All Flashcards
(15 cards)
Is Azathioprine safe in pregnancy?
Yes!
Are sulfasalazines safe in pregnancy?
Yes!
But in men, some evidence of sperm abnormalities and increased infertility risk
How long after receiving a biologic can love vaccines be given?
Safe to give live vaccines 6 months after biologic
Same goes for baby who has been exposed to biologic through mother/pregnancy
Are anti-TNFs safe in breast feeding?
Anti-TNFs are excreted in breast milk, but are safe to h the baby. No association with infection or change in growth
What are the side effects of Azathioprine?
Hepatitis Pancreatitis Nausea Lymphoma Non-melanoma skin cancer
(Not melanoma!)
What malignancies are IBD patients at higher risk for?
Colorectal cancer Haematological malignancies (lymphoma, leukaemia, hepatosplenic T cell lymphoma) Skin cancer - anti-TNF = melanoma - AZA = non-melanoma skin Ca
UC + PSC -> 5x higher risk of CRC and cholangiocarcinoma (vs UC without PSC)
NO association with GIST/carcinoid
What is hepatosplenic T cell lymphoma?
Highly fatal Haem malignancy seen in young men with IBD on combination AZA and anti-TNF
What is the action of Vedolizumab used in IBD?
Vedoluzimab is a monoclonal antibody that blocks gut lymphocyte trafficking. It targets a4b7 integrin on B and T cells
On intestinal mucosal lymphocytes it binds MAdCAM-1
(Similar to Natalizumab that inhibits B1 as well, thus blocking lymphocyte trafficking into the CNS)
Vedoluzimab has NO increased risk of serious infection if PML
What factors predispose to an ability to spontaneously clear HCV?
Jaundice Younger Female IL-28B genotype HLA type
When is interferon contraindicated in the treatment of HCV?
Interferon contraindicated in decompensated cirrhosis
When do you treat HBV?
HBV DNA >20,000
Liver inflammation (ALT >2x ULN)
Cirrhosis (must treat!)
Pregnancy/pre-pregnancy
Which conditions can cause HCC without preceding cirrhosis?
HBV and NASH cause HCV without cirrhosis
HCV and haemacromatosis will cause cirrhosis before HCC
What diagnosis is consistent with this liver biopsy: interface hepatitis, plasma cells at the interface, lymphocytes infiltrating portal tracts and lobules
Autoimmune hepatitis
What are the features of IgG4 disease?
Siladinitis Retroperitoneal fibrosis Ophthalmic involvement Cholangiopathy Pancreatitis
Diagnostic criteria:
- histology +
- imaging
- serology IgG4
- multi-organ involvement
- rapid response to steroids
In what trimester of pregnancy are anti-TNFs transported across the placenta?
2nd and 3rd trimester
No adverse effects with anti-TNF therapy in pregnancy, but aim to cease all anti-TNF in the 3rd trimester
Mother at higher risk of developing anti-TNF antibodies and having an infusion reaction to biologic when restarted post-partum
