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IBD Pharmacology Flashcards

1
Q

What is IBD?

A

Inflammatory Bowel Disease.
-> Chronic recurring inflammation of GI Tract

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2
Q

What are the 2 major types of IBD?

A
  • Crohn’s Disease
  • Ulcerative Colitis
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3
Q

True or False: There is no cure for IBD.

A

True

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4
Q

What are some symptoms of IBD?

A
  • Bloody diarrhoea
  • Urgency to empty bowels
  • Malnutrition
  • Severe -> fever and weight loss
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5
Q

IBD is more prevalent in younger adults or older adults?

A

Younger adults

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6
Q

True or False: Smoking may cause Ulcerative Colitis.

A

False.
-> It may prevent Ulcerative Colitis
-> It may cause Crohn’s Disease

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7
Q

How is inflammation presented in Crohn’s disease?

A

Inflammation of any part of the GI Tract.
- Discontinuous pattern -> skip lesions
-> ‘Gum to Bum’

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8
Q

Where is inflammation in Crohn’s Disease usually found?

A
  • Illium
  • Caecum
  • Colon
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9
Q

How is inflammation presented in Ulcerative Colitis?

A

Inflammation in a continuous pattern.
-> Usually starts at rectum and moves upwards.

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10
Q

What is usually the first sign of Crohn’s disease?

A

Mouth ulcers

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11
Q

Compare the pathology between Crohn’s Disease and Ulcerative Colitis.

A

CD - Inflammation of surface and penetration through the layers.
UC - Inflammation on the surface only.

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12
Q

What are some things which can be seen in a patients’ intestines with Crohn’s Disease?

A
  • Fat wrapping
  • Muscle hypertrophy
  • Fissures
  • Cobblestone appearance
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13
Q

What can be seen in a patients’ intestines with Ulcerative Colitis?

A

Ulceration within the mucosa.

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14
Q

Why may the temperature of a person increase with IBD?

A

Release of inflammatory mediators (cytokines) -> Increase in temperature

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15
Q

Why may a patient have anaemia with IBD? What needs to be checked for this?

A

Loss of blood in stools.
-> Haemoglobin levels

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16
Q

What is the Erythromycin Sedimentation Rate?

A

Red blood cells placed in tube to sediment at a rate.
-> Inflamed RBCs will clump together and sediment faster

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17
Q

What are some extra-intestinal manifestations of IBD?

A
  • Dermatological
  • Rheumatologic
  • Ocular
  • Kidneys
  • Liver
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18
Q

Give some examples of extra-intestinal manifestations of IBD.

A
  • Skin manifestations
  • Osteoporosis
  • Thromboembolic event
  • Ocular Manifestations
  • Arthritis
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19
Q

What may be seen on patients skin if they have IBD?

A

Skin lesions
-> Can be due to the IBD or treatment

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20
Q

True or False: Individuals with IBD can develop osteoporosis or osteopenia.

A

True

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21
Q

What can exacerbate osteoporosis in IBD individuals?

A
  • Steroids
  • Inflammation
  • Vitamin D deficiency
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22
Q

In some cases of osteoporosis, ankylosing spondylitis can occur. What is ankylosing spondylitis?

A

Arthritis in spine, causing inflammation and gradual fusing of the vertebrae.

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23
Q

What are some examples of ocular manifestations?

A
  • Conjunctivitis
  • Iritis
  • Episcleritis
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24
Q

What are some symptoms of ocular manifestations?

A
  • Ocular pain
  • Photophobia
  • Blurred vision
  • Headache
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25
Which type of IBD has an increased chance of malignancy?
Ulcerative Colitis
26
What happens to patients who have suffered from extensive colitis for longer than 8-10 years?
Undergo regular colonoscopy with multiple biopsies.
27
What are some risk factors of IBD?
- Genetic - Environmental triggers - Immune response - Gut microbiome
28
In which type of IBD is genetics more associated with?
Crohn's Disease
29
What are genes involved in when a patient has IBD?
- Immune system - Inflammation
30
Which type of immune response is Crohn's disease?
Th1 response
31
Which type of immune response is Ulcerative Colitis?
Th2 response
32
How can bad gut microbiome affect individuals with IBD?
Can attack intestines -> Increased immune response -> Increased inflammatory response
33
Give some environmental triggers of IBD.
- Diet - Exercise - Stress - Smoking - Infections
34
Which drugs can trigger IBD?
- NSAIDs - Antibiotics
35
Explain the simple gut immune response when there is an increase in bacteria.
- Increase in bacteria - Increase activity in immune cells - Release of cytokines
36
What are the 2 regulators involved in the process of the inflammatory response?
- Interleukins: proinflammatory - TNF (Tumour Necrosis Factor): proinflammatory, induce fever and apoptosis
37
What are the 3 key aims of treatment of IBD?
- Relieve pain - Reduce immune response - Reduce inflammation
38
True or False: TNF is a cytokine.
True
39
What is the process of TNF and what does it cause?
1. Binds to TNF receptor 2. Activates signalling pathways 3. Trigger immune cells release and cytokines 4. Inflammation
40
Excess production of TNF is linked to what?
- IBD - Rheumatoid arthritis
41
What chemical when produced can cause pain and inflammation?
Prostaglandins
42
What are some IBD treatments?
- Corticosteroids - Aminosalicylates - Antibiotics - Immunosuppressants - Biologic Agents
43
Which WBCs lie dormant in the surface between epithelial cells?
Dendritic cells
44
Does IBD affect the mucosal layer?
Yes which can increase permeability.
45
What is the role of corticosteroids, and how do they work?
Anti-inflammatory effect -> Genes are regulated up or down
46
What are the main cytokines?
- IL-1 - IL-6 - IL-12
47
What are some examples of steroids used in the treatment of IBD?
- Prednisolone - Hydrocortisone - Methylprednisolone
48
How do steroids work in IBD?
- Inhibition of cytokines - Inhibition of other genes linked to inflammation
49
How is 5-Aminosalicylic acid produced?
Sulfasalizine is broken down in the gut to form 5-ASA. -> Bond cleaved
50
What is the role of Aminosalicylates in IBD?
Anti-inflammatory effects -> Reduce leukotrienes and prostaglandins
51
Corticosteroids can be used in conjunction with what other treatment?
Aminosalicylates
52
What is the role of immunosuppressive agents?
- Suppress immune cells - Reduce production of cytokines - Reduce inflammation
53
When are immunosuppressive agents taken?
When corticosteroids and Aminosalicylates have failed in treatment.
54
What is an example of an immunosuppressive agent?
Thiopurines -> Azathioprine -> 6-mercaptopurine
55
How does azathioprine work?
- Converted to 6-mercaptopurine - Incorporated into DNA - Stops replication
56
What is the role of Azathioprine?
Incorporated in DNA -> Causes bone marrow suppression -> prevents immune cell production
57
How is TMPT involved with azathoprine?
Converts 6-mercaptopurine into an inactive metabolite. If not enough levels of TMPT: Increased levels -> Increased bone marrow suppression -> death
58
What is an alternative that can be used to azathioprine?
Methotrexate
59
What is the role of methotrexate?
- Inhibit dihydrofolate reductase - Reduces purine synthesis - Reduces DNA/RNA synthesis
60
What is biological agents used for the treatment of IBD?
Monoclonal antibody treatment
61
Give some examples of Biologic agents.
- Infliximab - Adalimumab
62
What is the role of the Biologic agents used in the treatment of IBD?
- Bind to TNF - Cannot bind to TNF receptor - Inhibits signalling and cytokines production - Reduction in inflammation

PHA223 (24 decks)

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