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5 Cards in this Set
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IBS C Water soluble fibres Stool softeners Linaclotide Prokonetic agents like SSRI |
IBS D Loperamide lomotil TCAs Colestyramine if bile acid involved Rifaximin |
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IBD consist of crohns and ulcerative colitis Ulcerative colitis affects colon Crohn’s disease affects any part of the GI tract Induce then maintain remission |
Rx Aminosalicylates; 5 ASA usually referred to as mesalamine and sulfasalazine. May be administered rectally or orally. Oral preparations release 5-ASA at specific site. Salofak and pentasa release ASA in the small bowel and available in small bowel and colon Sulfasalazine, olsalazine, asacol and mezavant release ASA in the colon. All oral 5-ASA are safe for induction of remission and prevention of relapse in mild to moderate UC Efficacy is dependent on luminal concentration |
5-ASA ineffective for induction or maintenance of pharmacologically or surgically induced remission of CD Sulfasalazine may have a modest benefit for induction of remission in mild colonic CD ASA and sulfasalazine effective for induction and maintenance in mild to moderate UC |
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Sulfasalazine more AE such as reversible oligospermia, hemolytic anaemia, rash headache, cross rxn with allergy to sulfonamide due to sulfapyridine moiety |
AE of ASA hypersensitivity rxns renal toxicity |
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Corticosteroids Induction of remission in UC and CD Moderately severe exacerbations oral prednisone 40-60mg/day. Use IV hydrocort or methylprednisolone Oral budesonide remission for mild to moderate ileocecal CD Budesonide enemas left sided UC Corticosteroids enemas for left sided UC |
Corticosteroids reserved for patients unresponsive to other drugs Not recommended for maintenance of remission of IBD; can cause avascular necrosis of femoral head Osteoporosis; supplement with vit D and calcium, smoking cessation and exercise Biphosphanates |
Bidesonide lower adrenal suppression, inactivated in the liver |
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Diarrhea, bloody stools, weight loss abdominal pain symptoms of IBD Rectal bleeding more common in UC Extra intestinal manifestation eg uveitis, arthritis, fever, perianal disease Colectomy cures UC but CD recurs after surgery |
Therapy determined by site and extent of disease, severity and presence of symptoms that suggest poorer prognosis (young age of onset, perianal disease and extensive small bowel involvement |
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