Bcps Gi - Ibd (Crohn's/ulcerative Colitis)

Front 1

Of the enviromental factors which one exacerbates Crohn's but improves ulcerative colitis

Back 1

smoking

Front 2

This disease is limited to rectum and terminal ilieum, can result in toxic megacolon, and puts patients at risk for colonrectal cancer

Back 2

Ulcerative colitis

Front 3

This disease can be located from mouth to anus, can involve perianal area, has mucosal ulcers that extend to submucosal area, is associated with malabsorption and fistulas/strictures

Back 3

Crohn's disease

Front 4

This drug is best for colonic disease involvement, is cleaved by colonic bacteria into two active components, and can cause folat malabsorption, gi disturbance, headache, arthralgia and rarely bonemarrow suppression, hemolytic anemia, hepatotoxicity

Back 4

sulfasalazine (5-aminosalicylate, sulfafyridine). avoid in sulfa allergy

Front 5

These drugsare considered first line CD/UC, selection of product predicated on disease location, rare instances of nephrotoxicity and one of them is associated with secretory diarrhea

Back 5

Non sulfa 5-Aminosalicylates
olsalazine = secretory diarrhea

Front 6

Use what sparingly because of risk of toxicmegacolon

Back 6

antidiarrheals. (immodium, hyoscyamine, probantheline, dicyclocmine)

Front 7

These have no role in maintenance but up to 50% of patients can become dependent. One product is indicated in terminal ileum or ascending colon disease.

Back 7

Corticosteroids
Budesonide (terminal ileum, ascending colon)

Front 8

Aminosalicylate products used for colonic involvement

Back 8

asacol HD, Pentasa, Lialda, Apriso, Dipentum, Balsalazide

Front 9

Aminosalicylate products for rectum involvement

Back 9

Canasa suppository

Front 10

Rowasa enema is indicated for what type of IBD

Back 10

rectum and terminal colon

Front 11

Used due to steroid sparing effect. Can be used for maintenance due to long onset of action. Need to determine thopurine methyltransferase acitivty prior to prescribing. Can cause pancreatitis, bone marrow suppression, hepatotoxicity.

Back 11

6-MP, Azathioprine.

Front 12

This medication is used for Crohn's maintenance, has long onset of action (mos to one year), can be steroid sparing, and can cause bone marrow suppression, pulmonary toxicity, hepatotoxicity, diarrhea, rash.

Back 12

MTX - 15-25mg weekly IM

Front 13

CHimeric ab against TNF. Useful for fistulizing CD, and moderate to severe UC/CD. 50% develop antinuclear ab. SE's are infection, HF exacerbation, Block box warning regarding Cancers such as hepatosplenic T-Cell lymphoma

Back 13

Infliximab

Front 14

Dose of Infliximab if used in heart failure

Back 14

Containdicated NYHA III/IV, 5m/kg / dose in other classes.

Front 15

Fully Humanized ab against TNF, used for maintenance therapy for modreate-severe CD (unresponsive to other therapies).

Back 15

Humira (adalimumab)
dosing 160mg x 1 day or 40mg /d x 2 days then
80mg 2 weeks later.
then 40mg every 2 weeks

Front 16

Advantage of adaliimumab over infliximab

Back 16

lack of antibodies to adalimumab

Front 17

This is a humanized monoclonal antibody linked to PEG with murine complimentary regions indicated for induction and maintenance of sever CD refractory to other therapies.

Back 17

Certolizumab (Cimzia)
Induction dose 400mg x 1 then 400mg @ weeks 2 & 4 then 400mg every 4 weeks

Front 18

Patients with a c-reactive protein level of 10mg/ml or greater respond better to what agent

Back 18

Cerolizumab

Front 19

This biologic is a humanized monoclonal antibody that antagonizes integrin heterodimers and inhibits alpha 4 integrin mediated leukocyte adhesion. It is indicated for induction and maintaining remission of CD unresponsive. It is associated the PML, hepatotoxicit. Do not use with other immunosuppresants.

Back 19

Natalizumab (Tysabri) Must enroll in Touch REMS program

Front 20

What test should be done prior to prescribing natalizumab to evaluate risk for PML

Back 20

JC virus (John Cunningham virus)

Front 21

First line thrapy for Crohn's mild to moderate distal disease

Back 21

Topical (enema/supp) aminosalicylate.
(If symptoms continue after oral aminosalicylate or topical steroid may respond to mesalamine supp/enema)

Front 22

IF patient with mild/moderate distal disease are refractory to po/topical aminosalicylate or topical steroid, what is next step for therapy

Back 22

Oral steroid 40 - 60mg
Infliximab 5mg/kg weeks 0,2,6

Front 23

Maintenance therapy for mild/moderate UC include what?

Back 23

mesalamine supp (proctitis)
mesalamine enema (distal dx to splenic fixture)
Oral suflasalazine, mesalamine, balsalizde

Front 24

Since po steroids have no role in maintenance therapy for CD (mild/moderate dx), what is used if symptoms cannot be managed in UC

Back 24

azathioprine/6-MP
Infliximab

Front 25

First line therapy for Mild to moderate UC extensive disease

Back 25

Oral sulfasalazine / 5-ASA or mesalamine

Front 26

Patient refractory to aminosalicylate and oral steroids can be treated with what

Back 26

azathioprine/6-MP (if not too ill for iv infliximab)

Front 27

Patients with severe UC refractory to oral/topical aminosalycylates should be treated with what

Back 27

IV corticosteroids x 7 - 10 days
300mg hydrocortisone, 60mg methylpred

Front 28

Can infliximab be used for severe UC disease

Back 28

Yes, especially if patient not sick enough for hospitalization

Front 29

In severe UC refractory to 3-5 days of IV steroids what drug can be used

Back 29

Cyclosporine IV 4mg/kg/day (conc. target 350-500), then po 8mg/kg/day (conc target 200-350)

Front 30

Treatment of toxicmegacolon

Back 30

bowel decompression, broad spectrum ab's, maybe colectomy

Front 31

Is there a role for metronidazole/ciprofloxacin in UC

Back 31

Not generally. Can be used in toxic megacolon or pouchitis

Front 32

Treatment of choice for CD in mild/moderate active disease for ileal, ileocolonic, or colonic disease

Back 32

Budesonide 9m5 daily for terminal ileal/ascending colon disease. Aminosaliclyates minimally effective but are used

Front 33

In perianal disease and in patients not responding to aminosalicylates in CD what antibiotics can be used

Back 33

Metronidazole 10-30mg/kg +/- ciprofloxacin 1 g / day

Front 34

In CD moderate to severe disease what are treatment options

Back 34

Corticosteroids
Infliximab
Certolizumab
adalimumab

Front 35

In CD patients whose therapy with aminosalicylates and corticosteroids has failed and who are naive to biologic agents what two agents are used

Back 35

infliximab / azathioprine

Front 36

In CD what can be used if patient did not respond to any other conventional medical therapy

Back 36

Natalizumab 300mg every 4 weeks

Front 37

If patient fails to respond to infliximab due to antibodies, what is another option

Back 37

Adalimumab

Front 38

Patients with a c-reactive protein greater than 10 will respond better to drug

Back 38

Certolizumab

Front 39

If patient has steroid dependent or steroid refractory disease and respond to an IM injection of this drug may continue weekly therapy. What is this drug for CD?

Back 39

Methotrexate

Front 40

What steroid is used up to 6 mos in CD for mild/moderate ileal disease

Back 40

Budesonide

Front 41

After induction of remission with corticosteroids or infliximab what can be used for maintenance tx in CD

Back 41

azathioprine/6-MP

Front 42

After Surgical resection of CD what can be used to prevent recurrence

Back 42

Azathioprine/6-MP or mesalamine

Front 43

Treatment for complex perianal fistula's

Back 43

biologics
antibiotics (cipro/metronidazole)
azathioprine/6-MP
cyclosporine/tacroliums

Front 44

Onset of action for 6-MP / azathioprine

Back 44

3 - 15 months

Front 45

In what disease has methtrexate shown efficacy in UC or CD?

Back 45

Crohn's

Front 46

Mild clinical severity of UC includes

Back 46

< 4 stools/day
no fever
normal ESR

Front 47

Moderate clinical severity of UC includes

Back 47

> 4 stools per day
minimal systemic symptoms

Front 48

Severe clinical severity of UC includes

Back 48

> 6 stools per day
Temp > 99.5
Hr > 90
ESR > 30
bowel wall edema/abdominal tenderness

Front 49

Fulminant clinical severity of UC includes

Back 49

> 10 stools per day with blood
Temp > 99.5
Hr > 90
ESR > 30
Requires blood transfusion
dilated colon