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604 GI Therapeutics > IBD > Flashcards

IBD Flashcards

1
Q

IBD S/Sx

A

*Blood in stool
Diarrhea
Abdominal pain/cramps
Weight loss
Fatigue
Change in QoL

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2
Q

IBD Diagnosis

A

*Monitor Labs (ESR, CRP)
*Stool Studies (Lactoferrin, Calprotectin, Leukocytes)
Monitor symptoms
Colonoscopy
CT/MRIs

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3
Q

Types of UC

A

a. Proctitis: Only rectum

b. Left sided/Distal Colitis: involvement up to splenic flexure

c. Extensive/Pancolitis: involves entire large intestine

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4
Q

UC characteristics

A
  • Confined to rectum + colon
  • Continuous inflammation
  • Progressive disease
  • NO perianal involvement
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5
Q

UC complications

A
  • Toxic megacolon
  • Colon cancer
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6
Q

Chron’s characteristics

A
  • Mouth to anus (entire GI tract)
  • Most common in terminal ileum
  • deep, patchy crypts
  • “cobblestone appearance”
  • Inc perianal involvement
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7
Q

Chron’s complications

A
  • Malnutrition/vitamin deficiency (SI involved)
  • Strictures
  • Fistulas/fissures (perianal involvement)
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8
Q

5-aminosalicylates - Drugs

A

Sulfasalazine
*Mesalamine
Olsalazine
Basalazide

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9
Q

Mesalamine preps

A
  • Rowasa: enema, delivers to the rectum and distal colon
  • Canasa: suppository, delivers to rectum ONLY
  • Pentasa: oral, delivers 5-ASA from rectum to jejunum (largest range of any rx)
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10
Q

Which disease are 5-ASA preferred?

A

UC

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11
Q

Immunomodulators - Drugs

A

*Azathioprine
6 - Mercaptopurine
Methotrexate
Cyclosporine

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12
Q

Benefits of combining Azathioprine with steroids/biologics?

A

a. Delayed effect (~3 months)

b. Steroid sparing (avoids long-term steroid therapy)

c. Inc efficacy of biologics due to dec antibody formation

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13
Q

Monitoring parameters on Azathioprine

A

a. CBC every 3 months

b. LFT/pancreatic enzymes

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14
Q

Azathioprine BBW

A

Lymphoma (inc. risk when combo with biologics)

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15
Q

Antibiotics - Drugs

A

Metronidazole
Ciprofloxacin
3rd gen cephalosporins

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16
Q

Which disease are ABX more commonly used?

A

Chron’s: perianal involvement (fistula/fissures)
- used short term to aid in closure
- cover gram(-) / anaerobes

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17
Q

Corticosteroids - Drugs

A

Prednisone
Methylprednisolone
Hydrocortisone
Budesonide

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18
Q

Budesonide formulations

A

a. Entocort: Chron’s (reaches terminal ileum)

b. Uceris: UC (only colon)

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19
Q

Benefits of Budesonide in IBD

A
  • 15x potency vs Prednisone
  • Poor systemic absorption = decreased ADEs
  • do NOT combo with other steroids
  • 8 week course of therapy
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20
Q

Biologics - Types

A

Anti-TNFs
Selective adhesion molecule (integrin) inhibitor
IL inhibitors

21
Q

Anti-TNF - Drugs

A

Infliximab (IV)
Adalimumab (SQ)
Certolizumab (SQ)
Golimumab (SQ)

22
Q

Response rate of Anti-TNFs in IBD patients?

A

~40%
- Infliximab #1 efficacy
- Adalimumab most convenient (monthly SQ inj.)

23
Q

Anti-TNF BBWs

A

1.) Infections (TB, invasive fungal, bacterial, viral, opportunistic)
- require PPD, CXR, HBV/HCV/HIV testing

2.) Malignancy (lymphoma, inc. when combo with AZA)

24
Q

Selective adhesion molecule (integrin) inhibitor - Drugs

A

Natalizumab (IV)
Vedolizumab (IV)

25
Q

Which integrin inhibitor is preferred?

A

Vedolizumab (a4b7) - only targets T-cells in GI tract

26
Q

Natalizumab BBW

A

PML (CNS infection)

27
Q

IL Inhibitors - Drugs

A

IL-12, 23: Ustekinumab (IV, then SQ)
IL-23: Risankizumab (IV, then SQ)

28
Q

NOT BIOLOGICS, but act like it - Types

A

JAK inhibitors
Sphingosine 1-Phosphate (S1P) Receptor Modulator

29
Q

JAK inhibitors BBWs

A
  1. Cancer
  2. MACE
  3. Thrombosis
  4. Infections
  5. Death
30
Q

When does FDA approve use of JAK inhibitors in IBD patients?

A

Patients who have failed 1 or more Anti-TNFs

31
Q

General Biologics ADEs

A

IV: infusion reactions
a.) Acute: HA, fever, pruritis, nausea
- Premedicate with APAP, Benadryl, IV Steroids
b.) Chronic: flu-like symptoms
- Premedicate with APAP, short-term steroids

SQ: injection site reactions

32
Q

Mild/Mod Active Crohn’s Diagnosis

A
  • PO without fever, abdomen pain, intestine obstruct
  • Weight loss < 10%
33
Q

Mild/Mod Active Crohn’s Treatment

A

PO Budesonide (Entocort) x8 weeks

34
Q

Mod/Severe Active Crohn’s Diagnosis

A
  • Fever >38 C
  • Weight loss > 10%
  • Abdomen pain
  • N/V
  • Significant anemia
  • Failed Mild therapy
35
Q

Mod/Severe Active Crohn’s Treatment

A

a. PO Prednisone 40-60 mg

b. Anti-TNF (Inflix/Adalim)

+/- AZA (for either)

36
Q

Severe/Fulminant Crohn’s Diagnosis

A
  • High fever >39 C
  • N/V with obstruction
  • Cachexia (muscle wasting)
  • Abscess
  • Persistent symptoms despite systemic steroid/biologic
37
Q

Severe/Fulminant Chron’s Treatment

A

a. IV MEPN/Hydrocortisone

b. IV Infliximab (after 6 weeks steroid)

c. *Surgery

38
Q

Maintenance Therapy for Crohn’s (Remission)

A

a. AZA if steroid induced remission

b. Biologic +/- AZA if biologic induced remission

39
Q

Perianal disease treatment

A

*ABX
Consider:
- Infliximab for closure
- Surgery if needed

40
Q

Mild Active UC Diagnosis

A
  • <4 stools
  • Intermittent blood
  • Occasional urgency
  • Normal Hgb/ESR
  • Elevated CRP/FC
41
Q

Mild Active UC Treatment for Distal/Left Sided

A

a. Topical 5-ASA
b. Oral 5-ASA

*If 5-ASA failure:
a. PO Budesonide (Uceris) x8 weeks

42
Q

Mild Active UC Treatment for Extensive Colitis

A

PO 5-ASA +/- Budesonide

43
Q

Mod/Severe Active UC Diagnosis

A
  • > 6 stools
  • Frequent blood
  • Often urgency
  • <75% normal Hgb
  • Elevated ESR/CRP/FC
44
Q

Mod/Severe Active UC Treatment

A

a. PO Budesonide x8 weeks

b. Prednisone 40-60mg

c. Biologic

+/- AZA (for all)

45
Q

Fulminant Active UC Diagnosis

A
  • > 10 stools
  • Continuous Blood
  • Continuous Urgency
  • Transfusion req (Hgb<8)
  • Elevated ESR/CRP/FC
46
Q

Fulminant Active UC Treatment

A

a. IV MEPN/Hydrocortisone

b. IV Infliximab

c. IV Cyclosporine

*Surgery (colectomy) will cure UC

47
Q

Maintenance Therapy for Mild UC (Remission)

A

Topical or Oral 5-ASA

48
Q

Maintenance Therapy for Mod-Severe-Fulminant UC (Remission)

A

a. AZA if steroid induced remission

b. Biologic +/- AZA if biologic induced remission

c. AZA or Vedolizumab if Cyclosporine induced remission

604 GI Therapeutics (5 decks)

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