Phar351 - Ibd

Front 1

Where does inflammation occur for UC?

Back 1

Large intestine, limited to inner lining of the intestinal walls.

Front 2

For IBD, there is an increased number of which innate immune cells in the lamina propria, causing an elevation in which cytokines?

Back 2

1. TNF-alpha

2. IL-1beta

3. INF-gamma, cytokines of the interleukin-23-Th17 pathway

Front 3

What are common symptoms to both UC and CD? (6)

Back 3

1. Diarrhea
2. Rectal bleeding
3. Urgency to have bowel movements
4. Abdominal cramps and pain
5. Fever
6. Weight loss

Front 4

What are complications to IBD? (3)

Back 4

1. Obstructions in bowel

2. Ulcers

3. Malnutrition

Front 5

Define: Distal colitis

Back 5

Proctitis and proctosigmoiditis

Front 6

Define: Left-side colitis

Back 6

Colitis up to the splenic flexure

Front 7

Define: extensive colitis

Back 7

Colitis up to the hepatic flexure

Front 8

Define: Pancolitis/ ulcerative colitis

Back 8

Colitis affecting the whole colon

Front 9

Ulcerative colitis has an increased risk for colonic cancer if disease is ____ years.

Back 9

>10

Front 10

How is mild UC defined?

Back 10

• <4 stools/ day, with or without blood
• No systemic signs of toxicity
• Normal erythrocyte sedimentation rate

Front 11

How is moderate UC defined?

Back 11

• >4 stools/day
• Minimal signs of toxicity

Front 12

How is severe UC defined?

Back 12

• >6 bloody stools/day
• Toxicity evident (fever, tachycardia, anemia, elevated erythrocyte sedimentation rate)

Front 13

How is fulminant UC defined?

Back 13

• >10 stools/day with continuous bleeding
• Toxicity
• Abdominal distension and tenderness
• Need blood transfusion
• Colonic dilation on abdominal plain films

Front 14

Goals of treatment of IBD? (6)

Back 14

1. Relieve symptoms
2. Improve nutritional status
3. Prevent disease reoccurence
4. Prevent development of colonic cancer
5. Treat extra-intestinal diseases
6. Improve quality of life

Front 15

What is induction vs. remission?

Back 15

Induction: getting back to normal state

Remission: maintaining normal state

Front 16

What is first line therapy to induce remission?

Back 16

5-ASA per rectum topical

Stay on 5-ASA to maintain remission

Front 17

What is second line therapy to induce remission?

Back 17

Steroid PO

Oral prednisone

Front 18

What is third line therapy to induce remission?

Back 18

Oral prednisone and immunosuppresive treatment, biological therapy or surgery.

Front 19

What are the treatment options for mild UC? (9)

Back 19

1. Supportive treatment (fluids, soft-nonallergic food, antidiarrheals)
2. Full dose 5-ASA (mesalamine)
3. Mesalazine 4g QHS per rectum
4. Oral corticosteroid - prednisone 30mg QD
5. Rectal corticosteroid
6. Immunosuppresive agent
7. Cyclosporine
8. Biological agent - infliximab
9. Antibiotic - Metronidazole

Front 20

Define: informed decision

Back 20

Patient knows all there is to know about medication before making a decision on whether to take it or not. This includes symptoms, side effects, interactions, monitoring and duration of therapy.

Front 21

What is the first line therapy for severe UC?

Back 21

Oral prednisone 30-60mg/day, tapering down to 0 (12-16 weeks).

Front 22

What is the second line therapy for severe UC?

Back 22

IV steroids in hospital (3-10 days)

If remission occurs, switch to oral prenisone and taper down to 0. Continue or restart oral 5-ASA.

If failure, biological therapy, iv cyclosporine, or colonectomy

Front 23

When is cyclosporine used in UC?

Back 23

It is offered for patients that refuse surgery or biological therapy.

Front 24

What are contraindications and adverse events with using infliximab?

Back 24

Active infections, TB and other opportunistic infections, invasive fungal infections, congestive heart failure, or hypersensitivity.

Risk of lymphoma. May cause liver toxicity (increase ALT and AST).

Front 25

Why do you use azathioprine in addition to infliximab?

Back 25

In 14-19% of patients, antibodies for infliximab develop. This is reduced to 1-2.5% if used with azathioprine.