Clinical Medicine

2021-09-24 14:41:24 باز کردن / نظر دهید

2021-09-24 14:41:23 جمعه مباركه

Managment Guideline for hospitalized acute severe UC

مريض ال Sever Ulcerative colitis هيجي بالاعراض التاليه :

●Bloody stool frequency ≥6 per day

●PLUS at least one of the following characteristics (ie, evidence of systemic toxicity):

•Fever (temperature ≥37.8 degrees C)

•Tachycardia (heart rate ≥90 beats/minute)

•Anemia (hemoglobin <10.5 g/dL [105 g/L])

•Elevated inflammatory marker (eg, C-reactive protein, erythrocyte sedimentation rate)

في قواعد عامة لأي مريض Sever Ulcerative Colitis ...

Test for C. difficile infection ( CDI)

ولو طلع المريض عنده CDI بنستخدمله ال Oral Vancomycin

Avoid NSAIDs drug & anticholinergic drug

Avoid Narcotics

لانها بتقلل ال GI motality وبتزود فرصه ال Sepsis ..

Don't Give TPN Unless patient can't tolerate Oral feeding

Give Anticoagulant

مريض ال Sever Acute UC بيكون عنده Hypercoagulopathy
فبنعطى Heparin او LMWH ك Prophylaxis

AGAINST broad spectrum antibiotics unless there's Indication for using it as pneumonia or other Infection

ال Broad spectrum Antibiotics بيزود ال Risk لل
C.difficile

كيف بنعالج مريض ال Sever Acute UC ...

بشكل عام اغلب ال Guideline اتفقو انه بدايه ال Induction تكون ب Steroid ولو ما صار Response خلال 3 ايام بيتشفت المريض على Infliximab او Cyclosporin بجرعه 2mg/kg IV وبتتقسم الجرعه لمرتين في اليوم ..

Induction therapy for hospitalized acute severe UC..


1st line : Start with methylprednisolone 60 mg/d or hydrocortisone mg / 6 h 100

2ed line : if steroid FAILED assessed after 3day switch to salvage medical therapy (cyclosporin or infliximab) or colectomy

3ed Line : Failed cyclosporin or infliximab after 4-7day
Do total or subtotal colectomy with end ileostomy.




Maintenance therapy for hospitalized acute severe UC :

TORONTO 2015

لو المريض اخد Infliximab في ال Induction هيكمل فيه ك maintenance بالاضافه لل Thiopurine
اما لو المريض مشى ع Cyclosporin ك Induction
فبيمشي ع Cyclosporin orally وبعدها يكمل ع Thiopurine
جرعه ال Cyclosporin orally بتكون ضعف جرعه ال I.V اللي مشى عليها المريض خلال ال Induction ...

During Using Cyclosporine Prophylaxis against Pneumocystis pneumonia is required


ACG 2019

If steroid used in induction use thiopurines as azathioprine

If Infliximab used in nduction continue infliximab

If Cyclosporine used in induction shift to thiopurines or vedolizumab




في مجموعه من المرضى ممنوع يستخدمو ال Cyclosporine

we do not use cyclosporine in patients with any of the following conditions:

●Hypertension (blood pressure >140/90 mmHg).

●Renal disease (serum creatinine >1.4 mg/dL [124 microm/L]).

●History of seizure disorders.

●Low serum total cholesterol (<120 mg/dL [3.11 mmol/L]).

●Low serum magnesium level.

●Low serum albumin (<2.3 g/dL [23 g/L]) [34].

●Prior intolerance or failure of immunomodulator therapy (eg, azathioprine).

●Prior failure of biologic agent (eg, infliximab)

●Inability to comply with dosing and monitoring requirements while on cyclosporine.

وهيك بنكون خلصنا ال Ulcerative colitis management ورح نبدأ ان شاء الله بال Crohns Disease Management Guideline

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2021-08-23 20:47:30 يسعد مساكم
#GIT_24 #IBD
Drug Used in Inflammatory Bowel Disease Treatment
في عنا اربع مجموعات دوائيه بنستخدمها في علاج ال IBD ...

Drug with 5 aminosalicylic acid

Corticosteroids

Immunomodulators

Biologic Agent

بشكل عام الادويه اللي بتعالج IBD بيكون استخدامها حاجه من الاتنين :
Induction Therapy
And/OR
maintenance Therapy

ال Induction لعلاج ال Active Episode of IBD
اما ال Maintenance لمنع ال Relaps



اول مجموعه واقدم مجموعه تم اكتشافها لعلاج ال IBD هي الادويه اللي بتحتوي على مركب ال 5aminosalicylic acid
وبتستخدم لل Induction وال Maintenance
في عنا مجموعتين للادويه اللي بتحتوي على ال 5Aminosalicylic acid :

Azo Compounds Mesalamine

اول مجموعه هي ال Azo compound
بتحتوي على ال 5Aminosalicylic acid مرتبط مع مركب آخر
فهي عباره عنProdrug ومن أمثلتها

Sulfasalazine
( 5Aminosalicylic acid + Sulfapyridin )

Oral: Tablets should be administered in evenly divided doses, preferably after meals. Delayed-release tablets should be swallowed whole.

Dose :
4-6 gram/day for Induction
2-4 gram /day for maintenance

Other Guideline for Sulfasalazine doses
Initial: 3 to 4 g/day in divided doses at ≤8-hour intervals; may initiate therapy with 1 to 2 g/day to reduce GI intolerance. Doses >4 g/day can increase the risk of toxicity.

Maintenance dose: 2 g/day in divided doses at ≤8-hour intervals when endoscopic exam confirms improvement

Dosage adjustment: If GI intolerance occurs, reduce dosage by 50% and gradually increase to target dose over several days. If GI intolerance persists, stop therapy for 5 to 7 days and reintroduce at a lower daily dose.

Crohn disease (mild to moderately active) (off-label use): Oral: 3 to 6 g/day in divided doses for up to 16 weeks

Balsalazide
( 5-aminosalicylic acid +4-aminobenzoyl-beta-alanine )
May administer with or without food. Maintain adequate hydration during therapy (to minimize nephrolithiasis risk).

Dose
Ulcerative colitis, remission induction: Oral:

Capsule: 2.25 g 3 times daily for 8 to 12 weeks.

Tablet: Males: 3.3 g twice daily for up to 8 weeks.

Ulcerative colitis, remission maintenance (off-label use): Capsule: 1.5 or 3 g twice daily for 6 to 12 months

Olsalazine

Administer with food in evenly divided doses. Maintain adequate hydration during therapy (to minimize nephrolithiasis risk).

Dose

Ulcerative colitis, remission maintenance: Oral: 1 g/day in 2 divided doses.

Ulcerative colitis, remission induction (off-label use): Oral: 2 to 3 g/day in 2 to 4 divided doses



ال Azo compound كلها prodrug بمجرد وصولها ال Intestine بيصيرلها Cleavage وبتحرر لل Active compound
5Aminosalicylic acid ( 5-ASA)

mechanism of action of 5-ASA is unknown; however, it is thought that it modulates local chemical mediators of the inflammatory response, especially leukotrienes, and is also postulated to be a free radical scavenger or an inhibitor of tumor necrosis factor (TNF); action appears topical rather than systemic

أشهر SE لل Azo compound خصوصا ال Sulfasalazine

Dose-related adverse effects (due to the sulfapyridine portion): GI disturbance, headache, arthralgia, folate malabsorption

فبننصح المريض ياخد folic acid supplement

Idiosyncratic adverse effects: rash, fever, pneumonitis, hepatotoxicity, bone marrow suppression, hemolytic anemia, pancreatitis, decreased sperm production in men

So CBC should be done 3-6 month of therapy

Serum creatinine should be monitored in Renal fauiler pateint

Avoid in patients with a sulfa allergy.



البوست القادم ان شاء الله رح نكمل مع تاني مجموعه بتحتوي على ال 5Aminosalicylic acid اللي هي ال Mesalamine

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