Term
| What are the inflammatory Bowel diseases, and what do they affect? |
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Definition
Crohn's disease - can affect any part of GI
Ulcerative Colitis - Affects colon |
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Term
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Definition
| Diarrhea, abdominal pain, rectal bleeding, weight loss |
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Term
| How is therapy determined in inflammatory bowel diseases? |
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Definition
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Term
| What are the 5-ASA preparations? Where do they RELEASE the ASA? |
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Definition
Release in small bowel: Salofalk, Mesasal, Pentasa
Release in the Colon: Sulfsalazine, olsalazine, Asacol, Mesavent. |
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Term
| Which 5-ASA preparations are effective in Ulcerative colitis? Why? |
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Definition
ALL OF THEM! This is because they all eventually get to the colon.
Salofalk, Mesasal, Pentasa are released in the small bowel, but still eventually reach the Colon.
Sulfsalazine, olsalazine, Asacol, and Mezavent primarily release in the Colon. |
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Term
| Which of the 5-ASA preparations has the LEAST favorable side effect profile? |
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Definition
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Term
| Side effects of Sulfasalazine |
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Definition
| HA, Nausea, Hepatotoxicity, hemolytic anemia, rash |
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Term
Treatment of exacerbations of UC or CD?
Moderate? Severe? |
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Definition
Prednisone - po for moderate
IV Hydrocortisone or methylprednisolone for severe |
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Term
| Duration of therapy for exacerbation of UC and CD using corticosteroids |
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Definition
UC: treat for 8-12 weeks
CD: 12 - 16 weeks.
Be sure to taper off dose of corticosteroids to avoid Cushings |
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Term
| When should corticosteroids be used in UC or CD? |
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Definition
| Refractory or unresponsive to other drugs |
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Term
| Budesonide, as effective as other corticosteroids orally? As an enema? Disadvantage of budesonide enema? Advantage of budesonide? |
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Definition
| Budesonide po is not as effective as other corticosteroids, but has less manifestations of cushing's. Budesonide enemas are as efficacious, but are very expensive |
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Term
What immunosuppressive agents are used vs CD or UC?
What are their side effects? |
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Definition
Azathioprine, Methotrexate, 6-mercaptopurine
Side effects: *Hypersensitivity, *pneumonitis, *Hepatotoxicity, Infection, bone marrow suppression, cytopenias |
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Term
| What is recommended to give with methotrexate to avoid some side effects? |
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Definition
| Methotrexate take with folic acid |
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Term
| When are Azathioprine, 6-Mercaptopurine, or methotrexate used? |
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Definition
| In refractory CD to control symptoms and reduce dose of corticosteroids |
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Term
| Treating diarrhea in CD or UC |
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Definition
Use diphenoxylate + atropine or loperamide
**CAUTION IN SEVERE DISEASEE** --> risk of toxic megacolon |
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Term
Management of Crohn's Disease:
Mild, Colonic Disease? |
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Definition
Management of Crohn's Disease:
Mild, Colonic Disease - Sulfsalazine or a 5-ASA 4-6 weeks |
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Term
Management of Crohn's Disease:
Mild, Illeal Disease? |
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Definition
Management of Crohn's Disease:
Mild, Illeal Disease - Budesonide 8-16 weeks |
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Term
Management of Crohn's Disease:
Mild, Illeal or Colonic Disease after remission? |
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Definition
Management of Crohn's Disease:
Mild, Illeal or Colonic Disease after remission:
D/C therapy for exacerbation, and consider maintenance therapy with MTX, AZA, or 6-mercatopurine |
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Term
Management of Crohn's Disease:
Mild, Illeal or Colonic Disease with no remission after treatment? |
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Definition
Management of Crohn's Disease:
Mild, Illeal or Colonic Disease with no remission after treatment:
TREAT as MODERATE:
Induce remission using oral prednisone for 10-16 weeks or oral budesonide (ONLY for ileal of right sided colonic disease) |
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Term
Management of Crohn's Disease:
Moderate disease? |
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Definition
Management of Moderate Crohn's Disease:
Induce remission using oral prednisone for 10-16 weeks or oral budesonide (ONLY for ileal of right sided colonic disease) |
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Term
Management of Crohn's Disease:
Moderate disease, with remission? |
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Definition
Management of Crohn's Disease:
Moderate disease, with remission:
D/C previous agents to control exacerbation, and start maintenance therapy with AZA, MTX, or 6-mercaptopurine |
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Term
Biologic Therapy in CD or UC
What agents are used?
Which are effective for induction of remission and fistula closing? Which is most effective? |
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Definition
Biologic Therapy in CD or UC
Infliximab, Adalimumab, Certolizumab pegol
Infliximab, Adalimumab --> Both efficacious in inducing remission as well as closing fistulas
Infliximab is MOST effective |
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Term
Management of Crohn's Disease:
Moderate disease, without remission to 1st line? |
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Definition
Management of Crohn's Disease:
Moderate disease, without remission to 1st line
SEE SEVERE CD:
IV steroids for 3-10 days, consider biologic therapy + AZA or MTX or 6-mercaptopurine |
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Term
Management of Crohn's Disease:
Severe disease? |
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Definition
Management of Crohn's Disease:
SEVERE CD:
IV steroids for 3-14 days |
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Term
Management of Crohn's Disease:
Severe disease, with remission to 1st line? |
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Definition
Management of Crohn's Disease:
Severe disease, with remission to 1st line
Switch to oral steroids and initiate AZA or MTX or 6-mercaptopurine |
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Term
Management of Crohn's Disease:
Severe disease, without remission to 1st line |
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Definition
Management of Crohn's Disease:
SEVERE CD with no remission following IV steroids for 3-14 days:
Switch to biologic therapy (infliximab etc.) + AZA, 6-MP, or MTX
Maybe surgery |
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Term
Management of Ulcerative Pancolitis:
Mild/Moderate Disease |
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Definition
| Oral 5-ASA and topical 5-ASA |
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Term
Management of Ulcerative Pancolitis:
Mild/Moderate Disease without remission following 5-ASA treatment |
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Definition
Management of Ulcerative Pancolitis:
Mild/Moderate Disease without remission following 5-ASA treatment:
TREAT AS SEVERE:
Oral prednisone 12-15 weeks (be sure to taper off) |
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Term
Management of Ulcerative Pancolitis:
Mild/Moderate Disease with remission following 5-ASA treatment |
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Definition
Management of Ulcerative Pancolitis:
Mild/Moderate Disease with remission following 5-ASA treatment:
D/C topical 5-ASA, continue maintenance dose of 5-ASA |
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Term
Management of Ulcerative Pancolitis:
Severe Disease |
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Definition
Management of Ulcerative Pancolitis:
Severe Disease:
12-16 weeks prednisone po |
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Term
Management of Ulcerative Pancolitis:
Severe Disease then remission following prednisone treatment |
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Definition
Management of Ulcerative Pancolitis:
Severe Disease then remission following prednisone treatment:
D/C prednisone (taper), then begin using 5-ASA oral for maintenance |
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Term
Management of Ulcerative Pancolitis:
Severe Disease WITHOUT remission following prednisone treatment |
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Definition
Management of Ulcerative Pancolitis:
Severe Disease WITHOUT remission following prednisone treatment:
IV steroids in hospital 3-10 days |
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Term
Management of Ulcerative Pancolitis:
Severe Disease not remitted by hospital IV prednisone |
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Definition
Management of Ulcerative Pancolitis:
Severe Disease not remitted by hospital IV prednisone:
Biologic therapy (infliximab etc.), IV cyclosporine, or colectomy |
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Term
Management of proctosigmoiditis
Everything. |
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Definition
Management of proctosigmoiditis
Start with topical 5-ASA, if it remits, discontinue topical 5-ASA. If it returns after remission, use topical 5-ASA again. If it returns AGAIN, add oral 5-ASA. If still no remission, use oral prednisone.
If Remission did not occur with first try of topical 5-ASA, use oral 5-ASA. If still no remission, use Oral prednisone.
If after oral prednisone no remission, go to hospital for IV steroids 3-10 days. If it remits then, taper down with oral prednisone to 0 and continue/restart 5-ASA. If no remission in the hospital consider biologic therapy, IV cyclosporine, or surgery |
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