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Inflammatory Bowel Dx (IBD) Flashcards

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0
Q

What’s used to treat acute exacerbation of IBD?

A

Short courses of oral and IV steroids

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1
Q

Name major types if inflammatory bowel dx (IBD)?

A

Ulcerative colitis (UC)

Crohn’s dx

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2
Q

What’s used for maintenance therapy to control inflammation and reduce flare-ups of IBD?

A

Aminosalicylates

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3
Q

Which is the main Aminosalicylates used for maintenance therapy to control inflammation and reduce flare-ups of IBD?

A

Mesalamine

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4
Q

What’s used in pts with IBD refractory to Aminosalicylates and immunosuppressants?

A

Anti-TNF such as Infliximab

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5
Q

Should AB and probiotics be take at the same time?

A

No!

Separated by at least 2 hrs

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6
Q

Sorbitol and IBS?

A

Sorbitol is used as a sweetener as can cause considerable GI distress in some pts with IBD

Sorbitol also has laxative properties

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7
Q

Lactose and IBD?

A

If pt is lactose-intolerant may worsen IBD

Both sorbitol and lactose are used as excipients (binders) in tabs

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8
Q

List antidiartheal (agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Loperamide (Imodium)

Bismuth subsalicylate (Pepto-Bismol)

Diphenoxylate 2.5mg + Atropime 0.025mg (Lomotil)

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9
Q

Brand name of Loperamide? (antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Imodium

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10
Q

How long can pt self-treat Loperamide (Imodium)?

A

No more than 2 days

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11
Q

Brand name of Bismuth Subsalicylate? (antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms)

A

Pepto-Bismol

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12
Q

SE of Bismuth subsalicylate (Pepto-Bismol)?

A

Black tongue/stop.

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13
Q

Brand name of Diphenoxylate 0.25mg + Atropine 0.025mg?

A

Lomotil

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14
Q

Which of the antidiartheal agents used for mild sx control: diarrhea, cramping/GI spasms is a controlled substance?

A

C V

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15
Q

List agents under Antispasmodic? (Used for mild sx control in IBD)

A

Dicyclomime (Bentyl)

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16
Q

Brand name of Dicyclomine (antispasmodic agent)?

A

Bentyl

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17
Q

SEs of Dicyclomine (Bentyl) - antispasmodic agent

A

Dizziness

Xerostomia

Nausea

Blurred vision

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18
Q

List oral steroids used for mild sx in IBD

A

Prednisone

Budesonide (Entocort EC)

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19
Q

What’s the brand name of Budesonide? Oral steroid used for mild sx of IBD

A

Entocort EC

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20
Q

Should u crush Budesonide (Entocort EC, Uceris) Oral steroid used for mild sx of IBD?

A

No!

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21
Q

Short-term SEs of oral steroids (Prednisone and Budesonide (Entocort EC))?

A

Increased appetite/wt gain

Fluid retention

Emotional instability (euphoria, mood swings, irritability)

Insomnia

GI upset

Higher doses - increase in BP and BG

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22
Q

Long-term SEs of oral steroids (Prednisone and Budesonide (Entocort EC))?

A

Adrenal suppression/Cushing’s syndrome

Impaired wound healing

HTN

Hyperglycemia

Cataracts

Osteoporosis

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23
Q

If oral steroids (Prednisone and Budesonide (Entocort EC)) are used long-term, what should be assesses? Supplement?

A

Bone density

Consider Bisphosphonates, optimize Ca and Vit. D intake

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24
Budesonide (Entocort EC) and first-pass metabolism?
Budesonide (Entocort EC) undergo 1st-pass metabolism, so,lower systemic exposure may occur
25
How do u d/c if oral steroids (Prednisone and Budesonide (Entocort EC)) is used longer than 2 wks?
Must taper over 3-4 wks
26
When's Budesonide (Entocort EC) preferred over prednisone in IBD?
If dx is in ileum or ascending colon
27
How do u use Prednisone and Budesonide (Entocort EC)?
Swallow whole - don't crush, chew or break
28
List topical agents used in mild sx control of IBD
Hydrocortisone (Cortifoam, Cortenema)
29
T/F? Topical steroids (Hydrocortisone (Cortifoam, Cortenema)) have proven to be effective for maintenance of remission of IBD?
False! They are not effective in maintenance of remission
30
Effect of potent inh (Ketoconazole, Itraconazole, Ritonavir etc) on Budesonide?
Budesonide may req dose reduction (3A4 substrate)
31
Grapefruit and Budesonide?
Avoid Grapefruit in Budesonide
32
List drugs used in maintenance therapy for IBD (Aminosalicylates)
Mesalamine (Asavo HD, Lialda - long acting orals) (Canasa - suppository) (Rowasa - enema) Sulfasalazine (Azulfidine, Sulfazine) Basalazide (Colazol, Glazo) Olsalazine (Dipentum)
33
What's the brand name of Mesalamine? Suppository? Enema?
Asacol HD; Lialda Canasa (suppository) Rowasa (enema)
34
Mesalamine and antacids, H2RAs or PPIs?
Avoid concomitant use of Mesalamine with antacids, H2RAs or PPIs Interferes with absorption
35
What's most effective for Distal dx/ proctitis in UC?
Topical mesalamine
36
CI to Sulfasalazine use? (Maintenance therapy in IBD)
Sulfa or salicylate allergy
37
Se to Sulfasalazine use? (Maintenance therapy in IBD)
HA Rash Anorexia Dyspepsia GI upset (n/v/d) Oligosoermia (reversible) all > 10% Folate deficiency
38
Sulfasalazine use and skin discoloration? (Maintenance therapy in IBD)
Sulfasalazine can cause YELLOW-ORANGE coloration of skin/urine
39
Sulfasalazine use and folate? (Maintenance therapy in IBD)
Sulfasalazine impairs folate absorption May give 1 mg/ day folate supplement
40
In what Grp of is Balsalazide (Glazo) approved?
Males only
41
SEs of Olsalazine (Dipentum) (Maintenance therapy in IBD)
Diarrhea Abdominal pain
42
Role of immunosuppressive agents in IBD?
Only for use if of fails maintenance therapy or used in combo with maintenance therap
43
List Immunosuppresive agents used in IBD
Azathioprine (Azasan, Imuran) 6-Mercaptopurine (Purinethol) Methotrexate (Rheumatrex, Trexail!
44
SE of Azathioprine (Azasan, Imuran)?
GI upset (n/v) Rash Increased LFTs Hematologic toxicities (leukopenia, thrombocytopenia)
45
Which Grp of pt may be more sensitive to myelosuppressive effects and may req a lower dose of Azathioprine (Azasan, Imuran)?
Pts with genetic deficiency of thiopurine methyltransferase (TPMT)
46
SE of Methotrexate (Rheumatrex; Trexail)?
N/v Increased LFTs Stomatitis Alopecia Photosensitivity
47
Preg cat. of Methotrexate (Rheumatrex; Trexail)?
X
48
Role of Monoclonal antibodies to TNF?
Last line... After everything else has failed
49
List monoclonal antibodies to TNF agents used in IBD
Adalimumab (Humira) Infliximab (Remicade) Golimumab (Simponi) Natalizumab (Tysabri) Certolizumab (Cimzia)
50
Brand name of Adalimumab? (monoclonal antibodies to TNF agents used in IBD)
Humira
51
Brand name of Infliximab? (monoclonal antibodies to TNF agents used in IBD)
Remicade
52
Brand name of Golimumab? (monoclonal antibodies to TNF agents used in IBD)
Simponi
53
Brand name of Natalizumab? (monoclonal antibodies to TNF agents used in IBD)
Tysabri
54
SEs of Adalimumab (Humira)?
Injection site rxns
55
BBW of Infliximab (Remicade)? Similar to the others, except Natalizumab (Tysabri)
Serious infections (some fatal) D/c tx if pt develops a severe inf; lymphomas and other malignancies; perform test for latent TB prior to starting therapy
56
CI of Infliximab (Remicade)?
Doses > 5 mg/kg in moderate-severe HF (NYHA class III/IV)
57
SEs of Infliximab (Remicade)?
Infusion rxns e.g. Hypotension, fever, chills, pruritus (may pre-treat with APAP, antihistamine and/or steroids); inf, URT sx, HA, abdominal pain
58
Monitoring of Infliximab (Remicade)?
TB test (prior to admin and annually) CBC LFTs HBV (prior to initiation)
59
Role of Infliximab (Remicade) in IBD?
Alternative 1st line in mod-severe Crohn's or UC
60
SEs of Golimumab (Simponi)?
Infection Upper respiratory tract (URT) sx Inj site rxns
61
BBW of Natalizumab (Tysabri)?
Risk for progressive multifocal leukoencephalopathy (PML)
62
SE of Natalizumab (Tysabri)?
Infusion rxns HA Fatigue
63
What should be done if there's no response to Natalizumab (Tysabri) after week 12?
D/c
64
Which immunosuppressant is parts of a REMS program?
Natalizumab (Tysabri) TOUCH prescribing program
65
How should Mesalamine and Budesonide not be taken?
Don't crush or chew
66
Which of the meds for IBD may one see a ghost tablet in the feces?
Asacol HD
67
T/F? Mesalamine is considered 1st line therapy for distal dx of IBD?
T Note: oral therapy is NOT preferred for initial tx
68
SE of long-term steroid use in IBD?
Poor wound healing Fat distribution Adrenal suppression Peptic ulcers
69
What dosage form does Infliximab (Remicade) come in?
IV ONLY
70
Which tests should be done prior to staring Infliximab (Remicade)?
CBC TB HBV
71
MOA of Infliximab (Remicade)?
Chimeric monoclonal antibody against TNF
72
List SEs that may occur from using Infliximab (Remicade)?
Infusion-related rxns Antibody induction Hepatoxicity Reactivation of latent TB

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