Term
up to 4 bloody or watery stools per day
no systemic signs of toxicity or increased ESR |
|
Definition
| mild stage of ulcerative colitis has what characteristics? |
|
|
Term
| > 4 stools per day with evidence of systemic toxicity |
|
Definition
| moderate stage of ulcerative colitis has what characteristics? |
|
|
Term
> 6 stools per day
evidence of aneamia, tachycardia, or increased ESR or CRP |
|
Definition
| severe stage of ulcerative colitis has what characteristics? |
|
|
Term
| > 10 stools per day with continuous bleeding, signs of systemic toxicity, abdominal distension or tenderness, colonic dilation, or requirement of blood transfusion |
|
Definition
| fulminant ulcerative colitis has what characteristics? |
|
|
Term
precipitating toxic megacolon
anticholinergics to reduce spasms may also reduce GI motility and should generally be avoided (hyoscyamine and dicylomine) |
|
Definition
| antidiarrheal agents (loperamide, diphenoxylate/atropine, codeine) affecting motility should be avoided in patients with active IBC due to the risk of ( ) |
|
|
Term
deliver 5-ASA to areas of inflammation in the GIT, favorable anti-inflammatory effects
mostly topical effects
FIRST LINE AGENT FOR MILD-MODERATE UC AND CROHN'S |
|
Definition
|
|
Term
aminosalicylate
sulfapyridine is the carrier molecule to allow colonic delivery
absorbed and excreted renally
ADRs are probably due to sulfapyridine
dose titration to avoid/limit ADRs
avoid if sulfonamide allergy
released in the colon |
|
Definition
|
|
Term
olsalazine
balsalazide
generally better tolerated than sulfasalazine |
|
Definition
| non-sulfa containing aminosalicylates |
|
|
Term
aminosalicylate
formulation with pH sensitive coat
releases in terminal ileum and colon |
|
Definition
| MOA of lialda and where is it released? |
|
|
Term
aminosalicylate
enteric coated for extended release
releases in colon |
|
Definition
| MOA os apriso and where is it released? |
|
|
Term
aminosalicylate
delayed release capsule that is released in the stomach, jejunum, ileum, and colon |
|
Definition
| MOA of pentasa and where is it released? |
|
|
Term
glucocorticoid for CD
low systemic bioavailability may prevent some long term effects
released into terminal ileum
only for terminal ileal/ascending colonic disease |
|
Definition
| MOA of budesonide and where is it released |
|
|
Term
reduces IBD associated GI inflammation
MAINTAIN REMISSION of IBD
reduce need for long term corticosteroids
role in active disease is limited
slow onset of action (3-12 months) |
|
Definition
| use of azathioprine in IBD |
|
|
Term
may interrupt inflammatory response directed against endogenous bacterial flora
metronidazole:
some patients with pouchitis (inflammation of surgically created intestinal pouches)
patients with CD with perianal fistulas
ciprofloxacin:
some efficacy in refractory active CD
ADRs:
both drugs - diarrhea
metronidazole long term - peripheral neuropathy |
|
Definition
| use of antibiotics for CD |
|
|
Term
active disease:
mesalamine suppository daily
maintenacne of remission:
may reduce suppository frequency to 3x/week |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
MILD DISEASE
proctitis |
|
|
Term
active disease:
mesalamine enema daily
OR
mesalamine po daily
OR
sulfasalazine po daily
maintenance of remission:
may reduce enema frequency to every other day
OR
taper po mesalamine or sulfasalazine |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
MILD DISEASE
left-sided disease |
|
|
Term
active disease:
mesalamine po daily
OR
sulfasalazine po daily
maintenance of remission:
taper po mesalamine or sulfasalazine |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
MILD DISEASE
colitits |
|
|
Term
active disease:
mesalamine suppository daily
if no response to mesalamine suppository - prednisone po daily
maintenance of remission:
may reduce suppository frequency to 3x/week
taper prednisone as soon as possible
consider adding azathioprine or 6-MP po daily |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
MODERATE DISEASE
proctitis |
|
|
Term
active disease:
mesalamine enema at bedtime daily
OR
mesalamine daily
OR
sulfasalazine daily
may combine enema and oral therapies
maintenance of remission:
may reduce enema frequency to 3x/week if symptoms permit
may reduce dose of oral agents if symptoms permit
consider adding azathioprine or 6-MP po daily |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
MODERATE DISEASE
left sided disease |
|
|
Term
active disease:
mesalamine po daily
OR
sulfasalazine po daily
if no response to mesalamine or sulfasalazine:
prednisone po daily
OR
infliximab IV
maintenance of remission:
taper mesalamine or sulfasalazine
if prednisone or infliximab were required:
taper prednisone as soon as possible
give infliximab IV q8 weeks
consider adding azathioprine or 6-MP po daily |
|
Definition
treatment of ulcerative colitis active disease and maintenacne of remission
MODERATE DISEASE
colitis |
|
|
Term
active disease:
hydrocortisone IV daily x7d
OR
infliximab IV
if no response to IV corticosteroids or infliximab:
cyclosporin IV
maintenance of remission:
change to oral corticosteroid and taper as soon as possible
restart oral mesalamine or sulfasalazine
may continue infliximab at maintenance doses IV q8 weeks |
|
Definition
treatment of ulcerative colitis active disease and maintenance of remission
SEVERE OR FULMINANT DISEASE |
|
|
Term
| may require 4-8 weeks of therapy |
|
Definition
| how long must the active disease of ulcerative colitis be treated before remission therapy can begin? |
|
|
Term
topical or oral corticosteroids
corticosteroids are for ACTIVE DISEASE
NEVER use long-term corticosteroids |
|
Definition
| what is not effective for maintaining remission of distal ulcerative colitis? |
|
|
Term
active disease:
mesalamine po daily
OR
sulfasalazine po daily
maintenance of remission:
taper mesalamine or sulfasalazine po daily |
|
Definition
treatment of crohn's disease - active disease and maintenacne of remission
MILD DISEASE
ileal or ileocolonic |
|
|
Term
active disease:
budesonide po daily x8 weeks
maintenance of remission:
taper budesonide po daily x3 months |
|
Definition
treatment of crohn's disease - active disease and maintenance of remission
MILD DISEASE
ileal +/- ascending colon |
|
|
Term
active disease:
mesalamine po daily
OR
sulfasalazine po daily
may add metronidazole OR ciprofloxacin po daily
maintenance of remission:
taper mesalamine or sulfasalazine po daily |
|
Definition
treatment of crohn's disease - active disease and maintenance of remission
MILD DISEASE
perianal |
|
|
Term
active disease:
same treatment as for mild disease
if inadequate response to aminosalicylate, consider:
infliximab or adalimumab or certolizumab
OR
prednisone po daily
OR
budesonide po daily x8 weeks
consider natalizumab if no response to prior therapies
if fistulizing disease consider infliximab or adalimumab
maintenance of remission:
continue aminosalicylate at maintenance dose
may continue infliximab at maintenance dose
if loss of response to infliximab, consider adalimumab
taper predinisone as soon as possible
taper budesonide po daily x3 months
consider adding azathioprine or 6-MP po OR methotrexate po/IM/SQ weekly
consider natalizumab if no response to previous therapies |
|
Definition
treatment of crohn's disease - active disease and maintenance of remission
MODERATE DISEASE |
|
|
Term
active disease:
hydrocortisone IV daily x7d
OR
infliximab (severe or fistulizing disease) IV
adalimumab or certolizumab
OR
consider natalizumab if no response to prior therapies
consider cyclosporin po daily for refractory disease
maintenance of remission:
taper corticosteroid as soon as possible
may contineu infliximab, adalimumab, certolizumab, or natalizumab
consider adding azathioprine or 6-MP po daily OR methotrexate po/IM/SQ weekly |
|
Definition
treatment of crohn's disease - active disease and maintenance of remission
SEVERE OR FULMINANT DISEASE |
|
|
Term
clinical presentation is similar
comorbid diseases complicate diagnosis
increased medication use, indluding NSAIDs
similar treatment:
corticosteroids can worsen DM, HTN, HF, and osteoporosis
TNFa inhibitors worsen HF
surgery:
higher risk for surgical complications
may not meet elegibility requirements for surgery |
|
Definition
| treatment of IBD in the elderly |
|
|
Term
risk of growth failure:
inadequte nutrition intake
aggressive nutritional intervention
chronic corticosteroids:
reduction in growth and bone mineralization
aminosalicylates, azathioprine, 6-MP, and infliximab are all options |
|
Definition
| treatment of IBD in children and adolescents |
|
|
Term
optimal to induce and maintain remission prior to conception
active IBD:
prematurity
low birth weight
aminosalicylates considered safe
sulfasalazine -> folate malabsorption
supplement with folic acid
corticosteroids well tolerated with minimal risk ot mother and fetus
azathioprine and 6-MP
used successfully in pregnancy patients
appear to carry minimal risk
category D
infliximab, adalimumab, certolizumab
category B
appear to carry minimal risk
natalizumab
category C, salvage therapy
MTX
contraindicated in pregnancy |
|
Definition
| treatment of IBD in pregnancy |
|
|
