IBD Therapeutics Flashcards
(37 cards)
What medications are used in IBD?
- Corticosteroids
- Aminosalicylates
- Antibiotics
- Immunosuppressants
- Biologic Agents
What is the aim of treatments in IBD?
- Reduce inflammation
- Reduce symptoms during flare-ups
- Prevent flare-ups from happening
Give some examples of corticosteroids.
- Prednisolone
- Methylprednisolone
- i.v. Hydrocortisone
In a patient with Crohn’s disease, what is done to induce remission in a patient?
Monotherapy with glucocorticosteroids
-> first presentation or single inflammatory exacerbation in 12 months.
What is an alternative to giving glucocorticosteroids to patients with Crohn’s disease?
Budesonide
-> less effective but fewer side effects than glucocorticosteroids
What is a downside of using corticosteroids for the treatment of chronic diseases?
Adverse effects may be greater than the disease
-> Having to weigh the benefits and risks
What can happen if corticosteroids are stopped abruptly?
Suppression of adrenal function
-> Takes time for adrenal glands to produce cortisol naturally. Have to be stopped slowly.
State some side effects of using glucocorticoids.
- Diabetes
- Osteoporosis
- Myopathy
State some side effects of using mineralocorticoids.
- Hypertension
- Sodium retention
- Water retention
What are the different forms corticosteroids used for the treatment of IBD?
- IV - hydrocortisone
- Oral - prednisolone
- Topical
What happens if a patient has adrenal suppression due to taking corticosteroids and has a severe trauma/disease?
Cannot respond to the trauma appropriately as there are low levels of cortisol - produced in high levels usually when this occurs.
If a patient is adrenal suppressed, and they attend a hospital for a trauma, what is usually given to a patient for treatment?
High dose of corticosteroids.
What must a patient carry if they are on a long-term corticosteroid?
Steroid Emergency Card
-> Given to other healthcare professionals to let them know.
Which patients will need a gradual withdrawal from a corticosteroid?
- Received 40mg or more of prednisolone for >1 week.
- Given repeated doses in the evening
- Received more than 3 weeks of treatment
- Received repeated courses
- Short course within 1 year of stopping long term therapy
What condition is more likely to occur in patients with IBD?
Osteoporosis
-> Lower BMI
-> Reduced physical activity
-> Disease activity
Which treatment for IBD is avoided the most?
Corticosteroids
What are the 2 things a patient must be put on if they have osteoporosis in IBD?
- Bisphosphonates
- Calcium and Vitamin D
What should be given to a patient when inducing remission in a patient with Crohn’s disease?
-> when trying to avoid corticosteroids
- Aminosalicylates
- Azathioprine
Give some examples of Aminosalicylates.
- Balsalazide
- Mesalazine
- Sulphasalazine
When is Azathioprine used to induce remission in patients with Crohn’s disease?
2 or more inflammatory exacerbations in a 12-month period.
What is a major side effect of azathioprine?
Neutropenia
-> Reduced levels of WBCs
What should be checked before giving a patient azathioprine?
Check TMPT levels.
Low levels of TMPT -> drug is not metabolised well -> increased levels of the drug -> toxicity.
What should be done if a patient is going to use azathioprine and they have high levels of TPMT?
They should be put on a higher level of the drug
What is an alternative to azathioprine?
Methotrexate
