IBD Part 2

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34 Terms

1

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

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2

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

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3

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

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4

What are the 5-ASA?

  • Mesalamine

  • Balsalazine

  • Olsalazine

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5

What is the CI of 5-ASA?

  • Salicylate allergy

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6

What are comments in mesalamine?

  • Better tolerated than sulfasalazine

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7

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

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10

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

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11

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

  • Allopurinol

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12

Dose of 6-mP or AZA should be reduced b

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13

Feboxustat is CI with AZA and 6-MP?

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14

Methotrexate is for which use only?

  • CD

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15

MTX is CI where?

  • Pregnancy and breastfeeding

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16

How is Cyclosporine used?

  • 20 weeks to see response

  • Cyclosporine levels should be checked

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17

Cyclosporine is CI with what?

  • DDI with all statins

  • CI with simvastatin, pitavastatin

  • NTW 10 mg atorvastatin, 5 mg rosuvastatin

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18

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

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