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42 Cards in this Set

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