Treatment

Question 1

summary treatment

Answer 1

• 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

Question 2

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

Answer 2

5ASA

Question 3

what are the side effects of 5ASA

Answer 3

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

Question 4

what are two examples of 5ASA

Answer 4

sulfasaline and mesalazine

Question 5

5 ASA is an ____ ______ drug

Answer 5

anti-inflammatory

Question 6

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

Answer 6

steroids

Question 7

examples of steroids

Answer 7

budesonide and prednisolone

Question 8

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

Answer 8

Why? Because some patients may become dependent on them

Question 9

what are the musculoskeletal side effects of steroids

Answer 9

Osteoporosis
Avascular necrosis
Proximal myopathy

Question 10

what are the GI side effects of steroids

Answer 10

nausea , vomiting and gastritis

Question 11

what are the cutaneous side effects of steroids

Answer 11

acne and thinning of the skin

Question 12

what are the metabolic side effects of steroids

Answer 12

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

Question 13

what are the neuropsychiatric side effects of steroids

Answer 13

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

Question 14

can also get ____ and ___ failure on steriods

Answer 14

cataracts, growth failure

Question 15

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

Answer 15

methotrexate

Question 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

Answer 16

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

Question 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

Answer 17

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

Question 18

what will always be measured before starting azathioprine treatment?

Answer 18

TPMT

Question 19

____ is not co-prescribed with azathioprine

Answer 19

allopurinol

Question 20

what are the side effects of azathioprine and immunosuppressants

Answer 20

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

Question 21

what is step 3 in the treatment of UC

Answer 21

immunosuppresants

Question 22

they have a slow onset of action

Answer 22

immunosuppressants

Question 23

what is step 4 in the treatment of UC

Answer 23

anti-TNF

Question 24

TNF alpha is a _____ ____

Answer 24

TNF alpha is a proinflammatory cytokine

Question 25

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

Answer 25

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

Question 26

when do TNF alpha work

Answer 26

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

Question 27

they have a rapid onset of action

Answer 27

Anti-TNF

Question 28

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

Answer 28

TB

Question 29

what is the treatment ladder for crohns

Answer 29

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

Question 30

when would you do an emergency surgery

Answer 30

Failure to respond to medical therapy Small bowel obstruction Abscess Fistulae

Question 31

when would you do an elective surgery

Answer 31

failure to respond to medical therapy

Question 32

what are the surgery options for crohns

Answer 32

Surgery: resection, stricturoplasty, fistula repair

Question 33

what is the surgery for fistula

Answer 33

seton- cord passing through fistula tract to keep it open for draining

Question 34

surgery for ___ is curative

Answer 34

UC

Question 35

UC - surgery | what is a koch pouch ?

Answer 35

rectum is removed and internal small bowel pouch formed

Question 36

UC - surgery | what is a j pouch ?

Answer 36

J pouch - functions as ‘new rectum’