IBD (Inflammatory Bowel Disease) Flashcards
(46 cards)
1
Q
What is Inflammatory Bowel Disease (IBD)?
A
- Group of inflammatory conditions of the colon & small intestines
2
Q
What are the major types of IBD?
A
- Ulcerative Colitis (UC)
- Crohn’s Disease (CD)
3
Q
What are the classic symtpoms of IBD?
A
- Bloody Dirrahea
- Others: Rectal Urgency, Tenesmus (feeling like you have to poop even tho the colon is empty), abdominal pain, fatigue, weight loss, night sweats, nausea, vomiting, constipation
4
Q
What is the difference between IBD & IBS (irritable bowle syndrome)?
A
- IBS does NOT cause Inflammation
- Both have similar symptoms tho: abdominal pain, bloating, gassy, constipation or diarrhea
5
Q
How is Ulcerative Colitis (UC) characterized?
A
- Mucosal inflammation confined to the rectum and colon with Superficial ulcerations
- Continuous
6
Q
What is it know as when UC is limited to the desceding colon & rectum? What about when just limited to the rectum?
A
- Descending colon & Rectum: Distal Disease (Treated with topical stuff)
- Just rectum: proctitis
The larger the area affected the worse UC is
7
Q
What are the classification of UC?
Mild, Moderate, severe, Fulminant
A
- Mod: > 4 stool/day with minimal signs of toxicity
- Severe: >6 bloody stools/day with signs of toxicity
- Fulminant: > 10 stools/day with Severe symptoms
Toxicity = fever, tachycardia, anemia, increase ESR
8
Q
How is Crohn’s Disease (CD) characterized?
A
- Deep, transmural inflammation taht can affect ANY part of the GI tract (ileum and colon are the most common places affeced)
- “Non-continuos pattern” - looks like cobblestone
UC ONLY affects the colon (descending colon & rectum)
9
Q
What are some of the symptoms of CD?
A
- Chronic Diarrhea, abdonimal pain, weight loss
10
Q
How to make the diagnosis for IBD?
A
- Could do blood tests or stool testing but
- Colonscopy with tissue biopsy is NEEDED
- Sigmoidoscopy might be helpful for finding UC
11
Q
What are some of the lifestyle measures that should be done for someone with IBD?
A
- Eating smaller more frequent meals that are low in fat & dairy
- Fiber SHOULD be added to diet
- Drink plenty of water (avoid caffeine & alcohols)
- Try to avoid Sorbitol & Lactose (both may cause GI issues)
12
Q
What are some supportive care things that should be done for someone with IBD?
A
- May use antidiarrheals or antispasmodics (i.e.; dicyclomine) - but use with caution in select patients with IBD
- Opioids should be avoided (SE: Constipation)
- Vitamins (i.e.; B12, Folate, D, Ca, Fe, Zn) are helpful in preventing deficiencies related to malabsorption
- Nicotine and Cigs can worsen CD BUT be protective in UC
13
Q
What are some natural products that may be used for those with IBD?
A
- Probiotics (lactobacillus or Bifdobacterium) can help reduce IBD symptoms
- Fish oils can help with inflammation
- Others: peppermint, chamomule, horehound, wheatgrass
14
Q
In mild disease of CD, what is the medication used for induction?
A
- Budesonide
15
Q
In mild disease of UC, what is the medication used for induction?
A
- Mesalamine (oral and/or rectal) with or without steroids
16
Q
In moderare to severe disease of CD, what is the medication used for induction?
A
- Biologics (i.e.; anti-tumor Necrosis Factor (TNF), IL Receptor antagonist) with or without immunomodulator (i.e.; thiopurine)
17
Q
In moderate to severe disease of UC, what is the medication used for induction?
A
- Biologics (i.e.; anti-tumor Necrosis Factor (TNF), IL Receptor antagonist) with or without immunomodulator (i.e.; thiopurine)
18
Q
In mild disease of UC, what is the medications used for maintenance therapy?
A
- Aminosalicylates
19
Q
In mild disease of CD, what is the medication used for maintenacne therapy?
A
- Oral Budesonide for 3 months (then DC or Switch to thiopurine or MTX)
20
Q
In moderate to severe disease of UC, what are some of the medications used for maintenance therapy?
A
- Immunosuppressive medications (i.e.; thiopurine, Anti-TNF drugs)
21
Q
In moderate to severe disease of CD, what are some of the medications used for maintenance therapy?
A
- Immunosuppressive medications (i.e.; thiopurine, Anti-TNF drugs) +/- steroids (more severe cases)
22
Q
What are some of the steroids used for IBD?
A
- Prednisone
- Budesonide (Entocort EC - ONLY for CD, Uceris - ONLY for UC)
Watch for 3A4 inhibitors with Budesonide (-azoles, Grapefruit…)
23
Q
What are some side effects for steroids used for IBD?
A
- Increase appetite/weight gain
- Emotional instability (mood swings, irritability)
- Insomina
- Increase BP & BG
- Cushings syndrome, osteoprosis (long term use)
24
Q
What are some additional notes for ALL steroids used for IBD?
A
- Avoid LONG TERM use
- Used longer than 2 weeks MUST TAPER to avoid withdrawal symptoms
- Used long tern- assess bone health (start Ca, Vit D or Bisphosphates if needed)
25
What are some **additional notes** for **Budesonide ONLY** used for **IBD**?
- Undergos **extensive 1st pass metabolism** = decrease **systemic exposure** compaired to others
- **DO NOT** crush or chew tablets
26
what are some fo the **rectal steroids** that are used for **IBD**?
## Footnote
-
- Hydrocortisone
- Budesonide Rectal Foam
27
What are some **additional notes** for the **rectal steroids** used for **IBD**?
- **ONLY** used for **UC**
- Can be used as an **alternative** to aminosalicaltes for **distal UC**
28
What are the **Aminosalicylates** that are used for **UC treatment**?
- **Mesalamine ER (Pentasa** - Caps; **Asacol** - Tabs; **Rowasa** - Emena; **Canasa** - Supps)
- Sulfasalazine
- Balsalazide
- Olsalazine
29
What is important to know about the **Mesalamine ER Suppository & Enema** dosing?
- Supp: 1 g recatlly **QHS, retain for at least 1 - 3 hours**
- Enema: 4 g reactally **QHS, retain in the rectum overnight** for ~8 hours
30
What is the **MOA** for the **Aminosalicylates**
- Unknown BUT does have a **topical anti-inflammatory effect in the GI tract**
31
What are some **contraindications** for **Mesalamine ER** used for **IBD**?
- Hypersensitivity to salicylates (i.e aspirin) or aminosalicylates
32
What are some **warnings** for **Mesalamine ER** used for **IBD**?
- **Hypersensitivity Reactions** (i.e.; Myocarditis, Pericarditis, Nephritis, Hematologic Abnormalities) are more common with **sulfasalamine** than **mesalamine**
33
What are some **side effects** for **Mesalamine ER** used for **IBD**?
- abdominal pain, nausea, headache, farting, burping
34
What are some **additional notes** for **Mesalamine ER** used for **IBD**?
- Mesalamine is the best tolerated Aminosalicylate
- **Rectal** form is more effective for **distal disease/proctitis** in UC (can use **oral and rectal** forms together)
35
What are the **thiopurines** used for **IBD**?
- Azathioprine
- Mercaptopurine
## Footnote
**NOT** FDA approved for IBD **BUT** are recommended in the guidline for **induction and maintenance of remission**
36
What are some **warnings** for **thiopurine** used for **IBD**?
- **Increased risk** of **myelosuppression** in those patients with **Deficiency** of **Thiopurine methyltransderase (TMPT)**
37
What are some **additional notes** for **thiopurine** used for **IBD**?
- **TMPT** genetic testing
- AZA is **metabolized into** mercaptopurine (do NOT use them in combo)
38
For those patients that can **not tolerate azathiopurine**, what are some **other options** that could be used?
- **Methotrexate** - NOT FDA approved BUT is recommended for **induction & maintenacne of remission** for moderate-severe **CD**
- **Cyclosporine** - resevred for **Severe acute UC** refacroty to steroids
## Footnote
MTX - **once weekly IM or SubQ injection**
39
What are the **Sphingosine-1-Phosphate (S1P) Receptors Modulators** that are used for **IBD**? What are they approved for?
## Footnote
UC or CD
- Ozanimod (Zeposia) & Etrasimod (Velsiptiy)
- Both approved for **UC**
40
What are the **Janus Kinase Inhibitors (JAK)** that are used for **IBD**? What are they approved for?
- Upadacitinib (**Rinvoq**) - UC & CD
- Tofacitinib (Xelijanz) - UC
41
What are the **Anti-TNF Monoclonal Antibodies** used for **IBD**? How do they work? What are they approved for?
- Infliximab, Adalimumab...
- They **bind** to human Anti-TNF-alpha, **preventing induction** of proinflammatory cytokines
- Used for **moderate-severe UC** or **CD**
## Footnote
More information in Steroids deck
42
What are some of the **interleukin receptor antagonists** used for **IBD**? what are they approved for?
- Ustekinumab (Stelara) - **UC** & **CD**
- Risankizumab (**Skyrizi**) - **CD**
- Mirikizumab-mrkz (Omvoh) - **UC**
43
What are the **intergrin receptor antagonist** that are used for **IBD**?
- Natalizumab (Tysabri)
- Vedolizumab (**Entyvio**)
## Footnote
**Approved** for **CD**, Multipe Sclerosis (Tysabri) & **Ulcerative Colitis (Entyvio)**
44
What is the **MOA** for the **Integrin Receptor Antagonists**?
- Blocking the ability of integrin to interact with adhesion molecules and preventing **inflammatory cells** from going into the **GI Tract**?
45
What are some **Boxed warnings** for **Tysabri** used for **IBD**?
- Progressive miltifocal leukoenceophalophaty (**PML**)
- **ONLY** available through the **REMS TOUCH** programs
46
What are some **warnings** for **Entyvio** used for **IBD**?
- Infusion site reactions, Infections
- ALL **immunizations** must be up to date before starting (avoid live vaccines)
