*IBD 3 (lecture 3) Flashcards Preview

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Flashcards in *IBD 3 (lecture 3) Deck (41)
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1

What are the 3 therapeutic strategies that can be used to treat IBD?

Lifestyle advice
Drugs
Surgery

2

Is diet implicated in the pathogenesis of IBD?

No but it can influence symptoms

3

What is the common theme of all drug therapies?

They have an anti-inflammatory effect (you should tailor the drugs to the patients needs e.g. mild/ moderate/ severe relapse, tropical, oral, IV administration?

4

What are the drug therapy options for UC? (4)

5ASA (mesalazine)
Steroids
Immunosuppressants
Anti-TNF therapy

5

What are the drug therapy options for Crohn's disease? (3)

Steroids
Immunosuppressants
Anti-TNF therapy
(used to use mesalazine but shown to be as effective)

6

How does mesalazine work?
Effect on risk of colon cancer?
Side effects? (2)

It has a topical effect having anti-inflammatory properties
Reduces risk of colon cancer
Diarrhoea
Idiosyncratic nephritis

7

What is a prodrug?

a medication or compound that, after administration, is metabolized (i.e., converted within the body) into a pharmacologically active drug.

8

What does the fact that 5-ASA are pro-drugs mean?

The active components are released in the colon depending on different factors such as pH, etc.

9

What type of topical preparations of mesalazine do you get?(2)

Suppositories
Enemas

10

What are some examples of 5-ASA conjugates?

Sulphasalazine
Balsalazide
Mezavant
Asacol (pH release)
Pentasa (delayed release)

11

Where is pentasa released?

From the duodenum to the colon (unlike the other drugs whcih are either released in the ileum or colon)

12

What is the advantage and disadvantage of using suppositories over enemas?

Suppositories coat

13

What aids spread of foam and liquid enemas?

Reflex contraction

14

How much of an enema stays in the rectum?

less than 10%

15

What type of enemas do patients prefer?

Foam enemas as it doesn't make them feel like they need to pass stool

16

What properties do corticosteroids have?

Systemic anti-inflammatory properties

17

Examples of corticosteroids? (2)

Prednisolone (oral or topical)
Budesonide

18

What is the purpose of corticosteroids?
What is the risk with corticosteroids?
What should corticosteroids therefore be used as a bridge to?

To induce remission (short course - start a high dose initially and reduce over 6-8 weeks)
Patients can become dependent on them
Maintenance therapy

19

What are the side effects of steroids?

Musculoskeletal (avascular necrosis, osteoporosis)
GI
Cutaneous (acne, thinning of skin)
Metabolic (weight gain, diabetes, hyerptension)
Neuropsychiatric
Cataracts
Growth failure

20

If steroids are not effective, what is then used?

Immunosuppression

21

What is immunosuppression used for in UC?

"steroid-sparing agents"

22

What is immunosuppression used for in Crohns?

Maintenance therapy

23

What are 3 examples of immunosuppressive drugs used to treat Crohns and colitis?

Azathioprine
Mercaptopurine
Methotrexate (used rarely)

24

Azathioprine:
onset of action?
What enzyme contributes to toxicity?
What drug should not be prescribed with this?
What should be regularly monitored in patients on this?
Side effects (4)?

Slow onset (16 weeks)
TPMT
Avoid co-prescription of allopurinol (XO inhibitor)
Regular blood monitoring required
Pancreatitis
Leucopaenia
Hepatits
small risk of lymphoma and skin cancer

25

What is tumour necrosis factor alpha?

A pro-inflammatory cytokine

26

What are 2 examples of antibodies to TNF?
How is each given?

Infliximab (IV infusion)
Adalimumab (S/C injection)

27

What does anti-TNF therapy do?

Promote apoptosis of activated T lymphocytes (rapid onset of action)

28

How long does Infliximab tend to put patients in remission for?

8-12 weeks (re-treatment maintains remission)

29

What is infliximab approved for treatment of?

Initially Crohns but is now approved for treatment of moderate - severe UC

30

What are the adverse effects associated with anti-TNF alpha therapy?

Infusion reaction in 13% of patients (HACA +ve)
Infection
Cancer (lymphoma, solid tumours)