
Q

how long can response take with aminosalicylates?

A

2-3 weeks

41
Q

what metabolizes sulfasalazine to 5-ASA and mesalamine?

A

intestinal bacteria

42
Q

C/I to sulfasalazine

A 
salicylate hypersensitivity
renal impairment (monitor SrCr)
43
Q

what needs to be monitored w/ sulfasalazine?

A

SCr

44
Q

Main ADRs with sulfasalazine

A

blood disorders (anemia, thrombocytopenia, granulocytopenia)
impair folic absorption
low sperm counts

45
Q

what are the idiosyncratic rxs with sulfsalazine (will go away once stop taking meds)

A

hepatocellular injury
agranulocytosis
lupus-like phenomena

46
Q

MOA of mesalamine

A

unclear

47
Q

ADRS with mesalamine

A

less than sulfasalazine
local itching and mild rectal iritation
idiosyncratic rxns

48
Q

how should you presibe mesalamine?

A

based on location (oral/ supossitory)

49
Q

what drugs has there idiosyncratic rxns pleuropericarditis, pancreatitis, nephrotic syndrome
?

A

mesalamine

50
Q

MOA of corticosteroids

A

anit-inflammatory effects

51
Q

name some corticosteroids

A 
prednisone
budesonide
prednisolone
hydrocortisone
methyprednisolone
52
Q

what corticosteroid is in syrup?

A

Prednisolone

53
Q

when should you taper w/ a corticosteroid.

A

If a patient is on the corticosteroid for more than 7 days

54
Q

if you can’t taper the patient down without the patient getting sick again, what should you give?

A

amtimetabolite and/or infliximab

55
Q

with long term use of corticosteroids what can happen?

A

glucose intolerance/ metabolic abnormalities

greater risk for adrenal insufficiency/ infection

56
Q

if one corticosteroids for greater than 3 months what can develop?

A

osteoporosis

eye problems

57
Q

what are 2 immunosuppressants

A

6-Mercaptopurine (6-MP) (pro drug)

Azathioprine

58
Q

MOA of immunosuppressives

A

Antagonizes purine metabolism; inhibits DNA, RNA and protein synthesis

59
Q

how long do immunosuppressives take to work?

A

weeks to months

60
Q

ADRS with immunosuppressive drugs

A

Bone marrow suppression (dose related)
Lymphoma (4 fold increase)
pancreatitis

61
Q

what infections can occur with immunosupressive drugs ? higher risk when on this and steroids

A

disseminated CMV, herpes zoster
pneumonia, viral hepatitis
Q fever
occurs w/o leukopenia

62
Q

what will the immunosupressions inhibit the metabolism of

A

Sulfasalazine, mesalamine
Allopurinol
Aspirin
Furosemide

63
Q

what drugs are an immunomodulator?

A

Methotrexate

tacrolimus

64
Q

MOS of methotrexate

A

folic acid antagonist with anti-inflammatory effects

65
Q

what does methotrexate reduce the need for?

A

steroid

66
Q

what do you need to monitor with methotrexate?

A

LFTs

67
Q

what category is methotrexate in pregnancy?

A

Category X

68
Q

what is the most significant side effect of methotrexate?

A

Hepatic fibrosis

69
Q

What is the MOA of cyclosporin?

A

inhibits production and release of IL-2 leads to inhibits activation of T-lymphocytes

70
Q

what should you give while giving cyclosporin?

A

IV steroids

71
Q

is cyclosporin alone able to maintain remission?

A

No, so you must switch over to AZA or 6-MP

72
Q

Big ADRS with cyclosporin?

A

HTN
electrolyte abnormalities
kidney problems

73
Q

MOA of tacrolimus

A

inhibits T-lymphocyte activation

74
Q

when will the ADRs of tacrolimus go away

A

when you decrease the dose

75
Q

Big ADRs of tacrolimus

A

Increased serum creatinine

76
Q

Monoclonal antibody that binds to TNF-alpha

Inhibits inflammatory cytokines, inhibits leukocyte migration and activation of neutrophils

A

Infliximab

77
Q

when is infliximab c/i?

A 
NYHA class III/IV failure 
Hepatitis (will reactivate hep B)
78
Q

what will your body develop against infliximab.

A

Antibodies. increased risk of infusion rx can lead to shorter duration of response

79
Q

with most monoclonal antibodies there are higher rates of what?

A

TB with extrapulmonary involvement

80
Q

what is a patient experiencing if they have these symptoms HA, dizziness, nausea, erythema at site, flushing, fever, chills, chest pain, cough, dyspnea, pruritis

A

Infusion rxn

81
Q

when do delayed hypersensitivities develop to monoclonal antibodies?

A

3-13 days

82
Q

how can you avoid delayed hypersensitivies w/ monoclonal antibodies

A

prednisone or methylprednisolone IV 30 minutes before

83
Q

Toxicities w/ monocolonal antibodies

A

autoantibodies (lupus like)

malignancy and lymphomas

84
Q

Only for crohn’s dz. recombinant fully-human immunoglobulin-1 anti-tumor necrosis factor (TNF)-alpha monoclonal antibody

A

adalimumab

85
Q

what type injection if adalimumab?

A

SQ

86
Q

what is the black box warning for Adalimumab ?

A

TB, invasive fungal and or other opportunistic infections

87
Q

for crohn’s in pts with evidence of inflammation who have had inadequate response to, or are unable to tolerate conventional therapies. Patient must be in special program. originally for MS

A

Natalizumab

88
Q

for crohn’s recombinant immunoglobulin-4 monoclonal antibody. infused

A

recombinant immunoglobulin-4 monoclonal antibody

89
Q

Major adverse effect with natalizumab?

A

progressive multifocal encephalopathy

90
Q

used for Failure to respond to sulfasalazine, tx of ileocolitis or colitis.

A

metronidazole

91
Q

ADRs with metronidazole

A

GI upset, metallic taste, paresthesias, antabuse-like rxn

92
Q

what 2 drugs together is recommended for fistula or abscess.

A

combination with standard tx

Metronidazole + Ciprofloxacin

93
Q

what can provide symptomatic relief of diarrhea. MOA- inhibits excessive GI motility and propulsion.

A

opiates

94
Q

which patients should you avoid opiates in?

A

Ulcerative colitis

95
Q

what drug can cause hypertrichosis?

A

Cyclosporin

Pharm II (16 decks)

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