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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