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Pediatric Pharm Exam 3 > Inflammatory Bowel Disease > Flashcards

Inflammatory Bowel Disease Flashcards

1
Q

Inflammatory Bowel Disease

A

Family of closely related intestinal disorders

Also known as IBD

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2
Q

Ulcerative Colitis (UC)

A

Mucosal inflammatory condition confined to the rectum and colon

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3
Q

Crohn’s Disease (CD)

A

Transmural inflammation of the gastrointestinal tract that can affect any part

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4
Q

Etiology (7)

A
  1. Unknown
  2. Host susceptibilities and environmental triggers
  3. Infectious diseases
  4. Genetics (hereditary)
  5. Environmental
  6. Immune defects
  7. Psychologic factors
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5
Q 
Ulcerative Colitis:
Distribution of disease in GI tract
Fistula, abscess, stricture
Location
Histology
Risk of colon cancer
A
  1. Distribution of disease in GI tract – colon and rectum
  2. Fistula, abscess, stricture – uncommon
  3. Location – mucosal
  4. Histology – crypt abscess, cryptitis
  5. Risk of colon cancer – high
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6
Q 
Crohn's Disease
Distribution of disease in GI tract
Fistula, abscess, stricture
Location
Histology
Risk of colon cancer
A
  1. Distribution of disease in GI tract – mouth to anus
  2. Fistula, abscess, stricture – common
  3. Location – transmural
  4. Histology – tissue granuloma
  5. Risk of colon cancer – high
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7
Q

UC Disease Severity Mild (4)

A
  1. < 4 BM per day
  2. No or minimal blood
  3. No systemic symptoms
  4. Normal ESR
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8
Q

UC Disease Severity Moderate (3)

A
  1. > 4 BM per day
  2. Minimal blood
  3. Minimal systemic complications
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9
Q

UC Disease Severity Severe (7)

A
  1. > 6 BM per day
  2. Positive blood
  3. Evidence of systemic complications
  4. ESR > 30
  5. Hb <75% normal
  6. Abdominal tenderness
  7. Bowel wall edema
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10
Q

Fulminant (7)

A
  1. > 10 stools per day
  2. Continuous blood
  3. Evidence of systemic complications
  4. ESR > 30
  5. Transfusions required
  6. Abdominal pain
  7. Dilated colon
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11
Q

Treatment - Goal of Therapy (4)

A
  1. Reverse and prevent further destruction of inflammatory response
  2. Maintain disease remission
  3. Prevent malignancy
  4. Optimize quality of life
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12
Q

Treatment Pharmacological (3)

A
  1. Generally, consider treatment as immune modulating therapy
  2. Induce remission
  3. Maintain remission
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13
Q

Treatment Drugs for IBD (6)

A
  1. Aminosalicylates
  2. Corticosteroids
  3. Antibiotics
  4. Immunomodulatory Agents
  5. Immunosuppressants
  6. Biologics
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14
Q

Aminosalicylates MOA (3)

A
  1. Unknown
  2. Works topically to inhibit pro-inflammatory cytokines
  3. Inhibits inflammatory transcription of NF-kB to block prostaglandin and leukotriene production
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15
Q

Aminosalicylates Available Agents (6)

A

Mesalamine: Ascacol®, Pentasa®, Rowasa®
Sulfasalazine
Balsalazide

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16
Q

Aminosalicylates ADE (7)

A
  1. Headache
  2. Nausea
  3. Photosensitivity
  4. Diarrhea
  5. Colitis
  6. Pancreatitis
  7. Hepatitis
17
Q

Corticosteroids MOA for IBD (4)

A
  1. Unknown
  2. Decreases transcription of proinflammatory cytokines
  3. Prevents nuclear translocation of NF-kB
  4. Inhibits inflammatory response
18
Q

Corticosteroids Available Agents for IBD (3)

A

Topical – Hydrocortisone

Oral – Prednisone/prednisolone and Budesonide (Enterocort®)

19
Q

Corticosteroids

Place in Therapy for IBD (3)

A
  1. Moderate to Severe
  2. Remission (induction)
    60%-80% in moderate disease
    50%-60% in severe disease
  3. Ineffective for maintenance therapy (IV is used for acute flare)
20
Q

Corticosteroids ADE (8)

A
  1. Weight gain
  2. Glucose intolerance
  3. Hypertension
  4. Neuropsychiatric events
  5. Decreased linear growth
  6. Bone loss
  7. Kyphosis
  8. Adrenal suppression
21
Q

Antibiotics - Place in therapy for IBD

A

Mucosal inflammation and abscesses present

22
Q

Antibiotics Available Agents for IBD (2)

A
  1. Metronidazole
    - Active CD
    - UC maintenance
  2. Ciprofloxacin
    - CD (perineum)
    - UC
23
Q

Immunomodulators Available Agents (3)

A
  1. Azithioprine (Imuran®)
  2. Mercaptopurine (6MP)
  3. Methotrexate
24
Q

Immunomodulators MOA
Azathioprine and mercaptopurine (1)
Methotrexate (2)

A

Azathioprine and mercaptopurine
1. Inhibit inflammatory response (protein synthesis, nucleic acid metabolism, clonal expansion of lymphocytes)

Methotrexate

  1. Unknown
  2. Inhibits proinflammatory cytokins and down-regulates activated T-cells and neutrophils
25
Q

Immunomodulators Place in Therapy (3)

A
  1. Prevention of clinical relapse
    - Failed previous therapy
    - Weaned from other therapy and now require induction
  2. Azathioprine and mercaptopurine
    - Induction of mucosal and clinical remission
  3. Methotrexate
    - Second line to azathioprine and mercaptopurine
26
Q

Immunomodulators
ADE
Azathioprine and mercaptopurine (7)

A
  1. Neutropenia
  2. Thrombocytopenia
  3. Hepatotoxicity
  4. Infection
  5. Rash
  6. Hypersensitivity
  7. Malignancy
27
Q

Immunomodulators ADE – Methotrexate (5)

A
  1. Neutropenia
  2. Thrombocytopenia
  3. Nausea
  4. Nephropathy
  5. Vasculitis
28
Q

Immunomodulators Pearls (4)

A
  1. Thiopurine methyltransferase deficiency
  2. Caution with mercaptopurine
  3. Risk of metabolite toxicity
  4. Patients receiving methotrexate should receive folic acid
29
Q

Immunosuppresants Available Agents (2)

A
  1. Calcineurin inhibitors
    - Tacrolimus
    - Cyclosporine
  2. Antimetabolites
30
Q

Antimetabolites Available Agent

A

Mycophenolate mofetil (Cellcept®)

31
Q

Antimetabolites Place in Therapy (2)

A
  1. Suppresses T and B cell proliferation

2. Decreases lymphocyte proliferation through inhibition of DNA synthesis

32
Q

Antimetabolites MOA (2)

A
  1. Alternative to mercaptopurine and azathioprine therapy

2. Used in conjunction with other agents

33
Q

Biologics MOA (2)

A
  1. Neutralizes pro-inflammatory cytokine TNF

2. Activates complement-mediated cytolysis of TNF-producing monocytes

34
Q

Biologics Available Agents (2)

A
  1. Humira - Adalimumab

2. Remicade - Infliximab

35
Q

Biologics ADE (4)

A
  1. Infusion Related Reactions: Shortness of breath, Chest tightness
  2. Hypersensitivity Reactions: Fever, Facial edema
  3. Positive ANA titers
  4. Infection
36
Q

Biologics Pearls (4)

A
  1. Patients may develop antibodies resulting in loss of response or infusion reactions
    - Pre-medicate with corticosteroids
    - Co-treat with corticosteroids
  2. Smoking reduces response to infliximab
  3. Limited data for use in pediatric patients with UC
  4. CAUTION in heart failure patients
37
Q

Adjunct Meds for IBS (3)

A
  1. Loperamide (Imodium)
    - Useful for proctitis or diarrhea
  2. Antispasmodics
    - Dicyclomine (Bentyl)
    - Propantheline (Pro-Banthine)
    - Hyoscyamine (Levsin)
  3. Cholestyramine (Questran)
    - Bile-salt-induced diarrhea after ileal resection

Pediatric Pharm Exam 3 (11 decks)

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