Inflammatory Bowel Disease Treatment Goals

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Questions and Answers

What is a primary goal of IBD treatment?

Eradicate the disease completely.

Focus on dietary modifications only.

Cure the condition through surgery.

Control inflammation and improve quality of life. (correct)

Why are drugs the preferred treatment for Crohn's disease over surgery?

There are no effective drug therapies for Crohn's disease.

Drugs are less expensive than surgery.

Surgery is only effective for ulcerative colitis.

The recurrence rate is high after surgical treatment. (correct)

Which of the following is NOT a major drug class used to treat IBD?

Antifungals (correct)

Immunomodulators

Aminosalicylates

Antimicrobials

What is the initial treatment for Ulcerative Colitis (UC)?

Corticosteroid for symptom relief with an aminosalicylate or biologic therapy. (A) Signup and view all the answers

What is the primary mechanism of action of 5-aminosalicylic acid (5-ASA) drugs?

Suppresses the production of pro-inflammatory cytokines and mediators. (D) Signup and view all the answers

What is an advantage of using rectal administration of aminosalicylates?

It allows for direct delivery of the medication to the affected tissues. (A) Signup and view all the answers

How do biologics reduce IBD-related inflammation?

By blocking specific proteins that play a role in inflammation. (C) Signup and view all the answers

What type of biologic therapy is infliximab (Remicade)?

Anti-TNF agent (A) Signup and view all the answers

Which of the following is NOT a common side effect associated with anti-TNF agents?

Hypersensitivity reactions (B) Signup and view all the answers

A patient is about to start therapy with an anti-TNF agent. Which of the following tests is essential before beginning treatment?

Tuberculosis and hepatitis screening (B) Signup and view all the answers

Which of the following best describes the mechanism of action of alpha 4-integrin inhibitors?

Inhibiting leukocyte adhesion (A) Signup and view all the answers

Which medication requires a restricted program due to the risk for progressive multifocal leukoencephalopathy?

Natalizumab (B) Signup and view all the answers

What is the primary action of IL-12/23 antagonists in the treatment of inflammatory bowel disease?

To prevent the activation of T-helper and natural killer cells (C) Signup and view all the answers

Which drug class is known to suppress the immune system by blocking the JAK enzyme?

JAK inhibitors (C) Signup and view all the answers

Why are corticosteroids given for the shortest possible time in treating inflammatory bowel disease?

To minimize long-term side effects (B) Signup and view all the answers

A patient with inflammation in the left colon, sigmoid, and rectum would benefit from which type of corticosteroid administration?

Suppositories, enemas, and foams (D) Signup and view all the answers

Which of the following best describes immunogenicity in the context of biologic therapies?

The ability to induce the production of antibodies against the drug (D) Signup and view all the answers

When is stopping and restarting a biologic drug most likely to cause infusion reactions?

When the drug is stopped and then restarted (A) Signup and view all the answers

Study Notes

Inflammatory Bowel Disease (IBD) Treatment Goals

IBD treatment aims to:
- Rest the bowel
- Control inflammation
- Correct malnutrition
- Provide symptomatic relief
- Improve quality of life
No cure exists for IBD

Drug Therapy for IBD

The goal is to induce and maintain remission
Five main drug classes are used:
- Aminosalicylates
- Antimicrobials
- Corticosteroids
- Immunomodulators
- Biologic therapies
Drug choice depends on inflammation location and severity
Initial ulcerative colitis (UC) treatment includes corticosteroids for symptom relief, then aminosalicylates or biologics based on severity
Crohn's disease management also includes biologics and corticosteroids, possibly as combinations.

Aminosalicylates (5-ASA)

Treat both UC and Crohn's, being more effective for UC
Mechanism unclear, thought to suppress pro-inflammatory cytokines and mediators
Administered orally or rectally
Oral forms have different coatings affecting drug release, improving targeted symptom relief
Rectal delivery is beneficial for inflammation in rectum/large intestine
Combination therapy (oral and rectal) is better than oral or rectal alone.

Biologic Therapies

Reduce IBD inflammation by blocking specific inflammatory proteins
Four main classes:
- Anti-TNF agents
- Alpha 4-integrin inhibitors
- IL-12/23 antagonists
- JAK inhibitors
Anti-TNF agents (e.g., infliximab) are given intravenously (IV) to induce/maintain remission in UC/Crohn's
Other anti-TNF agents are subcutaneous (SQ)
Common side effects (all anti-TNF agents): upper respiratory/urinary tract infections, headaches, nausea, joint/abdominal pain
More serious side effects: hepatitis reactivation, TB, opportunistic infections, cancers (especially lymphoma)
Testing for TB and hepatitis is required before starting anti-TNF therapy
Active infections delay treatment
Live virus immunizations are contraindicated
Education on preventing/recognizing infection symptoms (fever, cough, malaise, dyspnea) is crucial

Alpha 4-Integrin Inhibitors

(e.g., natalizumab, vedolizumab)
Inhibit leukocyte adhesion by blocking α4-integrin
Only used when other therapies (corticosteroids, immunomodulators, anti-TNFs) haven't been effective
Administered by IV infusion
Side effects include increased infection risk, liver toxicity, and hypersensitivity reactions
Natalizumab is restricted for use.

IL-12/23 Antagonists

(e.g., ustekinumab, risankizumab)
Inhibit IL-12 and IL-23, preventing T-helper and natural killer cell activation
Administered by IV first dose, then via injections every 8 weeks.
Precautions and side effects similar to anti-TNF agents.

JAK Inhibitors

(e.g., tofacitinib)
Suppress the immune system by blocking the JAK enzyme.
Prevent immune cell activation causing inflammation.
TB testing required before starting
Should not be combined with other biologics or immunomodulators

Corticosteroids

Decrease intestinal mucosa inflammation
Short-term use due to side effects of long-term use
Suppositories, enemas, and foams deliver corticosteroids directly to inflamed tissue in the sigmoid, rectum, and left colon.
Oral prednisone is for mild-to-moderate disease unresponsive to 5-ASA.

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Description

This quiz covers the treatment goals for Inflammatory Bowel Disease (IBD), focusing on managing symptoms and improving quality of life. It explores various drug therapies, including aminosalicylates and corticosteroids, and discusses their effectiveness for different types of IBD. Test your knowledge on the current practices in IBD management.