Internal medicine notes

Apr 16th, 2015
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Inflammatory BowelDiseaseInflammatory bowel diseaseUlcerative colitis- diffuse mucosal inflammation- limited to colon- defined by location (eg proctitis;pancolitis)Crohns disease-patchy transmural inflammationfistulae; stricturesany part of GI tractdefined by location or patternTreatment options1.2.3.4.5.6.7.AminosalicylatesCorticosteroidsThiopurinesCiclosporinMethotrexateInfliximabSurgeryAminosalicylatesMOA:precise MOA unknownact on epithelial cells; anti-inflammatorymodulate release of cytokines and reactiveoxygen speciesSulphasalazineSulfapyridine + 5-aminosalicylic acidCleaved in colon by bacterial action5-ASA poorly absorbed active moietySulfapyridine absorbed side effectsNewer formulationsMesalazine (5-ASA)Balsalazide (a prodrug of 5-ASA)Olsalazine (5-ASA dimer)Pharmacological propertiesOral; enema; suppositories PH dependent release/resin coated(eg Asacol; caution with lactulose Ph) Time controlled release (eg Pentasa) Delivery by carrier molecules (egSulphasalazine;olsalazine;balsalazide)IndicationsMaintaining remission in UCReduce risk of colorectal cancer by 75%(long term Rx for extensive disease)Less effective for maintenance in CDInducing remission in mild UC/CD(higher doses)Contraindications/cautions5-ASA- Salicylate hypersensitivitySulfapyridine- G6PD deficiency (haemolysis)- Slow acetylator

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