Therapy Iii Block 2: Ibd

Front 1

etiology of IBD

Back 1

"PINING"
psychological
infectious
NSAIDs
immunologic
nicotine
genetic

Front 2

pathophys of ulcerative colitis: predominant factor and IL factors

Back 2

Th2 predominant
IL-4, 5, 10

Front 3

pathophys of Crohn's disease: predominant factor and other factors

Back 3

Th1 predominant
TNF-a, IFN gamma, IL-2,12

Front 4

nonpharmacological options for IBD: avoid what/when deficient? strictures...avoid what? what do you want completely? last resort option?

Back 4

if lactase deficient: avoid lactose
strictures: avoid high residue foods
complete bowel rest: parenteral nutrition
surgery

Front 5

Aminosalicylates: effective when?

Back 5

2-4 weeks

Front 6

Aminosalicylates: drug interactions as a class

Back 6

warfarin, digoxin

Front 7

Mesalamine drug interactions

Back 7

warfarin, digoxin

Front 8

Corticosteroid long term toxicities

Back 8

"I GOO"
infection
glucose tolerance
osteoporosis
ophthalmologic

Front 9

Corticosteroid short term toxicities

Back 9

"AHH"
adrenal suppresion
hypertension
hyperglycemia

Front 10

Budesonide PO place in therapy: (treatment or maintenance), how long?

Back 10

treatment and maintenance of mild-moderate CD of ileum or ascending colon for 3 months

Front 11

Corticosteroids (besides budesonide): place in therapy (treat or maintenance)

Back 11

treatment of moderate-fulminant UC or CD

Front 12

Azathioprine dosage

Back 12

2-3 mg/kg/day

Front 13

Mercaptopurine dosage (6-MP)

Back 13

1-1.5 mg/kg/day

Front 14

Azathioprine dosage

Back 14

3-6 months

Front 15

when is dosage adjustment needed in Azathioprine, Mercaptopurine?

Back 15

TPMT genotype/phenotype of homo/hetero low activity, must reduce dose
CrCl <50: reduce dose

Front 16

Azathioprine, Mercaptopurine adverse effects

Back 16

"MARTIN"
myelosuppression
anemia
rash
thrombocytopenia
intrahepatic cholestatis
N/V/D

Front 17

Azathioprine, Mercaptopurine rare but serious adverse effects

Back 17

"N HeLP"
nephrotoxicity
HSTCL
lymphoma
pancreatitis

Front 18

Azathioprine, Mercaptopurine drug interactions

Back 18

"FAW"
febuxostat
allopurinol
warfarin

Front 19

Methotrexate onset of action

Back 19

can take up to 3 months

Front 20

Methotrexate dosing, with?

Back 20

15-25 mg IM WEEKLY with folic acid 1mg daily

Front 21

Methotrexate adverse effects

Back 21

"BP HN"
bone marrow suppression
pulmonary toxicity
hepatotoxicity
N/V/D

Front 22

Methotrexate place in therapy, treat or maintenance?

Back 22

maintenance of moderate-severe steroid refractory or steroid dependent CD

Front 23

Cyclosporine onset of action

Back 23

IV within 1 week

Front 24

Cyclosporine dosage

Back 24

2-4mg/kg/day IV

Front 25

Cyclosporine DI

Back 25

Cyp3A4 substrates (major), inhibitors (moderate)

Front 26

Cyclosporine adverse effects

Back 26

"NHN HITT"
nephrotoxicity
HTN
neurotoxicity
increase: TG, HA, tremors

Front 27

Cyclosporine place in therapy, treat or maintenance?

Back 27

IV within 1 week

Front 28

decreases need for immediate surgery

Back 28

Cyclosporine

Front 29

antibiotics used for IBD and doses

Back 29

ciprofloxacin 500 mg BID
metronidazole 20mg/kg/day divided doses

Front 30

when are antibiotics most effective in IBD

Back 30

most effective with perianal disease/fistulas

Front 31

antibiotics place in IBD therapy, treatment

Back 31

metronidazole:treatment of mild-severe CD as an adjunct
metronidazole +/- ciprofloxacin: treat fistulizing disease in CD

Front 32

Infliximab place in therapy: treat when not responding to what? maintenance when? treatment and maintenance of what? treatment of what?

Back 32

treatment of severe UC not responding to traditional treatment
maintenance of severe UC in patients receiving it for induction
treatment and maintenance of moderate-severe CD not responsive to traditional treatment
treatment of fistulas in CD

Front 33

adalimumab place in therapy, alternate to what?

Back 33

treatment and maintenance of moderate-severe CD not responsive to traditional therapy
alternative to infliximab if patient's have lost response or become tolerant

Front 34

antibiotics used for IBD and doses

Back 34

SC 160mg/day 1, 80 mg/day 15, 40mg every other week

Front 35

Certolizumab pegol dosing

Back 35

SC 400mg week 0, 2, and 4....then every 4 weeks

Front 36

Certolizumab place in IBD therapy

Back 36

treatment and maintenance of moderate-severe CD not responsive to traditional therapy

Front 37

TNF-a adverse effects

Back 37

"FIBRIL"
flu-like symptoms
infection
bone marrow suppression
reactivation of TB/hep B
infusion reaction
lymphoma

Front 38

if lose response to one TNF-a, what can you do?

Back 38

switch to another

Front 39

TNF-a inhibitors as a class are ideal for

Back 39

steroid refractory patients or patients not responsive to other immunosuppressants

Front 40

Natalizumab dosage

Back 40

IV every 4 weeks

Front 41

Natalizumab place in therapy, line in therapy

Back 41

treatment and maintenance of moderate-severe CD in patients unresponsive to or intolerant of TNF-a inhibitors
last line therapy

Front 42

Natalizumab adverse effects

Back 42

risk of progressive multifocal leukoencephalopathy

Front 43

UC treatment steps 1,2,3

Back 43

1. determine location of disease: distal v. extensive
2. determine severity
3. chose appropriate therapy

Front 44

1st line treatment of UC: mild and distal

Back 44

PO or PR 5-ASA, or PR steroids

Front 45

1st line treatment of UC: mild and extensive

Back 45

PO 5-ASA

Front 46

1st line treatment of UC: moderate, if inadequate response

Back 46

mild treatment +/- PO prednisone

add azathioprine or mercaptopurine or infliximab

Front 47

1st line treatment of UC: severe, if inadequate response

Back 47

IV every 4 weeks

Front 48

1st line treatment of UC: fulminant, if inadequate response

Back 48

IV hydrocortisone

IV cyclosporine or infliximab

Front 49

1st line treatment of CD: mild-moderate

Back 49

PO 5-ASA +/- metronidazole

Front 50

1st line treatment of CD: mild-moderate, if distal ileum or ascending colon

Back 50

PO budesonide

Front 51

1st line treatment of CD: moderate-severe, how long/

Back 51

mild treatment + PO steroids for 7-28 days

Front 52

1st line treatment of CD: moderate-severe, fistula or refractory

Back 52

infliximab

Front 53

1st line therapy of CD: severe-fulminant

Back 53

IV steroids

Front 54

1st line treatment of UC: moderate, if inadequate response

Back 54

IV cyclosporine if no response
infliximab if fistula or refractory

Front 55

complications of CD

Back 55

"DJ OATH"
dermatologic
joint
ocular
anemia
toxic megacolon
hepatobiliary

Front 56

IV steroids for toxic megacolon, dosing

Back 56

hydrocortisone 100mg every 8 hours
methylprednisolong 15mg every 8 hours

Front 57

treatment of toxic megacolon

Back 57

management: NOP, IV fluids + electrolytes, IV antibiotics, IV steroids if not previously on them

Front 58

where does ulcerative colities start at?

Back 58

rectum and works way up

Front 59

UC v. CD (layers affect, connect or not)

Back 59

UC: superficial, continuous
CD: deep, spotty, non continuous

Front 60

where can CD occur? most common?

Back 60

anywhere, more common in ileum

Front 61

***IBS v. IBD (CD or UC)

Back 61

IBD has blood in stool, IBS does not

Front 62

UC < CD symptoms (4)

Back 62

CD has rectal bleeding, fever, Ab pain, weight loss, and signs of malnutrition.....UC only has rectal bleeding

Front 63

symptoms that UC > CD

Back 63

rectal bleeding WITHOUT ab pain, fever, weight loss, malnutrition

Front 64

****how can UC be fixed?? can Crohn's be fixed?

Back 64

surgery, no...hard to pinpoint due to patchy sections, if know where UC section is, can solve area

Front 65

***Azulfidine: ingredient, how far reach?

Back 65

sulfapyridine + mesalamine (sulfasalazine)

rectum, distal colon, proximal colon

Front 66

***Asacol: ingredient

Back 66

mesalamine

rectum, distal colon, proximal colon, terminal ileum

Front 67

***Lialda: ingredient

Back 67

management: NOP, IV fluids + electrolytes, IV antibiotics, IV steroids if not previously on them

Front 68

***Pentasa: ingredient

Back 68

mesalamine

rectum, distal colon, proximal colon, terminal ileum, ileum, jejunum

Front 69

***Canasa: ingredient, dosage form, how far reach?

Back 69

mesalamine, suppository,

rectum only

Front 70

***Rowasa: ingredient, dosage form, how far reach?

Back 70

mesalamine, enema

rectum, distal colon

Front 71

***Apriso: ingredient, how far reach

Back 71

mesalamine

rectum, distal colon, proximal colon, terminal ileum

Front 72

***Dipentum: ingredient

Back 72

2 molecules of mesalamine (olsalazine)

rectum, distal colon, proximal colon, terminal ileum

Front 73

***Colazal: ingredient

Back 73

mesalamine + inert compound (balsalazide)

rectum, distal colon, proximal colon

Front 74

symptoms that UC > CD

Back 74

"CARPAL"
Canasa
Asacol
Rowasa
Pentasa
Apriso
Lialda

Front 75

***what 5-ASA has largest ADR?

Back 75

Azulfidine: sulfasalazine

Front 76

***side effect common to Dipentum: olsalamine

Back 76

diarrhea

NOT USED OFTEN

Front 77

***agent only reaches rectum

Back 77

Canasa: suppository mesalamine

Front 78

***agent reach rectum, distal colon ONLY

Back 78

Rowasa: enema mesalamine

Front 79

***agent reach rectum, distal colon, proximal colon

Back 79

Colazal (balsalazide), Azulfidine (sulfasalazine)

Front 80

***agent reach rectum, distal colon, proximal colon, terminal ileum

Back 80

Asacol
Lialda
Apriso
Dipentum (olsalazine)

Front 81

***agent reach rectum, distal colon, proximal colon, terminal ileum, ileum, jejunum

Back 81

Pentasa

Front 82

***Balsalazide benefit in structure, when use?

Back 82

mesalamine + inert compound, prevents absorption when combo use with PPI, H2RA, or antacid that would increase