IBD Part 2

In IBD, what are the updated guidelines for treatment?

• Separate disease activity from disease severity

• Include prognosis when deciding on induction and maintenance therapy

• Focus on mucosal healing and objective evidence of disease control, including fecal calprotectin

• All biologics are appropriate 1st line for pts whose severity warrants it

What is the window of opportunity?

• Intervention early in the disease is better to put a biologic vs drugs that may not work

• Another intervention point is surgery which is last line

What are sulfasalazine S/E? What are comments with sulfasalazine?

• Sulfapyradine groups causes a lot of ADRs vs Mesalamine

  • N/V/H

  • Rash, anemia, pneumonitis

  • Hepatotoxicity, nephritis

  • Thrombocytopenia, lymphoma

  • Hypersensitivity rxns more likely than with mesalamine

  • CI: salicylate, sulfa allergy

• DR tablets less GI intolerance

• May cause urine/skin to turn yellow-orange color

• Take folate 1 mg/day

• Caution in pts with G6PD deficiency

• Reduce sperm count and fertility inmates, reversible

What are the 5-ASA?

• Mesalamine

• Balsalazine

• Olsalazine

What is the CI of 5-ASA?

• Salicylate allergy

What are comments in mesalamine?

• Better tolerated than sulfasalazine

• …

What are the different formulations of Mesalamine?

• Mesalamine suppository → rectum

• Mesalamine enema or steroid enema → rectum, distal colon

• Apriso, balsalazide, lialda, olsalazine, deltzicol → rectum, distal colon, proximal colon

• Asacol HD → rectum, distal colon, proximal colon, terminal ileum

• Pentasa → rectum, distal colon, proximal colon, terminal ileum, ileum, jejunum

AZA gets converted to 6-MP which leads to what?

• TPMT → 6methyl mercaptopurine

  • Poor TPMT means more other pathways

• XO → 6 thiouric acid

• 6-thioinisoinc acid → 6-thioguanine nucleotides

What are XO inhibitors which interact with AZA and 6-MP

• Allopurinol

Dose of 6-mP or AZA should be reduced b

Feboxustat is CI with AZA and 6-MP?

Methotrexate is for which use only?

• CD

MTX is CI where?

• Pregnancy and breastfeeding

How is Cyclosporine used?

• 20 weeks to see response

• Cyclosporine levels should be checked

Cyclosporine is CI with what?

• DDI with all statins

• CI with simvastatin, pitavastatin

• NTW 10 mg atorvastatin, 5 mg rosuvastatin

QUIZ

• What is oligospermia? → reduce sperm count, med is sulfasalazine

• Which labs are markers of inflammation? → CRP, ESR (nonspecific)

• Uceris is what? → Budesonide

• Urine turn yellow/orange? → Sulfasalazine

  • NO SASLICAYLATE ALLERGY

• Mesalamine can be taken in sulfur but not salicylate allergy

• Chrons nutritional deficiency → B12 and Vitamin A, B, C, D, B12, folate, iron

• S/E in Chrons is terminal ilium

• Pts with actie inflammatory bowel disease → FIBER IS FALSE NO FIBER

• Not to be used in maintenenace of remission? → STEROIDS

• Prior to initiating azothiaprine → TMPT enzyme activity b/c low can cause myelosuppression

• Greater risk of colorectal cancer → UC patients not CD