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pharmacotherapy 2 > IBD > Flashcards

IBD Flashcards

1
Q

what are the doc in mild to mod acute UC

A

oral/topical mesalamine or oral budesonide
if topical not tolerated then oral mesalamine

topical corticosteroids, reserved for no response to mesalamine

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2
Q

what are the doc in mod to severe UC

A

prednisolone 40 - 60 mg per day or equivalent
azathioprine/ 6MP
biologic agents if unresponsive to oral therapies
azathioprine + AZT for maximal effect

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3
Q

DOC in severe to fulminant UC

A

Iv corticosteroids

Infliximab and omalizumab - severe UC

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4
Q

DOC in maintenance of UC remission

A

oral or topical aminosalicylates
rectal aminosalicylate for proctitis or left sided disease
immunosuppressants + biologics for steroid dependants

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5
Q

ttt of proctitis

A

induction - topical 5ASA
remission - Topical 5ASA
Refractor - oral 5ASA

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6
Q

ttt of mild to mod distal UC

A

Induction - 5ASA enema or foam or 6MP
remission - 5ASA enema or foam or 6MP
Refractory - infliximab or cyclosporine IV or surgery

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7
Q

ttt of mild to mod proctitis

A

induction - oral 5ASA or AZT
remission - oral 5ASA or AZT
refractory - infliximab or cyclosporine IV or surgery

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8
Q

ttt of severe proctitis

A

induction - IV corticosteroids
Maintenance - oral 5ASA or 6Mp/ AZT
Refractory - infliximab or cyclosporine IV or surgery

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9
Q

ttt of mild to mod CD

duration of ttt ?

A

Budesonide 9mg OD
prednisolone + methylprednisolone (superior but more adv effects)
aminosalicylate

16 wks

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10
Q

ttt of mod to sev CD

A

prednislone 40-60mg daily
oral budesonide - terminal ileum or ascending colon
anti TNF alpha agents + azt = ehnaced efficacy

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11
Q

sev to fulminant CD

A

hospitalization
abdominal distention, abscesses, massess, colonic distention - surgical intervention
IC corticosteroids
Biologics
fluid electrolytes replacemnt
nutrtiional therapy eneteral or parenteral for patients who can not eat for 5-6days

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12
Q

maintenance of CD

A

AZT +/- anti TNF alpha

immunosuppressants, biologics oral or topical aminosalicylates
oral budesonide 6mg instead of corticosteroids

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13
Q

induction of remission in

  1. mild to mod
  2. mod to sev
  3. refractory to steroids
  4. failed immunosuppressants
A
  1. aminosalicylate (mesalamine)
  2. corticosteroids (prednisolone, budesonide)
  3. immunosuppressants (AZT. MTX)
  4. biologics (infliximab)
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14
Q

what is the major contributor of the inflammatory process in CD what do its physiological effects include

A

TNF a
Its physiologic effects include activation of macrophages, procoagulant effects in the vascular endothelium, and increased production of matrix metalloproteinases in mucosal cells
induce production of nuclear factor κβ - stimulates more TNF a and proinflammatory cytokines

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15
Q

what are skip lesions. which disease are they found in

A

The pattern of inflammation in CD is discontinuous; areas of inflammation are intermixed with areas of normal GI mucosa, resulting in characteristic “skip lesions.”

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16
Q

what are the minerals added as adjunctive therapy in IBD

A

Vitamin B12, folic acid, fat-soluble vitamins, and iron

17
Q

which drug reduces diarrheal symptoms in patients with CD who had intestinal resection

A

cholestyramine

18
Q

which anticholineric is used for intestinal spasm and pain

A

hyoscine

19
Q

which diarrheal drugs are better avoided in active IBD

A

loperamide, diphenoxylate and codeine

20
Q

which aminosalicylate drug is used in IBD. describe the mechanism of how it works locally

A

sulfasalazine (azulfidine)
5ASA + sulfapyridine by a diazo bond
diazo bond degraded by bacteria. sulfapyridine renally excreted. 5ASA acts in the intestine

21
Q

what are the equivalent doses for corticosteroids

A

40 -60 mg of oral prednisolone
40-60mg of IV methylprednisolone
300mg/day of IV hydrocortisone

22
Q

which corticosteroid is recommended for active disease and why

A

budesonide because of low systemic bioavailability

23
Q

why is AZT/6MP not used in active disease

A

slow onset of action

24
Q

mtx is used in CD or UC

A

CD only

25
Q

infectious complications are a risk with? so what can be done

A

with immunosuppressants

standard immunizations should be ensured and live vaccinations should be avoided

26
Q

what are the adv effects of anti tnf a agents

A

parenteral admins
adv effects eg. lymphoma
high drug cost
antibodies may develop and reduce its efficacy

27
Q

monitor what in pts on prednisolone for more than 2 months or steroid dependant pts

A

bone mineral density, blood glucose, lipids, and BP, evidence of Cushing’s features or S&S of infection

28
Q

monitoring parameters in pts on immunouppressants ?

A

CBC, LFT’s, then every 2–4 weeks at the start of therapy and then approximately every 3 months

pharmacotherapy 2 (8 decks)

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