Flashcards in Unit 1-Drugs Used To Treat UC And CD Deck (48):
Location of UC
Colon and rectum (continuous pattern)
What should you test for when taking azathioprine and 6-MP?
Thiopurine methyltransferase (TPMT)-this enzyme metabolizes azathioprine to 6-MP...needs to be in an active state to work, can lead to toxicity from azathioprine if not converted.
Why do we use aminosalicylates?
Induce and maintain remission in MILD to MODERATE IBD
Adverse effect of natalizumab.
Progressive multi focal leukoencephalopathy
Location of CD
Mouth to anus (discontinuous)
When would you use cyclosporine for IBD patients?
With fulminant or refractory symptoms in active disease.
If patient is on sulfasalazine and pregnant, what should you give?
Supplement w/1mg folic acid 2x/day-b/c it depletes folate
If patient with IBD has pouch it is or CD with resection or perinatal fistula what antibiotic might you use?
Characterized by acute and chronic inflammation of GI tract.
UC and CR (IBDs)
What should you avoid with IBD?
Antidiarrheal meds that reduce GI motility.-risk precipitating acute clinic dilation (toxic mega colon)
Anticholinergic drugs-toxic megacolon
NSAIDS-can worsen IBD six
Caution with OPIODS-toxic megacolon
Does UC extend beyond the submucosal layer?
Which aminosalicylates is the least tolerated?
MOA of methotrexate
Use of Azathioprine and 6-MP.
Maintain remission of IBD.
Reduce need for long term use of corticosteroids
MOA of azathioprine and 6-mercaptopurine
Inhibit purine synthesis and reduce IBD-associated GI inflammation
What do you want to screen for before using biologics in IBD?
Latent TB and latent hepatitis.
Which disease has to do with the “depth” and penetration of transferral disease?
First line for moderate to severe active UC.
Biologics-inflict about, adalimumab, golimumab
-if PI therapies (mesalamine, sulfasalazine) don’t work
Azathioprine or 6-MP
-if unresponsive to corticosteroids
-may be combined with infliximab
Adverse effects of corticosteroids used long term in IBD.
Inc. risk of infection
Delayed growth in children.
Can you take methotrexate during pregnancy?
MOA of aminosalicylates
Provides anti-inflammatory effects to areas of inflammation in GI tract.
How long do azathioprine and 6-MP take to work?
First line for mild to moderate active UC.
Oral or topical aminosalicylate derivatives or oral budesonide
Use of methotrexate (in terms of IBD).
Maintaining remission of CD.
Reduce steroid use.
In UC ________cells produce __________.
Atypical type 2 T helper cell.s
Pro inflammatory cytokines.
First line for moderate to severe active CD.
Oral corticosteroid and biologics (can be combined with azathioprine)
Which topical med is best used for inducing remission in mild-mod active UC?
First line for tax severe to fulminant active CD.
Biologics may be used.
Contraindication for sulfasalazine
Immunosuppressant used to prevent organ rejection in transplant patients.
Supplements for IBD
B12, folic acid, fat soluble vitamins, iron
What cytokines cell plays a major role in CD?
TNF-alpha: activates macrophages, procoagulant, increased production of metalloproteinases in mucosal cells, also stimulates more production of TNF-alpha.
Major adverse effects of biologics in IBD
Deactivation of serious infections (TB, hepatitis B).
Exacerbation of heart failure
Lymphoma, including hepatosplenic T-cell lymphoma (rare)
-highest risk in younger males and those using azathioprine or 6-my
If a patient with IBD has refractory active DC what antibiotic would you use?
What should you assess in IBD/
Risk of bone loss (calcium + vitamin D supplementation in pots on long term corticosteroids)
Adverse effects of methotrexate.
Bone Marrow suppression
Which aminosalycilate causes the most secretory diarrhea?
How long may it take for remission to occur in first line treatment for active UC?