Term
|
Definition
1.Relieve symptoms and improve quality of life
2.Improve nutritional status& growth
3.Identify and treat extraintestinal manifestations
4.Prevent development of Cancer
5.Prevent recurrence |
|
|
Term
| First thing in management of CD |
|
Definition
| Establish site and activity |
|
|
Term
|
Definition
| Induce remission with SSZ/5-ASA for 4-6 weeks |
|
|
Term
| Mild Illeal/right colonic CD |
|
Definition
| Oral Budesonide for 8-16 weeks |
|
|
Term
|
Definition
| D/C and maintain on AZA/6MP/MTX |
|
|
Term
| If remission not achieved |
|
Definition
| Oral steroids(Prednisolone) |
|
|
Term
| Dose of ASA for remission |
|
Definition
| 4.8g/day in divided doses |
|
|
Term
| Dose of ASA for mantainance |
|
Definition
0.8-3.2 g per day
Abrupt discontinuation not recmonded |
|
|
Term
|
Definition
GI: Abdominal pain,cramps, diarrhoea,nausea, vomiting
hypersensitivity reactions: Pneumonitis ,Hepatitis and
rashes, Urticaria
Headaches
Worsening of colitis |
|
|
Term
| Interaction with metabolites |
|
Definition
| Increased risk of myelosuppression with AZA/6MP |
|
|
Term
|
Definition
|
|
Term
|
Definition
Induce remission with oral prednisolone for 10-16 weeks
Dose 40-60 mg |
|
|
Term
| Rx of moderated CD illeal/right sided colonic |
|
Definition
Oral budesonide 8-16 weeks
ive 9mg AM |
|
|
Term
|
Definition
| Mantainance therapy with AZA/6 MP/MTX |
|
|
Term
| Moderated CD not in remission |
|
Definition
IV steroids 3-10 days
Hydrocortisone 300-400mg OR
Methylprednisolone 40-60mg IV |
|
|
Term
| Moderated CD not in remission( continued) |
|
Definition
| Consider biologic therapy+ AZA |
|
|
Term
|
Definition
| Start IV steroids for 3-14 days |
|
|
Term
|
Definition
Switch to oral steroids
Prednisolone
Budesonide
Initiate AZA |
|
|
Term
|
Definition
Biologic therapy+AZA or 6MP or MTX
Consider Surgery in select cases |
|
|
Term
|
Definition
|
|
Term
|
Definition
GI discomfort, nausea, stomatitis, diarrhoea, vomiting, anorexia,
Increased risk of oppurtunistic infections
Rare: Pancreatitis,Hepatotoxic |
|
|
Term
| Interaction of AZA with Anticoagulants |
|
Definition
| increased risk of bleeding |
|
|
Term
| AZA interaction with allopurinol |
|
Definition
increased AZA toxicity,
Dose adjustment may be necessary |
|
|
Term
| AZA interaction with ACEI |
|
Definition
| Increased chance of neutropenia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| metabolism may be affected by genetic polymorphism |
|
|
Term
|
Definition
|
|
Term
|
Definition
25 mg im weekly
Coadministrationof Folic acid 1mg is recomonded |
|
|
Term
|
Definition
Flu like illness headache, oral ulcer
Hepatotoxicity, BM toxicity
Immunosuppression
Lymphoma |
|
|
Term
|
Definition
| Increased risk of hepatotoxicity,must abstain from alcohol |
|
|
Term
| Interaction of MTX with NSAID |
|
Definition
| May increase the MTX levels |
|
|
Term
|
Definition
| Contraindicated in pregnancy |
|
|
Term
|
Definition
| Adalimumab,Infliximab, Certolizumab |
|
|
Term
|
Definition
| Recombinant human antiTNF-alpha |
|
|
Term
| Indications of Adalizumab |
|
Definition
| Moderate or severe IBD which is not responsive to steroids |
|
|
Term
|
Definition
Active Disease: 160mg sc at week 0
then 80mg sc at week 2
Them 40 mg sc at week 4 and continue alternative week |
|
|
Term
| SE of Adalizumab/Infliximab |
|
Definition
Nausea, abdominal pain
injection site rxns
Infections: TB, Hepatis B,C,URTIs, opportunistic infections
ANA and SLE like rxnx
worsening of CHF
worsening of demyelinatin disease |
|
|
Term
| DI of Adalizumab/ Infliximab |
|
Definition
|
|
Term
| Pre tx evaluation before Adalizumab |
|
Definition
| TB, Hepatitis B and C, Varicella |
|
|
Term
|
Definition
|
|
Term
| Dose of Infliximab in active disease |
|
Definition
Active disease: 5mg/kg iv at 0, 2 and 6 weeks
May increase to 10mg/kg if no response |
|
|
Term
| Mnatainance dose of infliximab |
|
Definition
|
|
Term
| Mild to moderate Ulcerative pancolitis |
|
Definition
| High dose of oral 5ASA and topical ASA |
|
|
Term
| Mild to moderate Ulcerative pancolitis in remission |
|
Definition
| Withdraw topical ASA and continue oral ASA |
|
|
Term
| Mild to moderate Ulcerative pancolitis not in remission |
|
Definition
| High dose of oral 5ASA and topical ASA Add Prednisolone 30-60mg per day tapering to 0 within 12-16 weeks |
|
|
Term
| Severe Ulcerative pancolotis |
|
Definition
| Add Prednisolone 30-60mg per day tapering to 0 within 12-16 weeks |
|
|
Term
| Severe Ulcerative pancolotis not in remission |
|
Definition
IV steroids 3-10 days
Hydrocortisone 300-400mg OR
Methylprednisolone 40-60mg IV |
|
|
Term
| Severe Ulcerative pancolotis now in remission |
|
Definition
Switch to oral prednisolone 30-60mg per day and taper down to 0
Continue or start with ASA |
|
|
Term
| Severe Ulcerative pancolotis not in remission after IV steroids |
|
Definition
Biologic therapy
IV cyclosporin
Consider colectomy in severe cases |
|
|
Term
| Severe Ulcerative pancolotis now in remission after oral steroids |
|
Definition
Maintain 5-ASA
Consider AZA or 6 MP |
|
|
Term
|
Definition
|
|
Term
|
Definition
Renal toxicity,
Hypertension
Hypertrichosis
Cytopenias and oppurtunistic infections
gum hyperplasia
Nausea, diarrhea and electrolytes
imbalance
May ppt seizures |
|
|
Term
|
Definition
| In few patients with severe disease to avoid colectomy |
|
|
Term
|
Definition
|
|
Term
| Ulcerative proctosigmoiditis Rx |
|
Definition
topical 5 ASA
Enema:4gm QHS
Suppository:1gm QHS |
|
|
Term
| Maintainance dose of topical ASA |
|
Definition
Enema:2gm QHS OR
4gm every 2nd or 4th night
Suppository: 1gm every 2nd or 3rd night |
|
|
Term
| Ulcerative proctosigmoiditis Rx recurrent or not responding to topical therapy |
|
Definition
| Add oral ASA and try to reduce topical therapy |
|
|
Term
| Ulcerative proctosigmoiditis Rx recurrent or not responding to topical and oral therapy |
|
Definition
| Oral prednisolone+Immunosuppressives+-Biologic therapy |
|
|
