IBD

Question 1

What IV steroids are used in severe IBD?

Answer 1

Hydrocortisone

Question 2

What oral steroids are used in severe IBD?

Answer 2

Prednisolone

Question 3

What are some e.gs of 5-ASA meds?

Answer 3

Balsalazide, mesalazine, sulfasalazine

Question 4

What are rare SEs of 5-ASA meds?

Answer 4

Blood dyscrasias- any patients reporting bruising, bleeding, sore throat should have an urgent FBC performed

Question 5

How does azathioprine work?

Answer 5

Pro-drug converted to 6-mercaptopurine

Metabolised by thiopurine methyltransferase- low activity level associated with increased risk of toxicity

Question 6

When are biologics used in IBD?

Answer 6

Refractory (unresponsive) disease

Question 7

How do biologics work?

Answer 7

Mab which inhibit TNF-a

Question 8

What are some e.gs of biologics?

Answer 8

Infliximab
Adalimumab
Golimumab

Question 9

What are the adverse effects of biologics?

Answer 9

Immunosuppression- increased risk of infection, autoimmunity and malignancy

Reactivation of TB (CXR before starting)

Increased risk autoimmunity and ?malignancy

Infliximab- rarely life threatening hypersensitivity (resusc equipment!)

Question 10

Mx UC?

Answer 10

Limited- enemas, suppositories

Extensive- systemic treatment. Once controlled give 5-ASA

Severe unresponsive- ciclosporin, infliximab

Question 11

Mx Crohns?

Answer 11

Active- corticosteroids. Azathioprine or methotrexate as steroid-sparing agents

Anti-TNFs- active and maintenance

Often need surgery at some point

Question 12

Mx strictures ass with Crohns?

Answer 12

Treatment with abx- ciprofloxcin or metronidazole