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BCPS study guide

ulcerative colitis and crohn's

initial treatment for low severity ulcerative colitis topical aminosalycilates (sulfasalazine or mesalamine) or oral budesonide. can add oral aminosaliycilates if topical is not enough. oral steroids - 40-60 mg PO prednisone equivalent. can use nicotine replacement therapy in ex smokers.
once aminosalycilates and steroids have been tried, what is the next step for treatment of ulcerative colitis if more ill use TNF alpha inhibitors such as infliximab or adalimumab. if less ill can do azathioprine or 6 MP.
if TNF or AZA/6MP is not successful what is the next step for treatment of ulcerative colitis IV steroids - hydrocortisone 300 mg QD or methylpred 60 mg QD. can add TNF alpha if not already on. can also try cyclosporine with or without ASA/6MP unless already on.
if medication management is not successful, what is the last option for pts with ulcerative colitis colectomy
initial treatment for low severity Crohn's disease oral budesonide or aminosalycilates if terminal ileal or ascending colon. can add flagyl/cipro if perianal or colonic. next can add steroid therapy IV followed by TNF alpha and 6MP or AZA once symptoms improve
if no response from TNF + 6MP/AZA what is the next option for Crohn's disease natalizumab (Tysabri) or surgery. can try IV steroids, cyclosporine in the mean time.
Created by: mjuhlin