Medicines 49

Question 1

What is the treatment for mild to moderate ulcerative colitis?

Answer 1

🔹 Mild-to-Moderate UC
Proctitis:

1st line: Topical aminosalicylate

Add oral aminosalicylate or steroid if no response

Proctosigmoiditis / Left-sided colitis:

1st line: Topical + high-dose oral aminosalicylate

Add topical/oral steroid if no response

Extensive colitis:

1st line: Topical + high-dose oral aminosalicylate

If needed: Add oral steroid

Question 2

What is the treatment for moderate to severe Ulcerative colitis

or severe acute ulcerative colitis

Answer 2

🔸 Moderate-to-Severe UC
Managed under specialist care

Use:

Biologics (e.g. TNF-α inhibitors, anti-integrins)

JAK inhibitors, S1P modulators

🔺 Acute Severe UC (Medical Emergency)
Admit to hospital

IV corticosteroids (hydrocortisone or methylprednisolone)

If not tolerated: IV ciclosporin or infliximab

Surgery if no response in 72h or worsening symptoms

Exclude infections (e.g. CMV) if deterioration after initial response

Question 3

What is Crohn’s Disease – Acute & Maintenance Treatment

Answer 3

Acute (Induction):

1st-line: Corticosteroids (prednisolone, methylprednisolone, IV hydrocortisone)

Alt. (mild/moderate ileal/right-sided): Budesonide or aminosalicylates (less effective, fewer side effects)

Add-on if ≥2 flares/year or steroid-dependent: Azathioprine or mercaptopurine (unlicensed); methotrexate if thiopurines unsuitable

Specialist use: TNF-α inhibitors, other biologics, or JAK inhibitors (moderate–severe)

Maintenance:

Monotherapy: Azathioprine/mercaptopurine (unlicensed) if used for induction or poor prognosis

Methotrexate: Only if used for induction or thiopurine intolerance

Steroids/budesonide: Not for maintenance

Post-surgery (ileocolonic): Azathioprine ± 3 months metronidazole

Not recommended post-op: Mercaptopurine, biologics, budesonide, aminosalicylates

Question 4

What is the symptomatic treatment for Diarrhoea in chrons disease?

Answer 4

Loperamide or codeine: for non-colitic diarrhoea

Colestyramine: for bile acid-related diarrhoea

Use with caution depending on site/severity

Question 5

What is the treatment for fistulating chrohns disease

Answer 5

Metronidazole/ciprofloxacin (max 3 months for metronidazole)

Azathioprine or mercaptopurine to control inflammation

Infliximab if no response to conventional therapy – ensure drainage of sepsis first

Surgery (drainage, fistulotomy, seton insertion) often needed

Maintain treatment ≥1 year

Question 6

Which medications cause intracranial hypertension?

Answer 6

CLACT

Cyclosporine
Lithium
(A) High-dose vitamin A supplements
Corticosteroid withdrawal
Tetracyclines

Question 7

Medications that cause Hypernatraemia

Answer 7

1. Loop Diuretics
   Furosemide, Bumetanide, Torsemide
   ⮕ Cause more water than sodium loss → relative sodium excess
2. Osmotic Diuretics
   Mannitol
   ⮕ Pull water into urine, leading to dehydration
3. Sodium-containing drugs or infusions
   Hypertonic saline, sodium bicarbonate, effervescent tablets
   ⮕ Direct sodium loading
4. Mineralocorticoids
   Fludrocortisone
   ⮕ Promotes sodium retention
5. Lithium
   ⮕ Can cause nephrogenic diabetes insipidus → water loss and hypernatremia

Question 8

Medications that cause Hyponatramia

Answer 8

Mechanism: Water retention or sodium loss. Often due to SIADH (Syndrome of Inappropriate ADH Secretion).

1. Diuretics
   Thiazide diuretics (e.g., bendroflumethiazide, indapamide)
   ⮕ Promote sodium loss, especially in elderly
2. Antidepressants
   SSRIs (e.g., sertraline, fluoxetine)
   TCAs (e.g., amitriptyline)
   ⮕ Can induce SIADH
3. Antipsychotics
   Risperidone, haloperidol
   ⮕ Associated with SIADH
4. Antiepileptics
   Carbamazepine, oxcarbazepine, valproate
   ⮕ Increase ADH effect or secretion
5. Chemotherapy agents
   Cyclophosphamide, vincristine
   ⮕ Stimulate ADH release
6. Desmopressin (DDAVP)
   ⮕ Mimics ADH → water retention
7. NSAIDs
   ⮕ Potentiate ADH action by reducing renal prostaglandins