Ulcerative colitis and crohns

Question 1

INFLAMMATORY BOWEL DISEASE:

What is first second and third line treatment of crohns/UC?

Answer 1

1st: aminosalicylates
2nd azathiprine or mercaptopurine
3rd Monoclonal antibodies

(smoking cessation- crohns)

Question 2

what is crohns?

What is ulcerative colitis?

Answer 2

Crohns: is a long-term condition where the gut becomes inflamed.

UC:Ulcerative colitis is inflammation of the lower end of your digestive system, including your large bowel and rectum.

Question 3

INFLAMMATORY BOWEL DISEASE:

What are symptoms?

Answer 3

abdominal pain
diarrhoea
rectal bleeding
weight loss

Question 4

AMINOSALICYCLATES:

What are they indicated for?

Answer 4

1st line in UC (mainly sulfasalazine)
(with or without corticosteroids)

sulfasalazine- used in rheumatoid arthritis (used as DMARD)

Question 5

AMINOSALICYCLATES:

what are important side effects?

Answer 5

GI upset
blood abnormalities
renal impairment
Sulfasalazine; oligospermia, hypersensitivity reaction( including liver abnormalities)

Question 6

AMINOSALICYCLATES:

What are they contraindicated in?

Answer 6

aspirin hypersensitivity

Question 7

AMINOSALICYCLATES:

what are prominent side effects?

Answer 7

orange/yellow staining of body fluids
including tears and therefore contacts

sulfasalazine may colour urine red - harmless

Question 8

MONOCLONAL ANTIBODIES

What are they indicated for?

Answer 8

Immune mediated disorders;
rheumatoid arthriti, psoriasis, psoriatic arthritis, IBD

Allergic disorders; eczema, rhinitis, asthma

Cancer

Long term treatment conditions; osteoporosis, migraine, sickle cell disease.

Question 9

MONOCLONAL ANTIBODIES

How do they work?

Answer 9

Made by immunising animals with target proteins.

Specific to receptors, binding to their target inhibits or activates.

Question 10

MONOCLONAL ANTIBODIES

What are common indications?

Answer 10

immediate or delayed hypersensitivity reactions

Immune imbalance; immunosuppression, increased risk of severe infection or cancer.

Question 11

MONOCLONAL ANTIBODIES

What is an important warning?

Answer 11

Active and latent infection;
Hep B or C
TB

Interacts with live vaccines, risk of severe generalised infection.

Question 12

MONOCLONAL ANTIBODIES;

How are they given?

Answer 12

prescribed at 2-4 weekly intervals or longer

Adalimumab- 40mg every 4 weeks

Denosumab every 6 months

Not taken orally only sub cut as digested by gastric proteases and large and poorly permeable.

Question 13

AZATHIOPRINE AND MERCAPTOPURINE:

What are indications?

Answer 13

Crohns

Rheumatoid arthritis

eczema

Myasthenia gravis

1-3mg/kg

Question 14

AZATHIOPRINE AND MERCAPTOPURINE:

What are important interactions and how are they overcome?

Answer 14

Allopurinol

Manufacturer advises reduce dose to one-quarter of the usual dose with concurrent use of allopurinol

Question 15

AZATHIOPRINE AND MERCAPTOPURINE:

What is the most common side effect?

Answer 15

Bone marrow depression (dose-related); increased risk of infection; leucopenia; pancreatitis; thrombocytopenia

Question 16

AZATHIOPRINE AND MERCAPTOPURINE:

What are important side effects and how can they be managed?

Answer 16

Nausea- take with food

hypersensitivity -immediate withdrawal

neutropenia/thrombocytopenia- neutropenia dose dependent

Question 17

AZATHIOPRINE AND MERCAPTOPURINE:

What are monitoring requirements?

Answer 17

Monitor full blood count weekly (more frequently with higher doses or if severe renal impairment) for first 4 weeks (manufacturer advises weekly monitoring for 8 weeks but evidence of practical value unsatisfactory), thereafter reduce frequency of monitoring to at least every 3 months.

Question 18

AZATHIOPRINE AND MERCAPTOPURINE:

What are cautions?

Answer 18

Avoid in pregnancy, fine in breastfeeding use if benefits outweighs the risks.

Contraindications;
Absent thiopurine methyltransferase (TPMT) activity; very low thiopurine methyltransferase (TPMT) activity