IBD

Question 1

name some aminosalicylates (3)

Answer 1

mesalazine
olsalazine
sulfasalazine

Question 2

what drugs would you use to induce IBD remission and not for long-term therapy?

Answer 2

corticosteroids

Question 3

what do you need to monitor in someone on steroids?

Answer 3

assess for osteoporosis, assess for cushingoid features, hyperglycaemia, cataracts or glaucoma

Question 4

name some immunosuppressants used in IBD

Answer 4

azathioprine

methotrexate

Question 5

biological agents used in IBD

Answer 5

infliximab, adalimumab etc.

Question 6

does maintenance corticosteroid therapy reduce the risk of relapse in Crohn’s disease?

Answer 6

no

Question 7

when crohn’s is confined to the distal colon, what treatment might be effective?

Answer 7

topical corticosteriod
+
oral aminosalicylate e.g. mesalazine

Question 8

what drug isn’t effective if crohn’s has spread outside the colon?

Answer 8

aminosalicylates

Question 9

how long can a single infusion of infliximab or adalimumab induce remission for in someone with crohn’s disease?

Answer 9

3 months

Question 10

what option is there for crohn’s disease if it doesn’t respond to medical therapy?

Answer 10

surgical resection

Question 11

what drugs should be avoided in patienst with UC as they exacerbate symptoms?

Answer 11

NSAIDs and COX-2 inhibitors

Question 12

what drug, used to treat diarrhoea, can precipitate toxic megacolon if used in UC?

Answer 12

opioids

Question 13

if UC is limited to distal colon what is best drug to try first?

Answer 13

mesalazine

in form of foam/liquid enemas or suppositories

Question 14

if repeated coruses of steroids are needed in IBD what drug can be effective?

Answer 14

azathioprine

however - has a slow onset of action (12-16wks)

Question 15

how would you manage acute severe colitis?

Answer 15

1. fluid and electrolyte replacement
2. correct anaemia via transfusion
3. IV corticosteroid
4. infliximab and adalimumab can induce remission in 40% of cases of corticosteroid refractory disease (patients whose symptoms haven’t responded to corticosteroids)
5. colectomy if conservative treatmetn cant settle UC

Question 16

how to UC patients maintain remission?

Answer 16

1. topical and/or oral mesalazine for life

2. if disease flares occure despite regular mesalazine, add immunosuppressant e.g. azathioprine