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IBDFC Flashcards

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1
Q

Inflammatory Bowel Disease pathophysiology and types

A

Group of inflammatory conditions of the colon and small intestine
Ulcerative colitis and Crohn’s disease

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2
Q

sx of ibd

A

Symptoms: cramping, bloody diarrhea, fever, weight loss; Crohn’s can also cause malabsorption and anal fissures

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3
Q

tx of ibd

A

Treatment goals is to suppress inflammation to reduce Symptoms

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4
Q

food triggers of ibd

A

Food triggers include beans, alcohol, lactosecontaining dairy products, cabbage, broccoli. NOT MEAT

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5
Q

Ulcerative Colitis (UC) def

A

Mucosal inflammation confined to the rectum and colon with superficial ulcerations

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6
Q

sx of UC

A

Symptoms: abdominal cramping, frequent bowel movements, weight loss, fever, tachycardia

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7
Q

Crohn’s Disease (CD) def

A

Transmural inflammation of the GI tract that can affect any part (from mouth to anus), although 2/3 of cases are in the ileum
bowel wall injury is extensive and the intestinal lumen is often narrowed

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8
Q

sx of croh’s

A

Symptoms: abdominal pain, frequent bowel movements, weight loss/malnutrition, malaise

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9
Q

tx of UC

A

Treatment
Antispasmodics my be useful in Mild UC (dicyclomine)
with acute flareups of either condition, short courses of oral or IV steroids are used
with more moderate Symptoms, aminosalicylates (sulfasalazine or mesalamine) are used to control inflammation

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10
Q

crohns tx

A

Crohn’s , in moderatesevere cases, may require a stronger immunosuppresive agent (thioprine, 6MP, methotrexate)

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11
Q

severe UC or crohns tx

A

In severe UC or Crohn’s cases TNFblockers (infliximab) may be needed

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12
Q

Antidiarrheals & Antispasmodic

A

Antidiarrheals: loperamide (Imodium), bismuth subsalicylate (PeptoBismol, BSS), diphenoxylate/atropine (Lomotil)
Antispasmodic: dicyclomine (Benyl)

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13
Q

when to use antidiarrheals and antispasmotides in IBD

A

used for Mild symptom control: diarrhea, cramping/GI spasms

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14
Q

Loperamide (Imodium) MOA

A

antidiarrheal moa unkonw

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15
Q

CI loperamide

A

CI: abdominal pain without diarrhea; children 2 days

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16
Q

SE loperamide

A

SE: abdominal cramping, constipation, nausea

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17
Q

dose loperamide for IBD

A

Dose: 4 mg after first loose stool, then 2 mg after each subsequent stool (Max: 16 mg/day)

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18
Q

Bismuth Subsalicylate (PeptoBismol, BBS) USE

A

antidiarrheal

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19
Q

ci of pepto

A

CI: children with viral infections due to risk of Reye’s; salicylate allergy; history of severe GI bleed or coagulopathy

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20
Q

se of pepto

A

SE: black tongue/stool, hearing loss, tinnitus (toxicity(

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21
Q

dose of pepto

A

Dose: 2 tbsp or 2 tabs every 3060 minutes (Max 8 doses/day & 2 days of therapy)

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22
Q

Diphenoxylate/Atropine (Lomotil) USE

A

antidiarrheal

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23
Q

CI of lomotil

A

CI: children < 2; C. diff.; obstructive jundice

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24
Q

se of lomotil

A

SE: sedation, constipation, urinary retention, tachycardia, blurred vision, xerostomia, dizziness, depression

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25
dose of lomotil for ibd
Dose: 5 mg QID (Max 20 mg/day)
26
Dicyclomine (Bentyl) USE
Antispasmodic
27
CI of dicyclomine
CI: GI obstruction; severe ulcerative colitis; reflux esophagitis; narrowangle glucoma; myasthenia gravis; infants <6 months
28
se of dicyclomine
SE: (anticholinergic) dry mouth, blurry vision, urinary retention, constipation, dizziness, lightheadedness, drowsiness, xerostomia, confusion, tachycardia
29
dose of dicyclomine
Dose: 1020 mg QID (Max 160 mg/day)
30
when to take dicyclomine
Take 3060 minutes before meals
31
Steroids
Prednisone, budesonide (Entocort EC)
32
when to use steriuds for iBD
used to decrease severity of acute attack (use until acute flares resolve or weight is regained)
33
short term se of steroids
SE (shortterm): increased appetite/weight gain, fluid retention, emotional instability, insomnia, GI upset
34
longerm se of steroids
SE (longterm): adrenal suppression/Cushing's syndrome, impaired wound healing, HTN, hyperglycemia, cataracts, osteoporosis
35
which steroid undergoes much first pass metabolism
Budesonide: undergoes extensive firstpass metabolism so lower systemic exposure; do not crush tablet; is preferred agent if disease is in ileum or ascending colon; 3A4 substrate. less side effects but less effective than prednisone. use for 8 weeks for active tx.
36
Maintenance Therapy for IBD
Aminosalicylates: mesalamine, 5ASA, sulfasalazine Immunosuppressive Agents: azathioprine, 6mercaptopurine, methotrexate Monoclonal antibodies to TNF: infliximab, certolizumab, adalimumab, natalizumab
37
moa mesalamine
aminosalicilate
38
Mesalamine brands and formulations
Asacol, Pentasa, Lialda, Canasa (suppository), Rowasa (enema)
39
mesalalamine
SE: headache GI upset, loss of appetitie, N/V/D, photosensitivity > 10% chance of rash.
40
mx for mesalamine
Monitor: renal function, CBC, Symptoms of IBD
41
what meds to avoid with mesalamine
Best to avoid concomittant use with antiacids, H2RAs, or PPIs
42
whu use mesalamine over sulfasalazine
Better tolerated that sulfasalazine
43
can you crush or chew mesalamine?
Swallow caps whole
44
Sulfasalazine brands
Azulfidine, SulfazinAzulfidine ENtabs
45
ci of sulfasalazine
CI: sulfa or salicylate allergy; GI or GU obstruction
46
se of sulfasalazine
SE: headache, rash, anorexia, dyspepsia, GI upset, oligosperia, folate deficiency; arthalgia, crystalluria can cause skin/urine to turn yelloworange
47
mx for sulfasalazine
Monitor: CBC, LFTs, Symptoms of IBD
48
Azathioprine brand
Azasan, Imuran
49
bbw of azathioprine
BBW: chronic immunospuppresion can increase risk of neoplasia; hematologic toxicities and mutagenic potential
50
se of azathioprine
SE: GI upset, rash, increase LFTs, hematologic toxicities
51
mx azathioprine
Monitor: LFTs, CBC, renal function
52
what deficiency is important in azathioprine
Genetic deficiency of thiopurine methytransferase (TPMT) will be more sensitive to myelosupprssive effects
53
6Mercaptopure
Purinethol
54
6MP bbw
BBW: chronic immunospuppresion can increase risk of neoplasia; hematologic toxicities and mutagenic potential
55
se of 6mp
SE: GI upset, rash, increase LFTs, hematologic toxicities
56
mx 6mp
Monitor: LFTs, CBC, renal function
57
deficiency important in 6mp
Genetic deficiency of thiopurine methytransferase (TPMT) will be more sensitive to myelosupprssive effects
58
Methotrexate brand
Rheumatrex, Trexall
59
mtx bbw
BBW: renal; pneumonitis; bone marrow suppression; mucositis/stomatitis; dermatologic reactions
60
ci of mtx
CI: pregnancy; alcoholism; chronic liver disease; blood dyscrasias
61
se of mtx
SE: nausea, diarrhea, mucositis/stomatitis, skin reactions
62
mx of mtx
Monitor: CBC, LFTs, renal function
63
antidote of mtx
Antidote: leucovorin or levoleucovorin
64
Infliximab brand
Remicade
65
MOA of infliximab
CHIMERIC monoclonal antibody to TNF (adlimubam and azathioprine are fully HUMANIZED so less antibody production)
66
bbw of infliximab
BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy
67
ci of infliximab
CI: doses >5mg/kg in moderatesevere HF
68
warnings of infliximab
Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections
69
se of infliximab
SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis
70
mx of infliximab
Monitor: vitals, TB test, S&S of infection, CBC, LFTs, HBV, HF, malignancies
71
how to infuse infliximab
Should be infused within 3 hours of reconstitution; 2 hour infusion (requires a filter) (IV only)
72
Certolizumab brand
Cimzia
73
moa of certolizumab
PEGlinked HUMANIZED Monoclonal antibody to TNF
74
bbw of certolizumab
BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy
75
warnings of certolizumab
Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections
76
se of certolizumab
SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis
77
how to take certolizumab
Inject SQ into the abdomen or thigh
78
how to store certolizumab
Vials refrigerated; reconstituted vial are good for 24 hours in refrigerator or 2 hours at room temp
79
Adalimumab
Humira
80
moa adalimumab
HUMANIZED Monoclonal antibody to TNF
81
bbw adalimumab
BBW: infections (TB, bacterial sepsis, invasive fungal); malignancy
82
warning of adalimumab
Warnings: TNF inhibitors can cause demyelinating disease, hepatitis B reactivation, heart failure, hepatotoxicity, lupuslike syndrome, and infections
83
se of adalimumab
SE: infections, headache, abdominal pain; infusion rxns: hypotension, fever, chills, pruritis
84
mx of adalimumab
Monitor: vitals, TB test, S&S of infection, CBC, LFTs, HBV, HF, malignancies
85
how to take adalimumab
Inject SQ into the abdomen or thigh
86
how to store adalimumab
Store in refrigerator until use
87
Natalizumab brand
Tysabri
88
moa of natalizumab
HUMANIZED Monoclonal antibody that inhibits alpha4integrin
89
bbw natalizumab
BBW: risk for progressive mulifocal leukoencephalopathy (PML)
90
warning natalizumab
Warnings: hepatotoxicity, infection
91
when to dc if nor response natalizumab
Discontinue if no response by week 12
92
program to be enrolled in for natalizumab
Must be enrolled in manufacturer TOUCH prescribing programming
93
when to administer natalizumab
Must be administered within 8 hours of preparation
94
first line for ulcerative colitis
enema or rectal mesalamine suppositites for mild/mod dz
95
what type of mesalamine for chron's?
ORAL therapy with mesalamine or sulfasalizine
96
mesalamaine rectal suspension is called
rowasa. store at room temp. therapy can be up to 6 weeks. may have a sulfite. state if sulfa allergy. administer at night since enema once daily.

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