Pharmacotherapy of IBD Flashcards

Comprehensive vocabulary flashcards covering the pathology, classification, and pharmacotherapeutic management of Ulcerative Colitis and Crohn's Disease.

Harvey-Bradshaw Activity Index (CD)

A clinical tool used to assess Crohn's Disease activity based on patient well-being, abdominal pain, liquid stools, abdominal mass, and complications; a score of $< 5$ indicates inactive disease.

Simple Clinical Colitis Activity Index (UC)

An assessment tool for Ulcerative Colitis where a score of $< 4$ is indicative of inactive disease.

Mucosal healing

A therapeutic goal associated with decreased likelihood of flares, reduced progression to complications, and a decreased need for surgery or hospitalization.

Enteral nutrition (EN)

A nutritional support method shown to reduce inflammation and intestinal cytokine production, potentially helping to induce and maintain remission in CD.

Proctocolectomy

A surgical procedure involving the placement of a permanent ileostomy, which is considered curative in Ulcerative Colitis.

Mild Ulcerative Colitis

Disease severity characterized by $< 4$ stools daily, with or without blood, and no systemic disturbances such as fever or tachycardia.

Fulminant Ulcerative Colitis

Disease severity characterized by $> 10$ bowel movements daily with continuous bleeding, toxicity, abdominal tenderness, and colonic dilation.

Step-up approach

The treatment strategy typically used for Ulcerative Colitis, starting with safer medications and intensifying therapy if they are ineffective.

Step-down approach

The treatment strategy typically used for Crohn's Disease, starting with more intense therapy and deescalating as appropriate.

Mild-moderate Crohn's Disease

Disease state where patients are usually ambulatory with no evidence of dehydration, systemic toxicity, weight loss, or abdominal tenderness.

Aminosalicylates ($5$-ASAs)

A pharmacological class including sulfasalazine and mesalamine, used as first-line agents for induction and maintenance of remission in mild-to-moderate UC.

Budesonide ($MMX$)

A controlled-release corticosteroid used at a dose of $9\,mg/day$ to induce remission in mild-to-moderate IBD but not for long-term maintenance.

Tofacitinib ($Xeljanz$)

An oral tablet approved for moderate-to-severe UC in patients unresponsive to $TNF$-alpha inhibitors, carrying a black box warning for thrombosis.

Infliximab ($Remicade$)

A $TNF-\alpha$ inhibitor that binds $TNF-\alpha$ and induces $T$-cell apoptosis, used for moderate-to-severe UC and CD, including steroid-dependent or fistulizing disease.

Vedolizumab ($Entyvio$)

An integrin antagonist that binds to a specific subtype of the $\alpha 4$ subunit unique to leukocyte trafficking in the gut.

Azathioprine (AZA)

An immunomodulator with a slow onset of $3-6$ months, reserved for patients failing $5$-ASAs or those who are steroid-dependent.

Methotrexate

An immunomodulator administered weekly via $IM$ or $SC$ injection, used for maintenance therapy in Crohn's Disease.

Ustekinumab ($Stelara$)

A biologic that blocks $IL-12$ and $IL-23$ action by binding to the $p40$ protein subunit; used for moderate-to-severe CD.

Therapeutic Drug Monitoring ($TDM$)

Checking serum trough drug and antibody levels to guide management, classified as either Reactive (when symptoms worsen) or Proactive (in clinical remission).

Natalizumab

An integrin antagonist that binds the $\alpha 4$ subunit and requires enrollment in the $CD Touch^{\circledR}$ Prescribing Program due to risks of Progressive Multifocal Leukoencephalopathy ($PML$).