Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology II > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

(89 cards)

Start Studying
1
Q

What are the distinguishing factors of ulcerative colitis?

A

Mucosal inflammatory condition
Confined to the rectum and colon
Continuous pattern of involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are distinguishing factors of Crohn’s disease?

A

Transmural inflammation of GI tract (throughout the full thickness of the bowel wall
Can affect any segment of the GI tract
Skip pattern involvement
strictures, fistulas, and ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two conditions that cause IBD?

A

Ulcerative colitis and Crohns Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the sx of ulcerative colitits?

A

Bloody diarrhea and abdominal pain = cardinal sx

Severe cases: fever, anorexia, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the course for ulcerative colitis?

A

Chronic, recurrent, unpredictable
65-75% exacerbations and remissions
INCREASED RISK OF CANCER IS UC >7-10 YEARS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the extraintestinal manifestations of ulcerative colitis?

A

erythema nodosum, arthritis, pyoderma gangrenosum, uveitis, chronic active hepatitis, cirrhosis, sclerosing cholangitis, oral aphthous ulcerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the sx of Crohn’s Disease?

A

DIARRHEA AND ABDOMINAL PAIN= cardinal sx

Weight loss, vomiting, fever, perianal discomfort, bleeding= common complaints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the extraintestinal manifestations associated with Crohn’s disease?

A

Extraintestinal manifestations: erythema nodosum, arthritis, pyoderma gangrenosum, uveitis, ankylosing spondylitis, oral aphthous ulcerations, cholelithiasis, nephrolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the infectious causes of IBD?

A

Viruses
Bacteria
Mycobacteria
Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the genetic causes of IBD?

A

1st degree relatives have 4-20s risk of IBS
Metabolic defect
Connective tissue disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the environmental causes of IBD?

A

Diet

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the immune defect causes of IBD?

A

Altered host susceptibility

Immune mediated mucosal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the psychological causes of IBD

A

Stress
Emotional/physical trauma
Occupational

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the infectious factors of IBD?

A

–Increase in pathogenic bacteria
Bacteroides
Escherichia coli

–Decreased beneficial bacteria
Bifidobacterium
Lactobacillus species

–Clinical controversy
Mycobacterium avium subspecies paratuberculosis (MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the immunological factors of IBD?

A
  • CD patients have generalized impaired immune response
  • Trauma of skin or intestine
  • Decreased blood flow to site in pts with CD vs. non-CD pts
  • Decreased neutrophils and IL-8 accumulation at injury site (part of the healing process, starting to heal and clot)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the environmental factors of IBD?

A

Luminal bacteria
Aberrant immune response to enteric flora

Diet
Dietary antigens contribute to inflammation

Smoking
Protective for (Negative correlation) UC
More aggressive disease (Increase in flares) in CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the drugs to avoid with IBD?

A

Opiates
Reduce GI Motility

NSAIDS
Worsen IBS by disrupting mucosal barrier

Antidiarrheals
Loperamide, Diphenoxylate/Atropine
Risk of Precipitating Toxic Megalocolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the goals of therapy for IBD?

A

Resolve acute inflammatory process
Resolve complications (fistulas, abscess)
Alleviate systemic manifestations
Maintain remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the general principles of treatment of IBD?

A

Disease Location
Severity–Mild, Moderate, Severe
Complications–Fistulas, Toxic megacolon
Patient Response–Prior symptomatic response, tolerance
Therapy sequential– Treat acute disease, Maintain remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the Non-pharmacologic managements for UC?

A

Psychological support

Nutritional measures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the nutritional measures for non-pharmacologic management of UC?

A

NO DIET IMPROVES OR EXACERBATES UC
Reduce dietary fiber during exacerbation
Folic acid (1mg/day) when leafy veggies restricted or sulfasalazine being used
Oral iron if anemia or considerable rectal bleeding
Metamucil 1-2 times/day for mild diarrhea during remissions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can be used to treat mild-moderate ulcerative colitis?

A 
Sulfasalazine  
OR
Mesalamine    
OR
Aminosalicylate at dose equivalent to mesalamine 
OR 
if Distal Disease
Mesalamine Enema/Suppository
Corticosteroid Enema

Remission
Reduce dose by half
OR
With enema/ suppository: Reduce frequency to q 1-2days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you replace when you prescribe a patient sulfasalazine for UC?

A

Folic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can be used to treat moderate to severe UC?

A

Sulfasalazine OR Mesalamine
Plus Prednisone

Remission:
Taper prednisone, then reduce sulfasalazine or mesalamine after 1-2 months to approximately half

Refractory
Add Azathioprine or Mercaptopurine (6-MP) OR
Consider Infliximab (antibody) if no response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What can be used to treat severe or fulminant ulcerative colitis?
Hydrocortisone Remission: Change to prednisone add sulfasalazine or mesalamine If no response in 5-7 days: Cyclosporine IV If no response, patient candidate for colectomy
26
When is surgery necessary in UC?
High-grade dysplasia, suspected cure | Pts w/ severe disease required high-dose steroids that can't be tapered after 6-12 months
27
Can surgical resection in ulcerative colitis cure?
Yes
28
What is used for ulcerative colitis maintenance?
Aminosalicylates and/or AZA or 6-MP Alternative Infliximab
29
What are the non-pharmacologic managements of Crohns disease?
Psychological support | Nutritional meausres
30
What are the nutritional measures that are used as non-pharmacologic management of Crohns disease?
Limit fiber with cramping and diarrhea Decrease fat intake when steatorrhea Multivitamin with minerals daily
31
What do you treat mild-moderate Crohns thats in the ileocolic or colonic area with?
Sulfasalazine or Oral mesalamine
32
What do you treat mild-moderate Crohns thats in the perianal area with?
``` Sulfasalazine or Oral mesalamine and/or Metronidazole ```
33
What do you treat mild-moderate Crohns thats in the small bowel with?
``` Oral mesalamine or Metronidazole or Budesonide ```
34
What do you treat moderate to severe Crohn's with?
Mild-moderate protocol Add prednisone or If refractory and fistulizing disease Add infliximab ``` Inadequate response Adalimumab Natalizumab Certolizumab Once pt responds to therapy Taper prednisone after 2-3 weeks Add AZA, 6-MP or MTX (methotrixate) ```
35
Do you need to taper prednisone?
Yes
36
How do you treat severe-fulminant crohns?
Hydrocortisone IV If no response in 5-7 days Cyclosporin IV Assess need for surgical resection
37
What is the maintenance therapy for Crohns disease?
No role for long term corticosteroids Azathioprine/6-MP 1st line for maintenance Azathioprine/6-MP or mesalamine also effective after surgical resection to prevent recurrence Infliximab 5mg/kg IV q wk x 6, then q 8 weeks Methotrexate 25mg IM up to 16 weeks followed by 15mg IM weekly
38
What is the maintenance therapy for severe-fulminant disease?
``` Severe-fulminant disease Hospitalization--Surgical interventions, Supportive care Parenteral corticosteroids IV cyclosporin, tacrolimus Infliximab ```
39
What are the drugs used to treat IBD?
Aminosalicylates: Sulfasalazine Mesalamine Corticosteroids Immunomodulators: Azathioprine 6-MP Methotrexate (MTX) Cyclosporin Antibiotics Monoclonal Antibodies Infliximab (Remicade) Adalimab (Humira) Natalizumab (Tysabri)
40
What are the aminosalicylate drugs?
Sulfasalazine | Mesalamine
41
Sulfasalazine (Azulfidine)-MOA
Aminosalicylate | Metabolized by intestinal bacteria to to the active component 5-aminosalicylate (5-ASA) and sulfapyridine (mesalamine)
42
Sulfasalazine (Azulfidine)- use
Most commonly used for inducing and maintaining remission | Response can take 2-3 weeks
43
Sulfasalazine (Azulfidine)- contraindications
SALICYLATE HYPERSENSITIVITY | Renal impairment- monitor SCr
44
Sulfasalazine (Azulfidine)- side effects
NOT WELL TOLERATED N/V, heartburn, anorexia HA HYPERSENSITIVITY RXNS (RASH, FEVER)- DO NOT USE IN PTS W/ SULFA ALLERGY BLOOD DISORDERS (ANEMIA, THROMBOCYTOPENIA, GRANULOCYTOPENIA) CAN IMPAIR FOLIC ACID ABSORPTION IDIOSUNCRATIC RXNS (HEPATOCELLULAR INJURY, AGRANULOCYTOSIS, LUPUS-LIKE SYNDROME) LOW SPERM COUNTS
45
Mesalamine (Asacol, Rowasa, Pentasa, Canasa)- MOA
Aminosalicylate Unclear various effects on inflammatory process Formulations vary and target different parts of the colon Mesalamine or suppositories for rectosigmoid disease Delayed release formulations of mesalamine for Crohn’s ileitis Response is slow
46
Mesalamine (Asacol, Rowasa, Pentasa, Canasa)- side effects
Local itching and mild rectal irritation with topical enemas | Idiosyncratic rxns: pleuropericarditis, pancreatitis, nephrotic syndrome
47
What are the corticosteroids?
Prednisone, Budesonide, Prednisolone, Hydrocortisone, Methyprednisolone (available in a syrup)
48
Corticosteroids- MOA
Anti-inflammatory effects Improves Symptoms Improves disease severity
49
Corticosteroids-ROA
PO IV- hospitalization for parenteral Topical: suppositories, foams, enemas (effective in distal colonic inflammation)
50
How are corticosteroids used in crohns disease?
Budesonide for mild-moderate ileal or right sided disease For moderate-severe disease or patients unresponsive to aminosalicylates or budesonide Oral steroids For severe or fulminant disease or unable to tolerate PO IV steroids
51
How are corticosteroids used for ulcerative colitis?
IV hydrocortisone or methylprednisolone may prevent need for colectomy in some patients Steroids should be tried before surgery in most patients Methylprednisolone preferred for reduced mineralcorticoid effect
52
Corticosteroids- tapering
Induction of response takes 7-14 days Taper by 5mg/wk prednisone or equivalent Budesonide taper: 9mg6mg3mg Inability to taper is indication for amtimetabolite and/or infliximab therapy Parenteral steroid indicated in pts failing to respond to 7-14 days of high dose oral prednisone or equivalent
53
When do is tapering needed for corticosteroids and by how much should predinisone or equivalent be taperd weekly?
Anytime over 7 days the patient will need to be tapered | 5 mg/wk
54
Corticosteroids- monitoring for complications
Glucose intolerance/ metabolic abnormalities Hyperkalemia Hyponatremia glucose Greater risk for adrenal insufficiency and infections N/V Postural hypotension Long-term therapy (>3mo) Bone density Annual eye exam
55
What are the immunosuppressives?
6-Mercaptopurine (6-MP) | Azathioprine (Imuran)
56
What is azathiprine (imuran)?
A prodrug metabolized to 6-MP
57
Immunosuppressives- 6-Mercaptopurine (6-MP), Azathioprine (Imuran)- MOA
Antagonizes purine metabolism; inhibits DNA, RNA and protein synthesis Steroid-sparing achieve or maintain control and allow reduction or discontinuation of steroids
58
Is immunosuppressive maintenance therapy less toxic than chronic steroid therapy?
yes
59
Immunosuppressives- 6-Mercaptopurine (6-MP), Azathioprine (Imuran)- Toxicity bone marrow and pancreas5
``` Bone marrow suppression 2-5% Dose related Managed by dose reduction/withdrawal Leukopenia, thrombocytopenia, pancytopenia RISK OF LYMPHOMA 4 FOLD INCREASE ``` Pancreatitis 1.3-3.3% Dose independent Occurs within 3-4 weeks of start Resolves with stopping drug
60
Immunosuppressives- 6-Mercaptopurine (6-MP), Azathioprine (Imuran)- Toxicity GI effects, others, and Infections
GI effects N/V, abdominal pain Occurs early, improves with time or with dose reduction Other Fever, rash, arthralgias Dose independent Infections Disseminated CMV, herpes zoster, pneumonia, Q fever, viral hepatitis Occur without leukopenia Increased risk if combined with steroids
61
Immunosuppressives- 6-Mercaptopurine (6-MP), Azathioprine (Imuran)- drug interactions
``` Inhibition of metabolism leading to increased myelosuppression Sulfasalazine, mesalamine Allopurinol Aspirin Furosemide ```
62
What is the immunodulator drug?
Methotrexate
63
Immunodulator- Methotrexate- MOA
Folic acid antagonist with anti-inflammatory effects Reduces steroid needs Improves disease control
64
Immunodulator- Methotrexate- ADRs
Nausea | Elevated transaminases- huge problem have to monitor for LFT
65
Immunodulator- Methotrexate- Toxicities
Leukopenia N/V Absolute contraindication in pregnancy (Category X) --Stop therapy 3 months prior to conception --Folate supplementation prior to conception --Contraindicated in breastfeeding Hypersensitivity pneumonitis (rare) Hepatic fibrosis --Most significant in long term therapy --Risk with >1500 mg total cumulative dose and daily dosing --DC if moderate/severe fibrosis or cirrhosis found on biopsy
66
Cyclosporin (Neoral or Sandimmune)-MOA
MOA: inhibits production and release of IL-2  inhibits activation of T-lymphocytes Concomitant IV steroids recommended Cyclosporin alone unable to maintain remission Requires “bridging” with AZA or 6-MP Convert IV to PO PO dose is 2x IV dose Wean off cyclosporin and steroids over next few months
67
Cyclosporin (Neoral or Sandimmune)- toxicities
``` HTN Hypertrichosis- abnormal hair growth on the body ELECTROLYE ABNORMALITIES NEPHROTOXICITY Opportunistic Infections Requires PCP prophylaxis ```
68
Tacrolimus (Prograf)-MOA
inhibits T-lymphocyte activation | Fungus (streptomyces)
69
Tacrolimus (Prograf)- adverse reactions
``` Tend to resolve with dose reductions HA Increased serum creatinine Nausea Insomnia Leg cramps Paresthesias Tremors ```
70
What are the monoclonal antibodies?
Infliximab (Remicade) Adalimumab (Humira) Natalizumab (tysabri)
71
Infliximab (remicade)- MOA
Monoclonal Antibodies Monoclonal antibody that binds to TNF-alpha Inhibits inflammatory cytokines, inhibits leukocyte migration and activation of neutrophils
72
Infliximab (remicade)- Contraindications
``` NYHA class III/IV heart failure Dose should not exceed 5mg/kg in other pts with congestive heart failure ``` Hepatitis Reactivation of hepatitis B Autoimmune hepatitis Discontinue use with LFTs 5x ULN
73
Infliximab (remicade)- antibodies to infliximab
Increased risk of infusion rxn, shorter duration of response | regularly scheduled less immunogenic than episodic
74
Infliximab (remicade)- Toxicities infections and infusion reactions
INFECTIONS Bacterial, mycosal, mycobacterium Higher TB rates with more extrapulmonary involvement INFUSION REACTIONS During or after (1-2 hrs) HA, dizziness, nausea, erythema at site, flushing, fever, chills, chest pain, cough, dyspnea, pruritis Mechanism unclear- not IgE type 1 Doesn’t occur till after 1st infusion; not at every infusion
75
Infliximab (remicade)- Toxicities delayed hypersensitivity, autoantibodies, and malignancy and lymphoproliferative disorder
Delayed hypersensitivities 3-14 days after infusion Myalgia, arthralgia, fever, rash, pruritis, dysphagia, urticaria, HA Resolve spontaneously or require steroids Prednisone 40mg PO or methylprednisolone 100mg IV 30 min before Risk factor: long interval between treatments Autoantibodies 15-40% develop anti-dsDNA ANA Development of drug-induced lupus rare Reversible with DC Malignancy and lymphoproliferative disorder Longstanding CD and tx with immunosuppression more likely to develop lymphomas
76
Adalimumab (Humira)- MOA
recombinant fully-human immunoglobulin-1 anti-tumor necrosis factor (TNF)-alpha monoclonal antibody Evaluate for TB before starting therapy
77
Adalimumab (Humira)- Side effects
BLACK Box Warning of serious infections TB, invasive fungal, other opportunistic infections Rash, injection site rxn, HA, URI, development of autoantibodies to drug, development of anti-nuclear antibodies (ANA) Risk of reactivating hepatitis B
78
What are adalimumab (humira) recommended for?
Only crohns disease
79
How do you get Natalizumab (tysabri)?
Pts must be enrolled in special restricted distribution program Crohn’s Disease-Tysabri Outreach Unified Commitment to Health (CD-Touch) Prescribing Program
80
Natalizumab (tysabri)- MOA
recombinant immunoglobulin-4 monoclonal antibody
81
Natalizumab (tysabri)- adverse effects
Major adverse effect: progressive multifocal encephalopathy
82
What are the antibiotics used to treat IBD?
``` Metronidazole (Flagyl) Ciprofloxacin Metronidazole + ciprofloxacin Rifamixin Clarithromycin ```
83
Metronidazole (Flagyl)- indications
For treatment of ileocolitis or colitis Failure to respond to sulfasalazine For treatment of abscesses, rectovaginal fistulas, proctocolectomy wounds Low dose maintenance therapy to minimize recurrence of perineal disease
84
Metronidazole (Flagyl)- ADRs
GI upset, metallic taste, paresthesias, antabuse-like rxn
85
Ciprofloxacin
Effective in resistant disease when used in combination with standard tx
86
Metronidazole + ciprofloxacin
Improve and can promote closure of fistulas | Tend to recur once drugs stopped
87
Rifamixin
Data from open-label trial found statistically significant response in mild-moderate disease
88
Clarithromycin
Response in pts otherwise unresponsive
89
Opiates
Provide symptomatic relief of diarrhea Diphenoxylate/atropine, codeine, tincture of opium, paregoric, loperamide MOA: inhibits excessive GI motility and GI propulsion

Pharmacology II (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions