Inflammatory Bowel Disease Flashcards Preview

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Flashcards in Inflammatory Bowel Disease Deck (60):
1

these drugs can cause IBD

opiates, NSAIDs, antidiarrheals (loperamide, diphenoxylate/atropine)

2

pt with UC isnt getting many leafy veggies and is taking sulfasalazine. What should you prescribe

Folic acid

3

pt with UC is having considerable rectal bleeding. What should you prescribe?

Oral iron

4

a pt had mild/mod UC but now has mod/severe. What changes in their drug regimen

add prednisone (HUGE DOSE)

5

pt is refractory severe UC. what can i add?

azathioprine or mercaptopurine 6MP
or infliximab if no response

6

fulminant UC. How does therapy change?

hydrocortisone 100mg
if no response, cyclosporine or colectomy

7

Maintenance options for UC

aminosalicylates and/or AZA or 6-MP
or infliximab

8

m/m ileocolonic or colonic crohn tx

sulfasalazine
mesalamine

9

m/m perianal crohn tx

sulfasalazine
mesalamine
metronidazole

10

m/m small bowel crohn tx

mesalamine
metronidazole
budesonide (steroid)

11

m/s crohn tx what changes

follow the m/m protocol but add prednisone
add infliximab if refractory or fistulating
no response: add adalimumab, natalizumab, certolizumab

12

severe/fulminant crohn tx

hydrocortizone
no response- cyclosporin
surgical resection

13

do not use long term corticosteroids for maintenance of crohn. T or F

True

14

first line for maintenance of crohn

azathioprine/6-MP
(infliximab)
(methotrexate)

15

this class is commonly used for inducing and maintaining remission of IBD

aminosalicylates

16

this drug is metabolized by intestinal bacteria to 5-aminosalicylate and suldapyridine (mesalamine)

sulfasalazine

17

this drug is contraindicated in patients with renal impairment (monitor SCr) and in pts with salicylate hypersensitivity

sulfasalasine

18

this drugs SE include N/V heartburn, anorexia, HA, hypersensitivity rxns, blood disorders, folic acid absorption, idiosyncratic rxns (HC injury, agranulocytosis, lupus-like pneumonia), and low sperm counts

sulfasalasine

19

it is mandatory to prescribe a folic acid supplement with this drug

sulfasalasine

20

this drug comes in different formulations so it can better target parts of the colon (suppositories or delayed release formations)

mesalamine

21

SEs include local itching and mild rectal irritation with topical enemas and idiosyncratic reactions (pleuropericarditis, pancreatitis, nephrotic syndrome)

mesalamine

22

these drugs have anti-inflammatory effects to improve symptoms and decrease disease severity

corticosteroids

23

induction of response takes 7-14 days for this drug. it is important to taper

corticosteroids

24

a patient on this class of drug should be monitored for complications of glucose intolerance/metabolic abnormalities (hyperkalemia, hyponatremia, glucose)

corticosteroids

25

pts taking this class have greater risk for adrenal insufficiency and infections. N/V, postural hypotension

corticosteroids

26

If a pt is on this class for over 3 months, monitor bone density and do annual eye exams

corticosteroids

27

this is a prodrug that gets metabolized to 6-mercaptopurine

azathioprine

28

this class provides maintenance therapy that is less toxic than chronic steroid therapy

immunosuppressives

29

this class antagonizes purine metabolism; inhibit DNA, RNA and protein synthesis

immunosuppressives

30

toxic levels of this drug class can cause bone marrow suppression (dose related), lymphoma, pancreatitis, GI effects, fever, rash, arthralgias

immunosuppressives

31

this class can cause disseminated CMV, herpes zoster, pneumonia, Q fever, viral hepatitis

immunosuppressives

32

this class can react with other drugs leading to increased myelosuppression: sulfasalazine, mesalamine, allopurinol, aspirin, furosemide

immunosuppressives

33

this dug is a folic antagonist with anti-inflammatory effects. It reduces the need for steroids and improves disease control

methotrexate

34

ADRs include nausea and ELEVATED TRANSAMINASES (MONITOR LFT)

methotrexate

35

toxic levels of this drug can cause leukopenia, N/V, hypersensitivity pneumonitis, hepatic fibrosis

methotrexate

36

this drug is an absolute contraindication in pregnancy (categoryX). stop therapy 3 months prior to conception

methotrexate

37

this drug inhibits production and release of IL-2 and inhibits activation of T lymphocytes

cyclosporin (neoral or sandimmune)

38

this drug is unable to maintain remission alone. It requires "bridging" with AZA or 6-MP and is recommended to be used concomitantly with IV steroids

cyclosporin (neoral or sandimmune)

39

toxic levels of this drug can cause HTN, hypertrichosis, electrolyte abnormalities, nephrotox, and opportunistic infections (REQUIRES PCP prophylaxis)

cyclosporin

40

this drug comes from a fungus and inhibits T lymphocyte activation

tacrolimus

41

ADRs for this drug tend to be dose related. Include HA, increased serum creatinine, nausea, insomnia, leg cramps, paresthesias, and tremors

tacrolimus

42

this drug is a monoclonal antibody that binds to TNF-alpha. It inhibits inflammatory cytokines, leukocytes migration, and activation of neutrophils

Infliximab

43

Contraindicated in class III/IV heart failure and hepatitis (DC with LFTs 5x ULN)

Infliximab

44

Your body will develop antibodies to this drug, which leaves an increased risk of infusion reaction and a shorter duration or response

infliximab

45

toxic levels of this drug lead to infections (bacterial mycosal mycobacterium) and infusion reactions (NOT through an IgE and NOT at every infusion)

infliximab

46

this drug can cause delayed hypersensitivities 3-14 days after infusion that include myalgia, arthralgia, fever, rash, pruritis, urticaria, HA. Can treat with steroids

infliximab

47

a risk factor for toxic effects with this drug includes long intervals between treatments

infliximab

48

This drug can cause malignancy and lymphoproliferatve disorders in pts with longstanding Crohns who are immunosuppressed

infliximab

49

this drug is a fully human immunoglobulin 1 anti TNF alpha monoclonal antibody

adalimumab

50

evaluate for TB before starting therapy with this drug

adalimumab

51

this drug has a BBW for causing serious infections (TB, invasive fungal)
it can cause rash, HA, urticaria, development of autoantibodies
risk or reactivating hep B

adalimumab

52

this drug is for moderate to severe crohns in pts with evidence of inflammation who have had inadequate response to or are unable to tolerate conventional therapies

natalizumab

53

this drug is for pts in a specialty program. It is a recombinant immunoglobulin 4 monoclonal antibody

natalizumab

54

dont administer this drug with other immunosuppressants. You should DC if no response in 12 weeks and taper oral steroids as soon as there is a response

natalizumab

55

major adverse effect of this drug includes progressive multifocal encephalopathy

natalizumab

56

this ab is used for treatment of ileocolitis or colitis if there was failure to respond to sulfasalazine

metronidazole

57

ADRs include GI upset, metallic taste, paresthesias, antabuse-like rxn

metronidazole

58

this ab is effective in resistant disease when used in combo with standard treatment

cipro

59

this ab combo can be used to improve and promote closure of fistulas

metronidazole plus cipro

60

this class can provide symptomatic relief of diarrhea by inhibiting excessive GI motility or propulsion

opiates