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51 Cards in this Set
- Front
- Back
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what part of the body does UC and CD affect
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Ulcerative Colitis - colon only
Crohn's disease can affect any part of your GI tract |
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what type of IBD is continuous/discontinuous inflammation
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UC - continuous
CD - discontinuous |
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"collar button ulcer"/pseudopolyps refers to
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Ulcerative Colitis
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cobblestoning refers to
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Crohn's Disease
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what is the importance of knowing whether the pt smokes or not
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smoking makes Crohn's disease worse and pts should stop
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what are the symptoms of Ulcerative collitis
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bloody diarrhea
tenesmus |
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where does each classification affect:
Pancolitis: Left sided colitis: Proctosigmoid: Proctitis: |
Pancolitis: entire colon
Left sided colitis: transverse colon to recturm Proctosigmoid: sigmoid colon to rectum Proctitis: rectum |
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what is the classification of symptoms:
Mild Moderate Severe |
Mild - <4 stools a day
Moderate - > 4 stools a day w/ minimal signs of toxicity Severe - >6 blood stools a day and/or systemic toxicity (HR >90, T > 37.8 C, Hb < 10.5, ESR >30) |
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what are the symptoms of Crohn's disease
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chronic/nocturnal diarrhea
weight loss rectal bleeding inflammation outside of intestines arthritis skin manifestations/rash CD can affect entire body |
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what are the aminosalicylates
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mesalamine/mesalazine
sulfasalazine balsalzide |
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which is better at inducing remission rectal mesalamine or rectal steroid
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rectal mesalamine
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what are SE of aminosalicylates
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epigastric pain
rare: SJS/pancreatitis/agranulocytosis |
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what pregnancy category are the aminosalicylates
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Preg B - Pentesa
Preg C - Asacol |
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what area can each of the following reach
Mesalamine supp Steroid Enema Mesalamine Enema Balsalazide/Olsalazine Asacol Pentasa |
Mesalamine supp - rectum only
Steroid Enema - left sided Mesalamine Enema - left sided Balsalazide/Olsalazine Asacol - entire colon Pentasa - entire colon |
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what are the antibiotics that can be used to tx IBD
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metronidazole
ciprofloxacin |
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what are the preg categories of the antibiotics
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metronidazole - preg B
ciprofloxacin - preg C |
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which antibiotic would be best choice for pouchitis
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ciprofloxacin
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what are the main SE of the antibiotics
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metronidazole - peripheral neuropathy with prolonged use
ciprofloxacin - tendon weakness (increased w/ steroid use) |
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what are the corticosteroids
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methylprednisolone
hydrocortisone budesonide prednisone betamethasone |
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if you taper steroids before what time will the pt risk relapse
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don't taper <8weeks
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what is the use of corticosteroids in IBD
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remission of UC and CD
not used for maintenance due to SE |
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what pregnancy catergory are corticosteroids
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preg C
- has been associated with causing cleft palate |
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what are some SE of corticosteroids
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insomnia
weight gain immunosuppression thinning of skin moon face buffalo hump osteoporosis hyperglycemia |
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what are the thiopurine
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azathioprine
mercatopurine (6MP) |
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what is the onset of thiopurines
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3-6 months therefore usually start another medication while you wait for these to kick in
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pts who weren't responsive to mesalamine therapy should use what type of drugs
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thiopurines
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what are the AE of thiopurines
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allergic reaction
leukopenia myelotoxicity |
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what should you monitor when a pt is on thiopurines
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CBC for myelotoxicity
TPMT (TPMT metabolizes thiopurine and may cause myelotoxicity) |
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what pregnancy category are thiopurines
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they can be used in pregnancy
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what pregnancy category is methotrexate
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X
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what is 2nd line after thiopurines
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Methotrexate
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what are the AE of methotrexate
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GI, hepatoxicity
- folate can be given once a week to decrease GI SE |
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what are the Anti TNF drugs and what are they used for
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infliximab
adalimumab (humira) - Crohn's disease only |
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what are the calcinurin inhibitors and what are they used for
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cyclosporin - severe UC (unlabled use)
tacrolimus - steroid refractory UC |
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what are the pregnancy catergories of the calcinurin inhibitors
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Preg cat C
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how long is cyclosporin used
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3-6 months then d/c b/c of toxicity
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what are the AE of anti TNF drugs
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infections (TB)
antibody formation increased risk of non hodgkins lymphoma |
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what drug for IBD has an increased risk of non hodgkins lymphoma
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anti TNF drusgs
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what is the pregnancy category and CI of Anti TNF drugs
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preg cat B
CI: pts with stage 3 or 4 CHF |
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when trying to achieve remission in UC what is the course of therapy for SEVERE disease
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IV corticosteroids (given for 5 days max, no benefit after 7-10 days)
IV cyclosporin A IV inflixamab colectomy if no response within 4-7 days |
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when trying to achieve remission in UC what is the course of therapy for MILD TO MODERATE disease
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1st line: PO Mesalazine (2.4-4.8g/day) or balsalazide 6.75g/day
2nd line: PO prednisolone 20-40 mg/daily |
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when trying to achieve remission in UC what is the course of therapy for Proctitis
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1st line: topical mesalazine 1-2g daily
2nd line: topical corticosteroids |
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when trying to maintain remission in UC what is the course of therapy
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1st line PO mesalazine 1.2-2.4g/daily, sulfasalazine 2-4g daily, balsalazide 4.5g daily
left sided: topical mesalazine 1g daily 1st line for steroid dependent: azathioprine/mercaptopurine -if pt doesn't respond to thiopurines switch to IV infliximab |
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what are some indications for surgery in UC
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toxic megacolon
recurring episodes of UC dysplasia/carcinoma |
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what is pouchitis
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inflammation of the new rectum created after colectomy
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what is the dosing of drugs to tx pouchitis
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cipro 250mg bid
metro 400 tid |
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when trying to achieve remission in CD what is the course of therapy in severe disease
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1. prednisone for 7-28 days depending on weight gain
2. thiopurines - maintain steroid induced remission 3. IV methotrexate - steroid dependent or steroid refractory 4. IV infliximab, SQ adalimumab -alternative to steroid therapy |
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what is done in pts with fulminant disease of CD
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IV steroids + supportive therapy (TPN/lytes/fluids/etc)
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when trying to achieve remission in CD what is the course of therapy in moderate disease
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1. prednisone
2. budesonide - preferred for disease localized to ileum and/or right colon |
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what is done to maintain remission in CD
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smoke cessation
1st line: thiopurines (azathioprine/mercaptopurine) -methotrexate -infliximab, adalimumab *infliximab + azathioprine more affective than azathioprine alone *CI: history of demyelinating illness (MS) or optic neuritis |
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when trying to maintain remission in CD what pts can you not give infliximab + azathioprine
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pts with MS (demyelinating illness) or optic neuritis
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