GI: Crohns Disease Flashcards Preview

Pharmacy Pre-Registration 20/21 > GI: Crohns Disease > Flashcards

Flashcards in GI: Crohns Disease Deck (18)
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1
Q

Why can Crohns disease cause secondary osteoporosis?

A

Reduced absorption of dietary vitamins and minerals.

2
Q

What is fistulating Crohn’s disease?

A

When there is the formation of a fistula between the intestine and adjacent structures, such as the perianal skin, bladder, and vagina. It occurs in about 1/4 patients, mostly when the disease involves the ileocolonic area.

3
Q

What common harmful lifestyle factor can make Crohn’s worse?

A

Smoking

4
Q

In the treatment of acute Crohn’s, what is used to induce remission in patients with a first presentation or a single inflammatory exacerbation of Crohn’s in a 12-month period?

A

A corticosteroid (either prednisolone or methylprednisolone or intravenous hydrocortisone).

5
Q

Acute Crohns: In patients with distal ileal, ileocaecal or right-sided colonic disease, in whom a conventional corticosteroid is unsuitable or contra-indicated, what can be considered and why?

A

Budesonide can be considered, it is less effective but may cause fewer side-effects than other corticosteroids as the systemic exposure is limited.

Aminosalicylates (sulfasalazine and mesalazine) are an alternative option. But less effective.

6
Q

When would add-on treatment be used in Acute Crohn’s?

A

If there are two or more inflammatory exacerbations in a 12-month period, or if the corticosteroid dose cannot be reduced.

7
Q

Acute Crohn’s: What can be added to a corticosteroid or budesonide to induce remission?

A

Azathioprine or mercaptopurine can be added.

Azathioprine or mercaptopurine [unlicensed indications] can be added to a corticosteroid or budesonide to induce remission. In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, methotrexate can be added to a corticosteroid.

8
Q

Acute Crohn’s: Add-on treatment: In patients who cannot tolerate azathioprine or mercaptopurine or in whom thiopurine methyltransferase (TPMT) activity is deficient, what can be added to a corticosteroid?

A

Methotrexate

9
Q

Under specialist supervision, monoclonal antibody therapies with what are options for the treatment of severe, active Crohn’s disease, following inadequate response to conventional therapy?

A

Adalimumab: anti-TNF

Infliximab: anti-TNFa

10
Q

How does adalimumab work?

A

anti TNF

11
Q

How does infliximab work?

A

Anti TNF

12
Q

Acute Crohn’s. add-on treatment: what is a recommended treatment option for moderate to severely active Crohn’s disease when therapy with adalimumab and infliximab is unsuccessful or not tolerated?

A

Vendolizumab:
monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.

13
Q

How does Vendolizumab work?

A

monoclonal antibody that binds specifically to the α4β7 integrin, which is expressed on gut homing T helper lymphocytes and causes a reduction in gastrointestinal inflammation.

14
Q

In the maintenance of remission in Crohn’s, what drugs used as unlicensed monotherapy can maintain remission when previously used to induce remission?

A

Azathio and mercaptopurine

15
Q

What are the symptoms of Crohn’s relapse?

A

Weight loss, abdominal pain, diarrhoea and general ill-health.

16
Q

Methotrexate should only be used in patients to maintain remission if what?

A

If methotrexate was needed to induce remission or if they are intolerant of or not suitable for azathioprine or mercaptopurine.

17
Q

What drugs should not be used for the maintenance of remission in Crohn’s?

A

Corticosteroids or budenoside.

18
Q

What drug is licensed for the relief of diarrhoea associated with Crohn’s disease?

A

Colestyramine but also loperamide and codeine.

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