IBD THERAPY

Question 1

MANAGEMENT of IBD (2)

Answer 1

medical approach for patients with IBD is symptomatic care (ie, relief of symptoms) and mucosal healing

Question 2

step-up or stepwise approach number of steps

Answer 2

5

Question 3

Step I

Answer 3

Aminosalicylates (oral, enema, suppository formulations): For treating flares (acute attack) and maintaining remission; more effective in UC than in CD

Question 4

Step IA

Answer 4

Antibiotics: most commonly used for perianal disease (abcesses), fistulas, intra-abdominal inflammatory masses.

Question 5

Step II

Answer 5

Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only

Question 6

•Step III

Answer 6

Immunomodulators: used in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates

Question 7

Step IV

Answer 7

Clinical trial agents: Tend to be disease-specific (i.e., an agent works for CD but not for UC, or vice versa)

Question 8

THE FOLLOWING MEDICATIONS MAY BE USED IN PATIENTS WITH IBD: (5)

Answer 8

•5-Aminosalicylic acid derivatives
•Immunosuppressant agents
•Tumor necrosis factor inhibitors
Antibiotics
•Corticosteroid agents

Question 9

•Therapy for Crohn disease is generally less effective than that for ulcerative colitis

Answer 9

No answer here

Question 10

5-AMINOSALICYLIC ACID DERIVATIVES used for

Answer 10

for treating flares of mild to moderate ulcerative colitis and occasionally Crohn colitis and for maintaining remission.

Question 11

5-AMINOSALICYLIC ACID DERIVATIVES include(2)

Answer 11

Mesalamine

Sulfasalazine

Question 12

Sulfasalazine used for

Answer 12

This agent is used for acute disease and for maintenance of remission
considered as first-line therapy for Crohn disease

Question 13

Sulfasalazine is a prodrug that is metabolized to its active components

Answer 13

sulfapyridine and 5-aminosalicylic acid (5-ASA; mesalamine)

Question 14

Sulfasalazine mechanism

Answer 14

inhibits leukotriene synthesis and lipoxygenase

Question 15

Sulfasalazine ADVERSE EFFECTS >10% : (6)

Answer 15

• Anorexia
• Headache
• Nausea
• Vomiting
• Gastric distress
• Apparently reversible oligospermia

Question 16

Sulfasalazine ADVERSE EFFECTS <1% (7)

Answer 16

• Skin rash
• Pruritus
• Urticaria
• Fever
• Heinz body anemia
• Hemolytic anemia •Cyanosis

Question 17

•Mesalamine is

Answer 17

is a 5-ASA that acts systemically and also has activity as a topical anti-inflammatory.

Question 18

IMMUNOSUPPRESSANTS useful as

Answer 18

steroid-sparing agents, in healing fistulas, and in patients with serious contraindications to surgery.

Question 19

IMMUNOSUPPRESSANTS used for

Answer 19

patients who are refractory to or unable to tolerate steroids and in patients in whom remission is difficult to maintain with the aminosalicylates alone.

Question 20

Azathioprine useful in

Answer 20

Crohn disease complicated by recurrent rectal fistulas or perianal disease

Question 21

AZATHIOPRINE mechanism

Answer 21

inhibits mitosis and cellular metabolism by antagonizing purine metabolism and inhibiting synthesis of DNA, RNA, and proteins; these effects may decrease proliferation of immune cells and result in lower autoimmune activity.

Question 22

AZATHIOPRINE Adverse Effects >10% (2)

Answer 22

• Leukopenia (28-50%)

* Infection (20%)

Question 23

AZATHIOPRINE Adverse Effects <1% (8)

Answer 23

•Lymphoma (Frequency Not Defined) •Abdominal pain – Alopecia -Arthralgia -Diarrhea –Fever - malaise •Bacterial, fungal, protozoal, viral infections •Bone marrow suppression •Hepatotoxicity •Skin cancer •Macrocytic anemia . •others

Question 24

TNF INHIBITORS include

Answer 24

Infliximab

Adalimumab

Question 25

Infliximab mechanism

Answer 25

neutralizes cytokine TNF-alpha and inhibits its binding to the TNF-alpha receptor

Question 26

Adalimumab adverse effects

Answer 26

Development of antinuclear antibodies (50%))