Ibd, And Ibs Flashcards by Grace Dewling

what falls under IBD

Chrons disease, and ulcerative colitis

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What are the two categories of IBS

irritable bowel syndrome with constipation
Irritable bowel syndrome with diarrhea

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Ulecerative colitis vs chrons

Ulcerative colitis occurs mainly in the large intestine and in the colon

Chrons can occur anywhere in the gi tract, most often affects small intestine, before the large intestine and colon

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Non pharmacological tx for ibd (chrons and ulcerative colitis)

Eliminate certain food groups
Parenteral [TPN] used when bowel rest is indicated, when enteral is failed, or perforation

May require surgery, if disease is uncontrolled, despite maximum therapy, if fistula is present , prophylaxic against colon cancer

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First line med for ulcerative colitis

Mesalamine, differs based on formulation and the site of action

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Mesalamine, rowasa is what formulation… and site of action…

Canasa formulation… and site,…

Asacol

Pentasa

Rowasa: enema, rectum

Canasa: suppository, rectum

Asacol: ph resin dissolves in ph in the distal ileum and in the colon, rectum to ileum

Pentasa, timed release small intestines, and works from the rectum to the jejunum

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Sulfasalazine what is combination

Mesalamine, 5, asa amd sulfapyradine

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Sulfasalazine first line in

UC and chrohns,

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Sulfasalazine what supplemeny recomendation do u recommend in the pregnant patient

Folate supplement

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Sulfasalazine caution and severe adr

Caution sulfa allergy

Hepatotoxicity

Nephritis

Thrombocytopenia

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When are corticosteroid used in ulcerative colitis and chrons disease

Mod to severe UC and CD

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Long term use of corticosteroids can cause

Osteoporosis, hypertension, adrenal suppression, cushing

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What are two Sulfasalazine

Azulfidine
Sulfazine

Tablets work in Colin

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During pregnancy are corticosteroid safe, for chrons and ulcerative colitis ?
Which agents are preferred

For acute flare but would avoid for maintenance
Prednisone preferred, would avoid, dexmethasone during pregnancy

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Corticosteroid, budesonide, formulation and where does it target ?

Oral, controlled release, good for long duration works in the terminal ileum or colon, large first pass

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Methotrexate when is it used for chrohns

Used in moderate to severe chrons disease known as not a first line agent

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Methotrexate given how

IM weekly or is given orally WEEKLY
a common med error

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Methotrexate is category x med true or false

TRUE AVOID IN A PREGNANT PT

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Long term effects of methotrexate

Bone marrow suppression, pancreatitis, hepatitis

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When is immodulator used

In pt who fail Mesalamine, or dependent of corticosteroid

Can be combined with mesalalamine or corticosteroid

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Immunomodulator therapy agent

Azathioprine
Mercaptopirine
Methotrexate
Cyclosporine

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Azathioprine and mercaptopurine require what test prior

Tpmt polymorphism, may need to reduce dose by 30-70%

Assess genotype and phenotype. Of tpmt

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Is cyclosporine safe in pregnant pt

Yes

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Moa for cyclosporine

Calcineurin inhibitor, immunosuppressant

Biologics must screen for …… Pt should be up to date on what

HIV, tb, varicella, HBv, hep c Up to date on all immunizations before start

Anti TNF alpha meds

Adalumab Certolizumab Golimumab

Anti TNF alpha must use caution in pt with

Heart failure,

Adalimumab, golimumab are monoclonal antibodies that bind to ____ alpha and block them

TNF

Infliximab is safe during ______ and _____ trimester, some concern of fetal transfer

First and second

Influximab can be _____ pt may lose efficacy after 1 year of treatment

Immunogenic Up to 50% will lose efficacy

Adalimumab administration

Sub q Inject into thigh or lower abdomen Rotate injection site

JAK inhibitor

Tofacitinib and upadacitinib

Tofacitinib black box warning

Increased mortality and thrombosis risk, Monitor for shortness of breath and assess for unilateral swelling

JAK inhibitor has BBW for

Infection, and increased mortality risk

Natalizumab and vedolizumab moa

Monoclonal antibody directed against cell adhesion molecules, inhibit memory T cells across endothelium into inflamed gi tissue

Natalizumab requires enrollment in ______ due to adverse effect

CD touch program

Natalizumab adverse reaction is

Progressive multi focal leukoencephalopathy, associated with JC virus, risk of infection increases with duration of treatment if >2 years and occurs more frequently in immunocompromised patient.

Ozanimod moa

Sphingosine 1 phosphate [S1P] Inhibit lymphocyte from leaving lymph nodes and migrating to the GI tract

Ozanimod is it a oral med

Yes Ozanimod is oral agent

Ozanimod adverse effect

Macular edema, headache, Brady

Contraindication to use Ozanimod

Mi, unstable angina, sick sinus, mobitz 2 or 3, or sleep apnea

Pregnant pt on Ozanimod

Use contraceptive during use, and 3 months after discontinuing

Pt with IBD who also has a fistula or abscess what is treatment?

Metronidazole, 250 Or cipro 400 mg, iv

Risk for ABX in UC

Long term use include c diff, resistance

Short term effect cipro

QT PROLONGATION, PHOTOSENSITIVE, TENDON RUPTURE

Cipro or metro (flatly safe in pregnancy

Cipro, safe no increased birth effects

Ibs non pharmalocial tx

Gut directed psychotherapy Peppermint to provide relief Fod map SOLUBle fiber

Amitzia used for Ibs _____, and only for

Constipation Female

Amitzia, contraindicated in _______ [for Ibs constipation]

Mechanical bowel obstruction

Amitzia monitoring =

liver function, and hepatic impairment, risk of hypokalemia i

For Ibs insoluble fiber may aid in what Ibs

Constipation dominant

For Ibs want to avoind

Lactose

Ibs alternative therapy’s

Acupuncture, hypnotherapy, cbt

Fiber supplement for Ibs constipation

Psyillum, methylcellulose, polycarbophil

Fiber supplement side effects include

Bloat, flatulence, Increase dose gradually

Lubiprostone used for ____

Ibs c

Lubiprostone warning, contraindication

Pregnancy category c Contraindicated in known mechanical bowel obstruction

Lubiprostone monitor

Liver function, hepatic impairment First dose may cause Dyspnea, Risk for Hypokalemia

Linzess and Trulance warning

If severe diarrhea, dc and alert the provider Administer with high fat meal could worsen diarrhea Contraindicated with a known mechanical bowel obstruction

Tenapanir is reserved for who

Pt who fail other ibs constipation tx

Tenapanor contraindicated in who

Renal impairment may increase risk for Hyperkalemia, and diarrhea Contraindicated in a pt less than 6 years old

Monitoring for tenapanor

Frequency of dehydration Potassium in pt with renal impairment

When is peppermint oil used

Pain or other abdominal discomforts

Peppermint oil moa

Cause smooth muscle relaxation in the gut but limited studies exist on specific products

Lomotil is indicated for what

Diarrhea

Lomotil side effect

Tachy arrhythmia or constipation

Imodium mechanism of action

Acts on opioid receptor Antidiarrheal

Imodium indicated

Diarrhea, urgency

Imodium side effect

Constipation

Lomotil moa

Antidiarrheal , inhibit GU motility and propulsion

What is rifaximin MOA

Inhibit bacterial RNA synthesis

Rifaximin indicate for

Urgency Diarrhea, pain

Rifaximin side effect

Constipation

Alosetron moa

Selective 5HT3 receptor antagonist

Eluxadoline moa

Mixed mu and kappa agonist and delta antagonist on opioid receptor

Med Antidiarrheal

Imodium and Lomotil

Antispasmodic for ibs

Levsin, bentyl

Levsin and bentyl side effect

Xerostomia, retention, and Anticholinergic

Alosetron only indicated for Females, who have had symptoms >__ months and haven’t responded to other therapies

If pt on Alosetron develops _____ must discontinue the use asap Why?

If pt develop constipation Can lead to ischemic colitis

Alosetron do not use in what patients

Don’t use in patient with history of constipation or ischemic colitis

Alosetron monitor for what

Severe constipation

Eluxadoline dose adjustment

Decrease to 75 for patient without gallbladder

Eluxadoline discontinue use n pt with constipation > ___ days

Eluxadoline do not use PMH such as

Pancreatitis, alcohol use disorder, or liver disease

Eluxadoline dc in pt with _____ spas,

Oddi

Tofacitinib induction dose is ___ mg for 8 weeks, then __ mg

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Ibd, And Ibs Flashcards

(89 cards)