GI IBD Flashcards
(106 cards)
1
Q
Chronic, idiopathic, relapsing inflammatory disorders
A
Inflammatory Bowel Disease
2
Q
Mucosal inflammatory condition of the GI tract that is limited to the rectum and the colon (large intestine)
A
Ulcerative Colitis
3
Q
Transmural inflammatory condition that can effect any part of the GI tract from the mouth to anus
A
Crohn’s Disease
4
Q
True or false: IBD affects both sexes equally
A
True
5
Q
What ages are patients when they are diagnosed with UC?
A
20-25
6
Q
What ages are patients when they are diagnosed with CD?
A
Before 30
7
Q
What race is more affected by IBD?
A
Caucasians
8
Q
What environmental factors contribute to IBD?
A
1) Infection
2) Foods
3) Smoking
9
Q
What dietary antigens can cause inflammation in the GI Tract?
A
Red meat and alcohol
10
Q
True or false: smoking worsens UC, but is associated with improved symptoms of CD
A
False
11
Q
___ degree relatives have a __-fold increased risk of developing IBD
A
1st ; 13
12
Q
True or false: Genetics have more of an increased risk for CD over UC
A
True
13
Q
What type of agents does IBD respond to?
A
Immunosuppressant agents
14
Q
What are 5 presenting symptoms of IBD?
A
- Rectal bleeding
- Diarrhea
- Fever
- Weight loss
- Abdominal pain and cramping
15
Q
To diagnose IBD, what do you have to rule out first?
A
Infectious etiology
16
Q
Which type of IBD has continuous lesions?
A
Ulcerative Colitis
17
Q
What is the mucosal appearance with UC?
A
- Edema
- Mucous Erosions
18
Q
Type of UC where only the rectum is involved
A
Proctitis
19
Q
Type of UC that extends to the left splenic flexure
A
Distal colitis
20
Q
Type of UC that involves areas of the colon beyond
the left splenic flexure
A
Extensive colitis
21
Q
What is the mucosal appearance of Crohns Disease?
A
- Ulcers
- Stricters
- Fistulas
22
Q
What type of lesions are seen with CD?
A
Discontinuous (cobblestone appearance)
23
Q
What sites in the GI Tract are the most frequently affected sites?
A
- Ileum
- Colon
24
Q
Mild UC is described as:
A
< 4 stools/day with or without Blood and no systemic disturbances
25
Moderate UC is described as:
4 to 6 stools/day with or without Blood. Minimal systemic disturbances
26
Severe UC is described as:
7-10 stools/day With Blood and systemic disturbances
27
What 5 things describe systemic disturbances?
1. Fever
2. Tachycardia
3. Anemia
4. Abdominal tenderness
5. Bowel wall edema
28
Fulminant UC is described as:
> 10 stools/day with continuous bleeding (may require a transfusion) and marked systemic disturbances
29
Mild/Moderate CD is described as:
Ambulatory patients, can tolerate P.O. ; absence of fever, dehydration and abdominal tenderness;
Non-significant weight loss (<10% weight loss )
30
Moderate/Severe CD is described as:
1. Failed treatment for mild/moderate disease
OR
2. More prominent systemic symptoms and significant anemia
31
Severe/Fulminant CD is described as:
1. Patients with persisting symptoms despite use of corticosteroids
OR
2. Rebound tenderness; cachexia; evidence of intestinal obstruction or abscess
32
True or false: There is more of an increased risk with CD than UC
False
33
The risk for colon cancer starts about __ years after IBD diagnosis
8
34
An abnormal communication between 2 hollow organs or between a hollow organ and the exterior
Fistulas
35
True or false: Fistulas are more common with CD than UC
True
36
Toxic Megacolon causes severe inflammation that leads to _____ and _______.
Colonic dilation and perforation
37
How do patients present with Toxic Megacolon?
High fever, tachycardia, distended abdomen, increased WBC’s; dilated colon
38
What are the 6. Goals of therapy?
1. Relief of symptoms
2. Improve quality of life
3. Maintain adequate nutritional status
4. Relive intestinal inflammation
5. Decrease frequency of recurrence
6. Resolve Complications
39
Prototype Aminosalicylate
Sulfasalasazine
40
What is Sulfasalazine cleaved by?
Colonic bacteria to active portion
41
Dose-related adverse effects with Sulfasalazine?
1. GI disturbances
2. Headaches
3. Arthralgia
42
Idiosyncratic adverse effects seen with Sulfasalazine (5)?
1. Rash
2. Fever
3. Hepatotoxicity
4. Nephrotoxicity
5. Bone marrow suppression
43
What is a good counseling point to tell patients for Sulfasalazine?
Can cause yellow/ orange discoloration of the skin , urine, tears, and other secretions
44
What should you monitor for Sulfasalazine?
1. LFTS
2. Renal function
3. CBC w/ differential
45
What is a contraindication for the 5-ASAs?
Salicylate or aminosalicylate allergy
46
5-ASAs should be used in caution in patients who have what?
Renal or liver impairment
47
What form of mesalamine has a drug target for the small intestine and the colon?
Pentasa
48
Which aminosalicylate is best tolerated?
Mesalamine
49
True or false: Corticosteroids should be used for short time use only
True
50
What is the indication for the use of Budesonide?
For CD maintenance only (for 3 months then taper)
51
True or false: Budesonide undergoes extensive first pass metabolism
True
52
True or false: corticosteroids should not be used for maintenance treatment
True
53
What is the indication for the use of corticosteroids?
They work quickly to suppress inflammation and decrease flare ups
54
True or false: Thiopurines can be used for induction and maintenance therapy
False; maintenance only
55
What are the two thiopurines used?
1. Mercaptopurine
2. Azathiopurine
56
How long does it take thiopurines to start working?
Weeks-months
57
What enzyme is responsible for the metabolism of Aza and MP?
TPMT
58
What drug class should you use caution with when using the Thiopurines? Why should you use caution?
5-ASAs; can inhibit TPMT (decrease metabolism)
59
What are ADRs of the Thiopurines? 7
1. Pancreatitis
2. Bone marrow suppression
3. Anemia
4. Thrombocytopenia
5. Hepatotoxicity
6. Renal toxicity
7. N/V
60
What is a boxed warning for Azathiopurine
1. Chronic immunosuppression
2. Increased risk of cancers
3. Hematological toxicities
61
What is used as a backup for Thiopurines?
Methotrexate
62
What is the indication of cyclosporine?
Severe flares in UC
63
What is the indication for the JAK inhibitors?
Treats mod-severe active UC
64
What are the 5 boxed warnings for the JAK inhibitors?
1. Increased risk of opportunistic infections
2. Increased rate of cardiovascular death
3. Increased risk for malignancies
4. Higher rate of MACE
5. Risk of thrombosis
65
Upadacitinib
RINVOQ
66
What are the ADRs for Upadacitinib? 5
1. URTIs
2. Acne
3. Neutropenia
4. Increased LFTs
4. Rash
67
Infliximab
REMICADE
68
What are TNF Inhibitors indicated for?
Both CD and UC
69
True or False: TNF inhibitors can be used for both induction and maintenance of active disease
True
70
What should you pretreat with before using the TNF inhibitors?
1.APAP
2. BENADRYL
3. CORTICOSTEROIDS
71
What test should be performed before using TNF inhibitors?
PPD test
72
True or false: you can use live vaccines when administering TNF inhibitors
False
73
What exacerbations are seen with the TNF inhibitors?
Heart failure
74
What are boxed warnings of the TNF Inhibitors?
1. Opportunistic infections
2. Lymphoma and other malignancies
75
What should you monitor for with the TNF inhibitors?
1. TB
2. S/S of severe infection
3. CBC w differential
4. LFTs
5. HF or worsening HF
6. Malignancy
7. BP
76
Adalimumab
HUMIRA
77
What is HUMIRA indicated for?
Severe Crohn’s disease and mod-severe ulcerative colitis
78
How is HUMIRA administered?
SubQ
79
Certolizumab
CIMZIA
80
What is Certolizumab Indicated for?
Mod-severe Crohn’s disease
81
Golimumab
SIMPONI
82
What is SIMPONI indicated for?
Moderate/severe UC
83
What TNF Inhibitor is no longer recommended per the AGA?
Natalizumab
84
Vedolizumab
ENTYVIO
85
What is Vedolizumab indicated for?
Moderate to severe UC & CD
86
What is a RARE SE of Entyvio?
Progressive multifocal leukoencephalopathy (PML)
87
Ustekinumab
STELARA
88
What is Ustekinumab indicated for?
Mod-severe CD or UC
89
Risankizumab
SKYRIZZI
90
What is Skyrizzi indicated for?
Moderate to severe CD
91
What are ADRs of Risankizumab?
1. URTIs
2. Headache
3. UTIs
4. Arthralgias
92
Sphingosine 1-phosphate (S1P) receptor modulator
Ozanimod
93
Ozanimod
ZEPOSIA
94
What is Oxanimod indicated for?
Mod-severe UC
95
What are contraindications with Ozanimod? 4
1. In the last 6 months, MI, unstable angina, stroke, TIA, Class III or IV HF
2. Presence of AV block, unless they have a pacemaker
3. Untreated sleep apnea
4. Taking an MAOI
96
What are ADRS of Zeposia?
1. URTIs
2. Increased LFTs
3. Headache
4. Nausea
97
What assessments should be done prior to using zeposia? 4
1.CBC
2. LFT
3. ECG
4. Ophthalmic assessment
98
What is first line treatment for mild DISTAL UC?
Topical (enema/suppository) aminosalicylates
99
What is second line for mild DISTAL UC?
Oral aminosalicylate or topical corticosteroid
100
True or False: topical corticosteroids have no role in maintenance treatment
True
101
What should you use for remission/maintenance of mild DISTAL UC?
1. Mesalamine suppository/enema 3x/week
2. Oral aminosalicylate
102
What is first line in mild EXTENSIVE UC disease?
Oral aminosalicylate
103
What do you use for second line therapy in mild EXTENSIVE disease?
Oral corticosteroids
104
What is preferred for remission/maintenance treatment in mild EXTENSIVE disease?
Oral aminosalicylates
105
What is first line therapy for Moderate/Severe UC per the ACG guidelines?
1. Oral aminosalicylate or oral budesonide or systemic oral corticosteroids
106
What is first line therapy per AGA guidelines for moderate-severe UC?
Infliximab, Vedolizumab, adalimumab, golimumab
