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42 Cards in this Set
- Front
- Back
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What is the strongest IBD agent?
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nutrition
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What is the least strong IBD agent?
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anti-diarrheal/anti-spasmodic agents
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What is the order from least to strongest agents to treat IBD?
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anti-diarrheal/anti-spasmodic
antibiotics sulfasalazine steroids immunosuppressive anti-TNF ABs rectal agents nutrition |
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Why would you use anti-diarrhea/anti-spasmodic agents for inflammatory bowel disease?
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situations when decreasing motility will help by allowing more time for absorption
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In whom should you avoid giving anti-diarrheal/anti-spasmodic agents?
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active colitis, might give you toxic megacolon
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For what do you give muscarinic anticholinergics?
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relief of cramps
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What are the side effects of muscarinic anticholinergics?
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closed angle glaucoma, urinary retention
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With what drug don't you give muscarinic anticholinergics?
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decreased absorption with antacids
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Why is cholestyramine useful in inflammatory bowel disease?
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binds bile salts and causes constipation
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What are the bad side effects of cholestyramine?
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vitamin K is bound, elevated PT, can affect bioavailability of other agents
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How do you treat bacterial overgrowth of small bowel?
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cephalosporin, quinolone, metronidazole
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Why do Crohn's patients get overgrowth of the small bowel?
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disease or prior surgery allowing colonization
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How do you treat parasites in the small bowel?
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metronidazole for giardia and amoebic
quinacrine for giardia |
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How do you treat C dif pseudomembranous colitis?
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metronidazole or vancomycin
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How do you treat fistulous diseases?
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metronidazole, ciprofloxacin in perianal Crohn's
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Why do you use Metronidazole?
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bacterial overgrowth of small bowel, parasites, C dif pseudomembranous colitis, fistulous diseases
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What are the side effects of metronidazole?
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disulfram-like reaction, neuropathy, teratogenic effects
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What is the disulfram-like reaction?
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nausea, vomiting, flsuhing
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What is the early sign of neuropathy?
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dysgeusia
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What is dysgeusia?
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abnormal taste sensation
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What is sulfasalazine's MOA?
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bond connection between ASA and sulfapyridine is broken by bacteria in the colon
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What is probably the active compound in sulfasalazine?
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5-ASA, sulfapyridine is probably the cause of side effects
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How is sulfasalazine activated?
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small amount absorbed in small intestine or through enterohepatic circulation
active locally/topically in the colon |
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What are the toxic side effects of sulfasalazine?
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nausea, vomiting, headahces, fever
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What are the allergic side effects of sulfasalazine?
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exanthema, hemolysis, agranulocytosis, epidermolysis, pancreatitis, pulmonary fibrosis, sperm motility disorders
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Upon what are the toxic side effects of sulfasalazine dependent?
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sulfapyridine levels, slow acetylators have higher levels, need to monitor blood counts
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What is the problem with oral 5-ASA?
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causes renal toxicity and absorbed before duodenum
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Which forms of sulfasalazine are targeted to the colon?
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olsalazine
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Which forms of sulfasalazine are targeted to the small bowel?
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petnasa, asacol
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How is pentasa given?
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slow release coated microgranules, time dependent
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How is Asacol given?
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enteric coated, released in distal SB
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Why do you give SAZ?
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mildly to moderately active UC and maintenance of remission
not for Crohns unless the colon is involved |
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Why do you give 5-ASA?
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high doses for small bowel Crohn's
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What is the toxicity of olsalazine?
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watery diarrhea
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Why do you use corticosteroids in inflammatory bowel disease?
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to suppress disease activity
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What is the risk of prednisone wtih crohn's disease?
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osteoporosis, esp with small bowel disease and Ca and Vit D malabsorption
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What is bad about using corticosteroids with severe inflammation?
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can have intraabdominal catastrophe or infection, but be suppresses due to no symptoms
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Why would you use azathioprine for inflammatory bowel disease?
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steroid sparing if you need to give a lot of prednisone to suppress disease or don't tolerate steroids well
Crohns patients with fistulous disease |
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Why would you use 5-MP for inflammatory bowel disease?
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steroid sparing if you need to give a lot of prednisone to suppress disease or don't tolerate steroids well
Crohns patients with fistulous disease |
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Why do you give infliximab?
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for Crohn's or severe UC
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What are the adverse effects of infliximab?
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lymphoma risk, serum sickness after lapse in therapy
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What do you avoid in pregnancy?
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metronidazole, methrotrexate
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