IBD Flashcards
(49 cards)
1
Q
IBD
A
- Inflammatory bowel disease, that is chronic inflammatory disease of the GI tract
- Results in edema, ulceration, and tissue destruction
- Treatment requires flare therapy as well as maintenance therapy that prevents flare reoccurrence
2
Q
IBD s/s
A
Diarrhea, blood in stool, abdominal pain, cramping, weight loss, fatigue, change in daily activities
3
Q
Diagnosis of IBD
A
- Non invasive lab tests (ESR, CRP which are non specific markers of inflammation in the body)
- Stool studies (look for leukocytes in the stool)
- Endoscopy-colonoscopy (can look at entire colon and ileum, very invasive)
- CT/MRI (see if there is penetration of the disease into neighboring organs
4
Q
IBD disease location (UC)
A
- Confined to the rectum (proctitis)
- Inflammation up rectum, sigmoid colon, descending colon and stop at splenic flexure (left sided colitis or distal)
- Inflammation past splenic flexure (extensive disease or pan colitis)
5
Q
UC
A
- superficial inflammation
- confined to mucosa (continuous)
- anal involvement is not common
- patients at risk for megacolon or colon cancer
- Colectomy: removal of colon (cure)
6
Q
IBD disease location (CD)
A
- Anywhere from mouth to anus
- Most common is terminal ileum (2/3 of patients)
- Perianal involvement is common
7
Q
CD
A
- deep
- can go through all layers of intestinal wall
- patchy inflammation, cobblestone appearance
8
Q
CD complications
A
- Malnutrition
- vitamin deficiencies
- strictures
- fistulas
- no cure
9
Q
5-ASA
A
- Mesalamine
- Sulfasalazine
- Balsalazide
- Olsalazine
10
Q
Immunomodulators
A
- Azathioprine
- 6-mercap
- Methotrexate
- Cyclosporine
- Tacrolimus
11
Q
Antibiotics
A
- Metronidazole
- Ciprofloxacin or 3GC
12
Q
Corticosteroids
A
- Prednisone
- Methylprednisolone
- Budesonide
- Hydrocortisone
13
Q
Biologics
A
- Infliximab (UC/CD)
- Adalimumab (UC/CD)
- Certolizumab (CD)
- Golimumab (UD)
- Natalizumab (CD)
- Vedolizumab (UC/CD)
- Ustekinumab (UC/CD)
- Tofacitinib (UC)
14
Q
5-ASA
A
- act topically to reduce inflammation in GI tract
- have to get to intestinal sire to work, have to modify drug delivery to get to site.
15
Q
Sulfasalazine
A
- Sulfa is carrier
- Mesalamine is active component
- Sulfa is responsible for ADR: GI, rash, photosensitivity, blood dycrasias
16
Q
Olsalazine
A
- 2 ASA molecules linked together and cleaved apart by gut bacteria in colon
- better tolerated than sulfasal but high diarrhea rate
17
Q
Balsalazide
A
- Sulfasalazine without sulfa
- lots of drug to take
18
Q
Mesalamine products
A
- not used in CD
- supp can only penetrate rectum
- enema can penetrate all the way to splenic flexure
- PO products will release somewhere in small or large intestine
19
Q
Immunomodulators
A
maintain therapy remission
20
Q
Azathioprine
A
-UC or CD (usually used in combo b/c takes a while to go into effect)
21
Q
Methotrexate
A
- IM or SQ
- CD only
- CDC at least every 3 months
- LFTs and pancreatic enzymes
- Lymphomas (AZA alone or in combo with Infliximab)
22
Q
Corticosteroids
A
- work quickly and dec inflammation
- no role in maintenance therapy
- topical hydrocortisone (enema, supp, or foam)
- PO pred
- IV hydro or methylpred
23
Q
Budesonide
A
- more local, less systemic SE
- enteric coated capsule
- Entocort
- Uceris
24
Q
Abx
A
- best for perianal (fistulas, fissures)
- CD only
25
Biologics
- Induce and maintain remission
- Anti-TNF (I, A, C, G)
- Selective adhesion (integrin) inhibitors (N, V)
- JAK inhibitor (T)
- IL inhibitors (U)
26
Biologic ADR
- IV: acute; HA, dizziness, nausea, flushing, fever, chest pain, cough, dyspnea, pruritis (pre medicate with Tylenol or antihistamine to dec effects)
- delayed: myalgias, arthralgia, fever, rash, pruitis, urticaria, HA (flu-like symp)
- SQ: injection site pain
27
Infections (biologics)
- warning on all
- BBW for TNF inhibitors and JAK inhibitors
- acute TB
- fungal infections
- monitor for s/s of infection
- should not receive live vaccines if on biologic
28
BBW biologics
Malignancy (TNF and JAK inhibitors)
29
Natalizumab
- can cause progressive multifocal leukoencephalpy
- lethal infection of CNS (JC virus)
- must be monotherapy (w/o steroids or immunomodulators
- TOUCH safety program
- last line therapy
30
JAK inhibitor (T)
- inc risk of cancer, death, thrombosis, cardiovascular events
- BBW
- only allowed for patients who have not responded or cannot tolerate TNF inhibitors
31
CD mild-mod
- in the community
- no fever
- no abd pain
- no obstruction
- < 10 % weight loss
32
CD mod-severe
- failed mild-mod therapy
- fever
- > 10% weight loss
- abd pain
- N/V with obstructions
- anemia (dec Hgb)
33
CD severe-fulminant
- persistent symp despite steroids or biologics
- need hospital treatment
- high fevers
- persistent N/V
- obstructions
- not eating
- intestinal abssesses
- severe abd pain
34
Mild-mod active therapy (CD)
- 1st line: budesonide (Entocort) for 8 weeks
| - Patients with CD should not use 5-ASA products unless they have colonic involvement only (sulfsal specifically)
35
Mod-severe active therapy (CD)
- Systemic steroids (PO prednisone)
- Biologics (start with TNF inhibitor - Infliximab) - try others if no relief within 2-4 weeks
- AZA (reduces immune response but takes 4 months to get full effect
- steroid sparing
- better response rate when added with biologic
- reduce antibody production to biologic therapies
36
Severe-fulminant active therapy (CD)
- May need surgery
- IV steroids
- Infliximab of steroids don't work
37
Perianal disease - fistulas or fissures
- Abx
- surgery
- Infliximab
- Don't use abx if patient doesn't have fistulas
38
Maintenance therapy (CD)
- 1st line: 5-MP/AZA/MTX
- Budesonide - can be used for additional 3 months
- Biologics: Infliximab or whatever was used for active
- 5-ASA should not be used in CD
39
Mild UC
- < 4 stools/day
- intermittent blood in stool
- Hgb normal
- ESR normal
- CRP elevated
- FC >150
40
Mod-severe UC
- >6 stools/day
- frequent blood in stool
- Hgb <75% of normal
- elevated ESR/CRP
- FC >150
41
Fulminant UC
- >10 stools/day
- continuous blood in stool
- blood transfusions
- Hgb < 8
- Elevated ESR/CRP/FC
42
Mild distal active therapy (UC)
- 1st line: topical 5-ASA
- 2nd line: oral 5-ASA
- combo PO + PR
- if doesn't work use budesonide (Uceris)
43
Mild extensive active therapy (UC)
PO 5-ASA +/- budesonide
44
Mild extensive maintenance therapy (UC)
PO 5-ASA
45
Mild distal maintenance therapy (UC)
Topical 5-ASA or PO 5-ASA
46
Mod-severe active therapy (UC)
- budesonide, prednisone, biologic +/- 6-MP/AZA
| - cannot use Methotrexate
47
Mod-severe maintenance therapy (UC)
- use what induced remission
- steroid: use 6-MP/AZA
biologic: continue +/- AZA
48
Fulminant active therapy (UC)
- 1st line: IV steroids, IV Infliximab
- IV cyclosporine
- surgery (colectomy) - cure
49
Fulminant maintenance therapy (UC)
- Use what induced remission
- Steroids: 6-MP/AZA
- biologic: continue +/- AZA
- cyclosporine: 6-MP/AZA or vetalizumab
