Inflammatory Bowel Disease

Question 1

What are the 2 types of IBD?

Answer 1

Crohns
Ulcerative Colitis

Question 2

What are the characteristics of IBD?

Answer 2

Inflammation
Swelling
Ulceration of intestinal tissue
Chronic with periods of reumission

Question 3

What are the symptoms of IBD?

Answer 3

Stomach pain
Weight loss
Diarrhoea
Bloody and mucus
Tiredness
*Joint pain
*Inflammed eyes
*Rashes

Question 4

What is Ulcerative Colitis?

Answer 4

Only affects large bowel
Inflammation on inner lining

Question 5

What is Crohns?

Answer 5

Can affect any area of GI tract
All layers of tissue can be inflammed

Question 6

How to diagnose IBD?

Answer 6

Symptoms
Blood tests- anaemia, vitamin deficiencies, inflammatory markers
X-ray, CT, MRI
Sigmoidoscopy, colonoscopy

Question 7

Diagnosis for Crohns?

Answer 7

Small bowel enema
Small capsule endoscopy

Question 8

Causes of IBD?

Answer 8

Genetic links
Autoimmune disease
Environmental
Previous infection

Question 9

Prevalence of IBD?

Answer 9

Late teens and early 20s
White ethnic groups
Women more than men
1 in 350 people

Question 10

What are the 4 treatments of IBD?

Answer 10

Corticosteroids
Aminosalicylates
Cytokine modulators
Immunosuppresants

Question 11

Steroid formulations?

Answer 11

Oral- MR and GR
Rectal- enema and foams

Question 12

Examples of steroids?

Answer 12

Hydrocortisone
Beclomethasone
Budesonide
Prednisolone

Question 13

What is the pharmacology of steroids?

Answer 13

Reduce inflammatory mediators directly
Have effects on expression of genes associated with inflammatory and anti-inflammatory proteins

Question 14

Cautions of steroids?

Answer 14

Congestive heart failure
Hypothyroidism
Osteoporosis
Untreated infection

Question 15

Side effects of steroids?

Answer 15

Insomnia
Dyspepsia
Cushing’s syndrome
Impaired healing
Adrenal suppression- long term

Question 16

Interactions with steroids?

Answer 16

Grapefruit juice and budesonide
Steroids antagonise diuretics

Question 17

Aminosalicylate formulations?

Answer 17

Oral- GR and MR caps/tabs, granules, suspensions
Rectal- foams, enemas and suppositories

Question 18

Examples of aminosalicylates?

Answer 18

Balsalazine
Mesalazine
Olsalazine
Sulfasalazine

Question 19

Aminosalicylate rare side effects?

Answer 19

Blood disorders- report unexplained bleeding, bruising, purpura, sore throat, fever, malaise
Renal function- checked before treatment then every 3 months
Salicylate sensitivity

Question 20

Sulfasalazine side effects?

Answer 20

Colours urine
Colours lenses orange
Decrease digoxin concentration
Absorbs folate

Question 21

What are cytokine modulators?

Answer 21

Monoclonal antibodies which inhibit pro-inflammatory cytokine, tumour necrosis factor alpha
Stop expansion of activated T-cells by interrupting the calmodulin- calcineurin cascade

Question 22

Examples of cytokine modulators and administration?

Answer 22

Subcutaneous
Infliximab
Adalimumab
Golimumab
Vedolizumab

Question 23

What are immunosuppressants?

Answer 23

T-cell effects
Anticancer drugs with blood toxicity and liver toxicity therefore require regular monitoring (blood tests)

Question 24

Immunosuppressant examples and administration?

Answer 24

Oral/ injection
Azathioprine
Ciclosporin
Mercaptopurine
Methotrexate

Question 25

What is methotrexate?

Answer 25

Weekly dose with folic acid
Only use 2.5mg tablets
Report sore throat, bleeding, bruising
FBC, renal and lier monitoring
Safety card
High risk drug

Question 26

Non- drug treatment?

Answer 26

Smoking cessation
Attention to diet
Surgery- stoma operations, resection operations