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GI: Inflammatory Bowel Disease > Treatment > Flashcards

Flashcards in Treatment Deck (36)
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1

summary treatment

- IV fluids
- IV steroids - only once infective/ischaemic colitis is ruled out
- GI rest

If they fail to settle….
Rescue medical therapy - can get more potent immunosuppressants
Surgery - can remove the affected colon

2

what is the 1st step in the ladder of treatment for UC?

5ASA

3

what are the side effects of 5ASA

diarrhoea, idiosyncratic nephritis (have to check renal function before starting treatment)

4

what are two examples of 5ASA

sulfasaline and mesalazine

5

5 ASA is an ____ ______ drug

anti-inflammatory

6

what is the 2nd step in the ladder of treatment for UC?

steroids

7

examples of steroids

budesonide and prednisolone

8

Patients are given a short course which is tapered as the weeks go on - high dose initially
Why? ]


Why? Because some patients may become dependent on them

9

what are the musculoskeletal side effects of steroids

Osteoporosis
Avascular necrosis
Proximal myopathy

10

what are the GI side effects of steroids

nausea , vomiting and gastritis

11

what are the cutaneous side effects of steroids

acne and thinning of the skin

12

what are the metabolic side effects of steroids

Makes you want to eat all the time so can lead to weight gain, diabtes and hypertension

13

what are the neuropsychiatric side effects of steroids

Can get loads of energy and do manic things
Once off treatment patients can become depressed
Can disrupt sleep pattern

14

can also get ____ and ___ failure on steriods

cataracts, growth failure

15

immunosuppressants are thiopurine based medicines: azathioprine/mercaptopurine (6MP)
give and example

methotrexate

16

____ is a purine analogue that interferes with ____ synthesis and inhibits the proliferation of quickly growing cells, especially cells of the immune system like-_ and __ cells

This is a purine analogue that interferes with DNA synthesis and inhibits the proliferation of quickly growing cells, especially cells of the immune system like t and b cells

17

During metabolism ____ converts 6-MP (azathioprine) to 6-TGN (which is active), while ____ converts 6-MP to 6-MMP which is inactive.
Need to be careful with some patients - those who have reduced ____ activity as 6-___ can accumulate and cause toxicity and myelosuppression

During metabolism HPRT converts 6-MP to 6-TGN (which is active), while TPMT converts 6-MP to 6-MMP which is inactive.
Need to be careful with some patients - those who have reduced TPMT activity as 6-TGN can accumulate and cause toxicity and myelosuppression

18

what will always be measured before starting azathioprine treatment?

TPMT

19

____ is not co-prescribed with azathioprine

allopurinol

20

what are the side effects of azathioprine and immunosuppressants

- pancreatitis
- leukopaenia
- hepatitis
- small risk of lymphoma, skin cancer

21

what is step 3 in the treatment of UC

immunosuppresants

22

they have a slow onset of action

immunosuppressants

23

what is step 4 in the treatment of UC

anti-TNF

24

TNF alpha is a _____ ____

TNF alpha is a proinflammatory cytokine

25

anti- TNF are antibodies to TNF alpha - they can be ______ (e.g. infliximab) or ____ (e.g. adalimumab)

anti- TNF are antibodies to TNF alpha - they can be chimeric (e.g. infliximab) or huma (e.g. adalimumab)

26

when do TNF alpha work

anti-TNF (TNF alpha is a proinflammatory cytokine) work at the point where naive T cells are being presented with the antigen and will switch off the immune response at this point and prevent the drive of inflammation by causing apoptosis of activated T cells

27

they have a rapid onset of action

Anti-TNF

28

have to make sure there is no ___ before starting anti-TNF

TB

29

what is the treatment ladder for crohns

1. - steroids
2. immunosuppressants
3. anti-tnf

30

when would you do an emergency surgery

Failure to respond to medical therapy
Small bowel obstruction
Abscess
Fistulae