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NAPLEX (2023/2024) EXAM STUDY GUIDE COMPLETE RATED A.
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NAPLEX (2023/2024) EXAM STUDY GUIDE COMPLETE RATED A.
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NAPLEX (2023/2024) EXAM STUDY GUIDECOMPLETE RATED A.
Distal disease: limited to descending colon and rectum; treat with topical
(Rectal) treatment
Proctitis: inflammation limited to rectum
Mild, moderate, severe, fulminant
- moderate > 4 stools per day with minimal signs of toxicity
- severe >/= 6 bloody stools per day with evidence of toxicity
- fulminant > 10 bloody stools per day and severe sx
Chrohn's disease (CD)
✔✔deep, transmural inflammation that can affect any part of the GI tract;
ileum and colon are most commonly affected
CD and UC comparison
✔✔CD: bloody or non-bloody diarrhea, fistulas/strictures common,
entire GI tract, transmural, non-continuous (cobblestone) appearance,
smoking is risk factor
UC: bloody diarrhea, fistulas/strictures uncommon, colon, superficial,
continuous pattern, smoking is protective
Supportive care in IBD
✔✔vitamin supplements to prevent deficiencies related to malabsorption
,probiotics
fish oils
Induction of remission options for CD
✔✔Steroids (+/- thiopurine or methotrexate)
Anti-TNF +/- thiopurine
Ustekinumab (Stelara)
Induction of remission options for UC
✔✔5-ASA (oral or rectal) +/- steroids or thiopurine
Anti-TNF +/- thiopurine
Ustekinumab (Stelara)
IV cyclosporine
Tofacitinib (xeljanz)
Vedolizumab (Entyvio)
Maintenance of remission in CD
✔✔Mild disease of ileum and/or right colon:
- oral budesonide for </= 3 months; the, d/c tx or change to thiopurine
or MTX
Moderate-severe disease
- anti-TNF agents: adalimumab, infliximab, certolizumab
- thiopurines (azathioprine, mercaptopurine)
,- MTX
- IL receptor antagonist: ustekinumab (Stelara)
Refractory/steroid dependent
- Integrin receptor antagonists: vedolizumab, natalizumab
Maintenance of remission in UC
✔✔Mild:
-5-ASA (mesalamine) rectal and/or oral
Mod-Severe: (alone or in combo)
-Anti-TNFs (Humira, Remicade, Simponi)
-Thiopurine (azathioprine, mercaptopurine)
-Cyclosporine* (if SEVERE UC)
-IL-receptor antagonist: Ustekinumab (Stelara)
-JAK inhibitor: Tofacitinib (Xeljanz) (NOT FIRST-LINE)
Refractory:
- Integrin receptor antagonist: Vedolizumab (Entyvio)
Budesonide
✔✔Entocort EC: for CD only
Uceris: for UC only
, For management of acute flares; undergoes extensive first-pass
metabolism; less systemic exposure than oral steroids
*major CYP3A4 substrate
Rectal steroids
✔✔Hydrocortisone (cortifoam)
Budesonide Rectal (uceris)
*indicated for UC only
Aminosalicylates: Meslamine ER
✔✔Indicated for treatment of UC; topical anti-inflammatory effect in GI
tract
ER capsules (Pentasa)
ER tabs (Asacol HD)
Enema (Rowasa): retain overnight (8 hours)
Suppository (Canasa): retain at least 1-3 hours
CI: hypersensitivity to salicylates
Integrin Receptor Antagonists
✔✔Natalizumab (Tysabri): injection, approved for Crohn's disease and
MS; REMS
- every 4 weeks; d/c if no response by 12 weeks
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