Inflammation 4

• Inflammation 4

Inflammatory Bowel Disease (IBD)

• Involves chronic inflammatory conditions of the digestive tract
• Includes Crohn's disease and Ulcerative Colitis (UC)
• Risk factors are family history and environmental or bacterial triggers
• Has autoimmune components. GI cells get targeted by an atypical immune response
• Systemic signs and symptoms include fever, anemia, fatigue, weight loss, and rash
• Crohn’s disease can occur anywhere within the GI tract and causes patchy (skip) lesions which can cause lesions in the mouth
• UC affects the large intestine and starts low near rhe anus, and spreads upwards

Treatment for IBD

• Drugs classes
• Glucocorticoids provide short-term treatment and are good for flare-ups
• Aminosalicylates are a good treatment option
• DMARDs (Methotrexate) decreases the immune response and must be used in low doses due to high potency
• Stem cell research using mesenchymal stem cells offers potential treatments

Colonoscopy

• A scope is inserted into the lower GI tract for imaging
• Can help locate cobblestone appearance of surface
• Can help search for fistulas
• Can help search for patchy inflammation
• Can help search for thickening of colon wall

Aminosalicylates

• Sulfasalazine (Azulfidine, Salazopyrin) is a type of aminosalicylate
• PO administered
• Metabolizes in the colon to active metabolites
  • 5-ASA: salicylate (NSAID)
  • Sulfapyridine: immunomodulatory activity (DMARD)

Salicylates

• 5-ASA (Asacol, Teva, Mesalamine) is another
• Route of administration is PO or rectal and works as an NSAID

Asthma

• Also known as bronchial asthma
• A chronic inflammatory airway disorder, but not autoimmune
• Incidence: up to 10% of Canadians
• Risk factors: family history and atopy
• Etiology involves extrinsic asthma. Noxious stimuli trigger allergens, particles, infection, or stress
• There is reactivity of the airways to the mentioned stimuli
• Chronic hypersensitivity develops over time.
• Chronic inflammatory changes can cause epithelial injury
• High goblet cell activity leads to excessive mucous production
• Presentation includes bronchial inflammation, bronchoconstriction, and mucus production.

Asthma Challenges and Treatment

• Chronic bronchial inflammation is a key challenge
• Risk of acute attacks, such as a sudden extreme inflammatory response
• Stabilizing bronchial inflammation and minimizing attacks is the focus
• Avoidance of triggers is crucial
• Daily 'maintenance' drugs are used to decrease bronchial inflammation as controllers
• Correct administration technique using inhalation equipment is important
• Immunizations decrease respiratory infection risk, such as Prevnar to help pneumococcal issues
• Recognizing the signs and symptoms of an attack is beneficial
• Asthma attack drugs, known as 'rescue' drugs or 'relievers,' are available in an emergency
• Call 911 if the attack persists

Asthma Controllers

• Anti-inflammatory drugs that are inhaled
• First-line 'maintenance' treatment
• Offer prophylaxis against 'attacks'
• Drug class: Glucocorticoids such as Pulmicort (Budenoside), Qvar (Beclomethasone), Flovent (Fluticasone)

Asthma treatments

• Mast cell stabilizers like Cromolyn (cromoglicic acid)
• Leukotriene modifiers such as Singulair (montelukast)

Maintenance Biologics

• Biologics, specifically antibodies offer long term maintenance
• Drug: Xolair (omalizumab) as an SC shot
• Has a high affinity for free IgE
• Decreases expression of mast cell-bound IgE
• Reduces mast cell response and allergic inflammation

Asthma Symptoms

• Without treatment bronchoniles narrow due to cytokine release
• Goblet cells increase mucous production
• Trapping CO2 in the alveoli

Asthma Attacks

• Wheezing, shortness of breath, and decreased or no air entry into lung lobes
• Tachycardia is another symptom
• Patients can experience anxiety or panic during an attack
• Sufferers may become fatigued.
• Involves limited inspiration and a longer expiration phase, leading to air trapping in alveoli
• Hyper-inflated lungs occur with low gas exchange
• Ventilation-perfusion mismatch can lead to respiratory issues
• Hypoxemia and hypercarbia can both stem from attacks
• High pulmonary pressures can cause increased RVED, resulting in low CO

Asthma Rescue

• Bronchodilator drugs are inhaled
• Beta 2 adrenergic agonists
• The class of drugs are inhaled, like Albuterol
• The use non-inhalation routes if airways are closed
• Potent, high receptor affinity
• Stimulate SNS's B2 receptors
• Work fast

Asthma Treatment

• Asthma can be countered with Anticholinergics
• They are less potent
• Work to antagonize PNS responses
• They have a slower onset of action
• Offer synergy with Beta2 adrenergic agonists
• Atrovent (Ipratropium) is one such drug

Severe Asthma

• Severe attack could mean ER admission and symptoms of that could be life threatening
• Intervention is needed to help 02 levels, or beta2 adrenergic, or inhaled Ventolin
• Calcium channel blockers can help smooth muscles, as can magnesium sulfate(MgSO4), IV
• Anticholinergics and synergies can help too
• Adrenergics/Sympathomimetics, IV, and Epinephrine (Adrenalin) causes vasoconstriction

Supportive treatments for asthma

• Glucocorticoids IV of Dexamethasone
• Antihistamines IV like Benadryl
• Magnesium sulfate (MgSO4), IV can treat severe bronchoconstriction
• Electrolyte solution is an enzymatic activator
• Calcium channel blocker, with asthma treatment
• Stabilizes mast cells & T-cells, decreasing pro-inflammatory mediators
• Enhances release of NO. Vasodilation and improved has exchanged
• Caution. May result in hypotension. Risk is ok during asthma attacks

Asthma vs Anaphylactic Shock

• Anaphylaxis: systemic vasodilation & bronchoconstriction; Tx: ABCs
• Asthma: airway/breathing
• Asthma Attack something will bronchodilate
• ASTHMA ATTACKS and ANAPHYLAXIS share features, clear differences too
• ANAPHYLAXIS. trouble breathingcoughing, wheezing, stridor,
• asthma. no hives, swelling, vomiting, o diarrhea
• both asthma atacks anaphylaxis cause bluish skin, increased heart, decreased blood pressure, altered mental
• If not sure if attack ot anaphylaxix TREAT BOTH epinephrine then albuterol

This lesson covers Inflammatory Bowel Disease (IBD), including Crohn's disease and Ulcerative Colitis (UC). It explores risk factors, autoimmune components, systemic signs/symptoms and treatment options like glucocorticoids, aminosalicylates, and DMARDs. It also discusses colonoscopy and stem cell research.