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NAPLEX Prep > Irritable Bowel Disease > Flashcards

Irritable Bowel Disease Flashcards

(52 cards)

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1
Q

What is ulcerative colitis

A

Mucosal inflammation confined to the rectum and colon with superficial ulcerations

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2
Q

Infllammation limited to the rectum

A

Procritis

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3
Q

What is Crohn’s disease

A

Deep transmural inflammation of any part of the GIT → diarrrhea

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4
Q

Difference between CD and UC

A

GD: entire GIT, transmural, non-continuous (cobblestone)
UC: Colon (rectum), superficial, continuous

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5
Q

How to diagnosis IBD

A

Colonoscopy with tissue biopsy
Endoscopy if upper GI sx are present

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6
Q

Lifestyle mods for IBD

A

Smaller, more frequent meals → low fat and dairy
Antidiarrheals or antispasmodics for sx (Dicyclomine)
Vitamin supplements due to malabsorption
Probiotics (Lactobacillus, Bifidobacterium) → reduce abdominal pain

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7
Q

Best treatment for acute exacerbations

A

Short courses of PO or IV steroids

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8
Q

Tx for mild CD

A

PO budesonide ≤3 months → dc to thiopurine or methotrexate

Taper steroid over 8-12 weeks

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9
Q

Tx for mod-severe CD

A

Anti-TNF +/- methotrexate or thiopurine
IL receptor antagonist
Integrin receptor antagonist

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10
Q

Tx for refractory CD

A

JAK inhibitor
Integrin receptor antagonist

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11
Q

Tx for mild UC

A

Mesalamine:
Rectal → distal disease
Rectal +/- PO → extensive disease

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12
Q

Tx for moderate-severe UC

A

Anti-TNF +/- thiopurine
IL recepor antagonist
Integrin receptor antagonist

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13
Q

Tx for refractory UC

A

JAK inhibitor
PO Sphingosine-1-phosphate receptor modulators

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14
Q

PO steroids for CD

A

Prednione
Budesonide

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15
Q

Budesonide

A

Enterocort EC (CD)
Uceris (UC)

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16
Q

Short term ADR of PO steroids

A

Weight gain, ↑ appetite, emotional instability, insomnia

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17
Q

Long term ADR of PO steroids

A

Hyperglycemia, Cushings/adrenal suppression, osteoporosis, impaired wound healing, ↑ BP

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18
Q

Taper cut off for steroids

A

≥2 weeks

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19
Q

What to consider if long term steroids are require

A

Assess bone density → optimize calcium and Vit D intake → bisphosphonates may be required

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20
Q

Why is budesonide the steroid of choice for IBD

A

Undergoes extensive first-pass metabolism to reduce systemic exposure

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21
Q

Indication for rectal steroids

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A

UC only (distal)

22
Q

Rectal steroids

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A

Hydrocortisone (enema, foam)
Budesonide (foam)

23
Q

Metabolism of budesonide

24
Q

MOA and indication for mesalamine

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A

Aminosalicylates to treat UC → topical anti-inflammatory effect in the GIT

25
Types of aminosalicylates
Mesalamine ER SUlfasalzine Balsalazide Olsalazine
26
Formulations of mesalamine
ER capsules: Pentasa, Apriso ER tablets: Asacol HD, Lialda Enema: Rowsa Suppository: Canasa
27
Counseling of Rowsa
4 g rectally QHS, retain in the rectum overnight for approximately 8 hrs
28
Counseling for Canasa
1 g rectally QHS, retain for at least 1-3 hrs
29
CI of mesalamine
Salicylate allergy
30
Mesalamine formulations that release a ghost tablet
Asaxol, Delzicol
31
CI of sulfasalazine
Sulfa and salicylate allergy
32
Amionosalycilate product that is more likely to cause hypersensitivity reactions
Sulfasalazine
33
Indication for thiopurine
Induction and maintenance of remission
34
Tiopurines
Azothioprine Mercaptopurine
35
Azathioprine
Azasan
36
Mercaptopurine
Purixan
37
Warning of Azathiopurine
Genetic deficiency of TPMT → myelosuppression
38
Metabolism of Aza
Metabolized to mercaptopurine
39
Counseling of mercaptopurine
Take on an empty stomach
40
Indication for methotrexate
Moderate-severe CD Once weekly IM or SC inje
41
Indication for cyclospronie
Severe actor UC refractory to steroids
42
JAK inhibitors approved for refractory IBD
Upadacirinib (Rinvoq) - UC and CD Tofacitinib (Xeljanz) - UC
43
S1P receptor modulators
Ozanimod (Zeposia) Etrasimod (Velsipity) UC only
44
Anti-TNF
Inflixumab Adalimumab
45
IL receptor antagonist
Ustekinumab (Stelara, Wezlana) - UC and CD Reisankizumab (Skyrizi) - CD Mirikizumab-mrkz (Omvoh) - UC
46
Integrin receptor antagonist
Natalizumab Vedolizumab
47
Natalizumab
Tysarbi
48
Vedolizumab
Entyvio
49
Dosing of Tysarbi
300 mg IV over 1 hr Q4W Discontinue if no response by 12 weeks
50
Dosing of Entyvio
DC in no benefit in 4 weeks
51
BBW of Tysarbi
PML → REMS
52
Warning of Entyvio
Infusion reactions and infections All immunizations should be up to date → avoid live vaccines

NAPLEX Prep (71 decks)

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