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GI Therapeutics Exam > IBD > Flashcards

IBD Flashcards

1
Q

what part of mucosa expands in IBD

A

lamina propria

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2
Q

dx of IBD

A

sx (bloody stool, weight loss, BAD abdominal cramping)
lab (inc ESR = erythrocyte sedimentation rate
(inc CRP = c reactive protein)
stool studies (lactoferrin and calprotectin detect leukocytes in stool)
ENDOSCOPY IS A MUST
CT scans
MRIs

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3
Q

are ESR and CRP specific or non specific markers

A

non specific markers of inflammation

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4
Q 
no anal involvement
prochitis
left sided distal colitis
pancolitis
all describe \_\_\_\_\_\_
A

ulcerative colitis

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5
Q

extensive vs. non-extensive disease in UC

A

determined by whether or not it extends beyond the left splenic flexure

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6
Q

CD location

A

can be anywhere from mouth to anus
BUT
2/3 of cases are in the terminal illeum
perianal involvmenet is common (fissures and fistulas)

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7
Q

Does UC or CD involve the anus

A

CD!

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8
Q

prochitis

A

UC in rectum

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9
Q

pancolitis

A

UC that spreads from the rectum to beyond the left splenic flexure

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10
Q 
UC
confined to \_\_\_\_\_
superficial or deep?
continuous or discontinuous?
complications?
cure?
A

mucosa
superficial
continuous

toxic megacolon, colon cancer
colectomy (bowel removal) is only cure

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11
Q

CD
superficial or deep?
continuous or discontinuous?
complications?

A

deep (mucosa–> submucosa–> muscularis–> serosa
discontinuous, patchy, cobblestone
complications
- malnutrition, vitamin deficiency
- strictures (narrowing)
- fistulas
- strictures and fistulas require surgery

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12
Q

IBD 5-ASA options, MOA, dosage forms

A

5-ASA is Mesalamine
Sulfasalazine (sulfapyridine + 5-ASA)
Osalazine (5-ASA + 5-ASA)
Balsalazide (4-aminobenzoyl-B-alanine + 5-ASA)

“topical aspirin”, dec PGs, dec Leukotrienes via COX
PO and PR

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13
Q

sulfasalazide AE

A

due to the sulfapyridine metabolite

GI, rash, photosensitivity, blood dyscrasias

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14
Q

balsalazide vs sulfasalazine

A

balsalazide is better tolerated than sulfasalazine

both are generic

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15
Q

balsala and osala po release at

A

terminal ileum

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16
Q

mesalamine po releases at

A

jejunum

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17
Q

mesalamine suppository releases at

A

rectum

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18
Q

tx options for IBD

A

5-ASAs, immunmdulators, corticosteroids, biologics,

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19
Q

immunomodulators for IBD

AE/monitor

A 
Azathioprine
6-MP
Methotrexate
AE: bone marrow suppression/leukocytopenia, thrombocytopenia--> CBC q3mo
LFTs and pancreatic enzymes
lymphomas (esp AZA + infliximab)
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20
Q

corticosteroids for IBD
use
drugs

A 
work acutely to decrease inflammation, not for chronic use!
topical hydrocortisone 100mg 
   - topical enema
   - 25mg suppository
   - 10% HC foam
prednisone 20-60mg po
IV HC or MEPN
Budesonide
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21
Q

Budesonide for PUD
vs prednisone?
local or systemic?
dosage forms and indication

A
  • 15x more potent than prednisone
  • more local, less systemic AE
  • Entocort releases in terminal ileum (2/3rds of CD cases!)
  • Uceris releases throughout colon so use for Ulcerative colitis
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22
Q

ENtocort

A

ER budesonide capsule

releases in terminal ileum so use for CD bc 2/3rds of CD cases are in the terminal ileum

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23
Q

Uceris

A

ER budesonide capsule

releases throughout colon so use for UC!

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24
Q

Biologics options for PUD

A 
infliximab
adalimumab
certolizumab
golimumab
natalizumab
Vedolizumab
Ustekinumab
Upatacitinib
Tofacitinib

Can I Get A New Vest Until Tomorrow???

25
Q

what drugs are for CD?

A

AZA, 6-MP, MTX
Infliximab
Budesonide

26
Q

which biologics are IV

AE?

A

Infliximab (Remicade)
Natalizumab (Tysabri)
Vedolizumab (Entyrio)
Ustekinumab (Stelara)

AE are infusion related: ACUTE = HA, dizzy, flushing, angina, cough, dyspnea, priuritis
DELAYED 13-14d = myalgias, fever, rash, arthralgias, priuritis, urticaria, HA

27
Q

which biologics are SQ`

AE?

A

Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)

injection site rxn!

28
Q

which biologics are po

A

Tofacitinib (Xeljanz)

Upacitinib (Rinvoq)

29
Q

which biologics are anti-TNFa

A

Infliximab (Remicade)
Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)

30
Q

which biologics are selective adhesion molecule (integrin) inhibitors

A

Natalizumab (Tysabri)

Vedolizumab (Entyvio)

31
Q

which biologic is a IL-2, IL-23 - i

A

Ustekinumab

32
Q

JAK-i s

A

Tofacitinib (Xeljanz)

Uptacitinib (Rinvoq)

33
Q

how to prevent AE with IV biologica for IBD

A

pre med w
1000mg APAP
50 mg IV/PO Benadryl
+/- IV HC 50mg

34
Q

all biologics
AE
what is done before tx initiation

A

infections (BBW TNFa-i and JAK-i)
active or reactivates TB
invasive fungal infection (candida, aspergillis)
bacterial (legionella, listeria) –> monitor s/sx infxn
** do not admin live vaccines
before tx…
- TB skin test
- Chest X Ray
- Hepatitis B status (need HepB vaccine)

35
Q

JAKi and TNFai have BBW for

A 
infection
malignancy (lymphomas in children and adolescents)
36
Q

Natalizumab
brand
AE
caveats

A

Tysabri, integrin-i
PML (progressive, multifactorial leukoencephalopathy)
(reactivation of human JC polyoma virus –> CNS infection)
must admin as monotherapy
pt and prescriber enroll in TOUCH safety program

37
Q

JAK-i drugs and AE

use

A

Tofacitinib (Xeljanz)
Upadacitinib (Rinvoq)
cancer, CV events, thrombosis, death all BBW
only use if patient cannot tolerate more than 1 TNFa-i

38
Q

mild to moderate CD s/sx

A 
ambulatory
no fever
no abd pain
no obstruction
weight loss <10%
39
Q 
ambulatory
no fever
no abd pain
no obstruction
weight loss <10%

which class of CD severity?

A

mild-moderare

40
Q 
fever >38C
weight loss >10%
abdomonal pain and tenderness
N/V
NO obstructions
anemia
dec Hgb

which class of CD severity?

A

mod-severe

41
Q

mod-severe CD s/sx

A 
fever >38C
weight loss >10%
abdomonal pain and tenderness
N/V
NO obstructions
anemia
dec Hgb
42
Q

severe CD s/sx

A 
persistent sx (fatigue, abd pain, anemia, malnutrition) despite steroids or biologic treatment
often inpatient
fever >39C
persistent NV
intestinal obstruction
cant eat
abscesses
43
Q

mild to mod CD treatment

A

po Budesonide x8weeks (+ 8 more prn)

add sulfasalazine ONLY if colonic involvement

44
Q

mod-severe CD treatment

A

Prednisone 40-60mg po qd
Infliximab (try other TNFa-i if no change in 2-4wks)
+/- AZA/6MP/MTX

45
Q

why add AZA/6MP/MTX in mod-severe CD

A

decreases Ab production to the biologics

as they onset at 4-6mo, the steroids can hold the patient over in that time with steroid maintenance then taper

46
Q

severe-fulminant CD treatment

A

surgery
IV steroids (HC, MEPN)
not improving on IV steroids –> IV Infliximab

IV fluids and TPN also

47
Q

patient with mild to mod CD, given budesonide po x8 weeks and has colonic involvement so sulfasalazine is added to the regimen

after 8 weeks there is no improvement/change
what should the patient be given

A

40-60mg po prednisone then taper down
Infliximab
should probably add AZA/MTX/6-MP to prevent antibody production and cover the patient as they taper down the steroid

48
Q

patient with mod-severe CD gets po prednisone, infliximab and AZA

after 2-4 weeks there is no improvement so the patient is switched to Humira (adalimumab)

after 2-4 weeks there is no improvement so the patient is switched to Certolizumab

at this point the patient has tried several biologics, has a fever of 39.5C, has abscesses and severe abdominal pain

what should be given to the patient?

A

at this point the patient is considered to have progressed to severe/fulminant

surgery
IV steroids (HC, MEPN)
probs no IV infliximab bc they already tried it

also admin IV fluids, TPN etc.

49
Q

maintenance treatment for CD

A

first line = 6-MP/AZA/MTX
budesonide <4mo
biologics
no 5-ASAs unless sulfasalazine for colonic involvement

50
Q

UC remission s/sx

A 
asx
formed stools
no blood
Hgb, ESR, CRP all wnl
low FC <150-200
51
Q

UC mild s/sx

A 
<4 stools a day
intermittent blood
Hgb, ESR wnl
CRP inc
FC >150
52
Q

mod-severe UC s/sx

A 
>6 stools a day
frequent blood
Hgb dec >25%
inc ESR, CRP
FC >150
53
Q

fulminant UC s/sx

A 
>10 stools a day
continuous blood
need blood transfusion
Hgb <8
inc ESR, CRP, FC
54
Q

mild UC and distal (not past left splenic flexure)

active and maintenance treatment

A 
active
    - topical mesalamine supp or enema
    - pr mesalamine
    - both is preferred just depends on if they want butt 
      stuff 
     - refractory --> Budesonide (Uceris!!) x 8 weeks
maintenance
    - po or pr mesalamine
55
Q

mild UC and extensive (past left splenic flexure)

active and maintenance treatment

A 
active
    - po 5-ASAs
    - +/- budesonide x8weeks
maintenance
    - po 5-ASAs
56
Q

mod-severe UC active treatment

A

budesonide
prednisone 40-60mg po
biologic (infliximab)
+/- 6MP/5ASA

57
Q

fulminant UC active treatment

A

IV steroids (MEPN, HC) and/or IV infliximab
IV CYA
blood products

if tried biologics, steroids, blood products and no relief –> surgery!

58
Q

mod-severe and fulminant UC maintanance treatment

A

if remission with budesonide/IV steroid –> 6-MP/AZA

if remission with CYA –> 6-MP/AZA or vadolizumab

GI Therapeutics Exam (10 decks)

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