IBD

What are the 2 major types of IBD?

• Ulcerative colitis

• Chrohns Disease

Classic symptom of IBD

Bloody diarrhea

What medication can cause IBD flares?

NSAIDs

Difference between IBD & IBS?

IBS does not cause inflammation

Entire GIT

A. Ulcerative colitis

B. Crohns disease

B. Crohns disease

Colon ONLY

A. Ulcerative colitis

B. Crohns disease

A. Ulcerative colitis

Transmural depth

A. Ulcerative colitis

B. Crohns disease

B. Crohns disease

Superficial depth

A. Ulcerative colitis

B. Crohns disease

A. Ulcerative colitis

Continuous

A. Ulcerative colitis

B. Crohns disease

A. Ulcerative colitis

IBD diagnosis

Colonscopy with tissue biopsy

Nonpharm food/drinks IBD

• Smaller, more frequent meals that are low in fat dairy

• Drink plenty of water

Acute exacerbation TX

• Crohns: steroids

• UC: aminosalicylates +/- steriods

Crohns Disease TX (mild vs mod-sev disease)

MILD DISEASE: 

Oral budesonide for ≤ 3 months, then d/c or change to thiopurine or MTX

MOD-SEVERE DISEASE:

• Anti-TNF +/- MTX or a thiopurine

• IL receptor antagonist

• Integrin receptor antagonist (Vedolizumab)

• Alternatives: JAK inhibitor

Ulcerative colitis TX (mild vs mod-sev disease)

MILD DISEASE:

Mesalamine (5-ASA)

MOD-SEVERE DISEASE:

• Anti-TNF +/- thiopurine

• IL receptor antagonist

• Integrin receptor antagonist

• Oral S1P

• Alternative: JAK inhibitor

Budesonide brand

Entocort EC, Uceris

Mesalamine brand names

Pentasa (ER caps), Enema (Rowasa), Suppository (Canasa)

Mesalamine suppository needs to be retained for ≥ __-__ hours

1-3

Mesalamine enema needs to be retained _____

overnight

Azathioprine genetic testing

TPMT

Azathioprine is metabolized to ______

mercaptopurine

Natalizumab brand

Tysabri

Natalizumab ___ over 1 hour every ___ weeks

IV every 4 weeks

Vedolizumab brand

Entyvio (IV), Entyvio Pen (SC)

T/F: Vedolizumab comes in IV and SC

True

Vedolizumab should be d/c if no benefit by week ____.

14

What steroids are avaliable as rectal foam products for IBD?

A. Prednisone and budesonide

B. Budesonide and dexamethasone

C. Hydrocortisone and prednsione

D. Hydrocortisone and methylprednisolone

E. Budesonide and hydrocortisone

E. Budesonide and hydrocortisone

Uworld

Is entocort EC only for UC or CD

CD

Is Uceris only for UC or CD

CD

Oral steroids

Prednisone

Budesonide

Oral steroids short term side effects

Increased appetite/weight gain

emotion instability

insomnia

Why use alternating days for steroids

Decrease adrenal suppression

If long term use of steroids required what must be done

Assess bone density

Optimize calcium and vit D intake

Consider bisphosphonates

Why does budesonide provide less systemic side effects

Extensive first pass metabolism

Can you chew/crush budesonide

no

Are rectal steroids for UC or CD

UC

Budesonide DDI

CYP3A4 inhibitors

Aminosalicylates indication

UC

Aminosalicylates

sulfasalazine

mesalamine

Balasalazide (Colazal)

Olsalazine

Sulfasalazine contraindication

sulfa allergy

Mesalamine contraindication

Hypersensitivity to salicylates or aminosalicylates

Which is more effective for distal disease/proctitis in UC, rectal or oral mesalamine

Rectal

Which mesalamine formulation can result in a ghost tablet

Delzicol

Which aminosalicylate can cause staining of the teeth/tongue

Balasalazide

List thiopurine

Azathioprine

Mercaptoprine

Azathioprine warnings

Genetic deficiency of thiopurine methyltransferase (TMPT)

increased risk of myelosuppression

Azathioprine montoring

CBC

List integrin receptor antagonists

Natalizumab

Vedolizumab

BW of natalizumab

Progressive multifocal leukoencephalopathy (PML)

Only available thru REMS

Vedolizumab warnings

Infusion rxns

Infections

Immunizations must be up to date (avoid live vaccines)

Is vedolizumab for UC or CD

UC and CD

Is natalizumab for UC or CD

CD

Is methotrexate for UC or CD

CD

Methotrexate dosing frequency

IM or SC once weekly

Is cyclosporine for UC or CD

UC

Interleukin receptor antagonist for CD and UC

Ustekinumab (Stelara)

Janus kinase inhibitor for UC only

Tofacitinib (Xeljanz)

Anti-TNF agents for both UC and CD

Adalimumab

Infliximab

Anti-TNF agents for only UC

Golimumab

Anti-TNF agents for only CD

Certolizumab