Pharmacological Management
Aminosalicylates (5-ASA)
- Sulfasalazine (Azulfidine) and mesalamine (Asacol, Pentasa) are first-line treatments for mild to moderate IBD flares and maintenance therapy.
- These medications work by reducing inflammation in the intestinal mucosa through inhibition of inflammatory mediators.
Memory Aid: "5-ASA = 5 Actions: Anti-inflammatory, Antioxidant, Antimicrobial, Antiproliferative, Apoptosis promotion"
Key Points
- Monitor for hypersensitivity reactions including rash, fever, and blood dyscrasias
- Sulfasalazine can cause folate deficiency - supplement with folic acid
- Take with food to minimize GI upset and ensure adequate fluid intake
Corticosteroids
- Prednisone, prednisolone, and budesonide provide rapid anti-inflammatory effects for acute IBD exacerbations.
- Budesonide has fewer systemic side effects due to high first-pass metabolism in the liver.
Critical Alert: Never stop corticosteroids abruptly - must taper gradually to prevent adrenal insufficiency
Key Points
- Monitor for hyperglycemia, hypertension, mood changes, and infection risk
- Long-term use increases risk of osteoporosis - consider calcium/vitamin D supplementation
- Not recommended for maintenance therapy due to significant side effects
Immunomodulators
- Azathioprine (Imuran) and 6-mercaptopurine suppress immune system to reduce intestinal inflammation.
- These medications have a slow onset of action (3-6 months) but are effective for maintaining remission.
Key Points
- Requires regular monitoring of CBC, liver function tests due to bone marrow suppression risk
- Increased infection risk - educate patients about avoiding sick contacts
- TPMT enzyme testing recommended before initiation to prevent toxicity
Biological Therapies
- TNF-alpha inhibitors (infliximab, adalimumab, certolizumab) block inflammatory cytokines responsible for IBD symptoms.
- Reserved for moderate to severe disease unresponsive to conventional therapy.
Black Box Warning: Increased risk of serious infections and malignancy
Key Points
- Screen for tuberculosis, hepatitis B/C before initiating therapy
- Monitor for infusion reactions with IV biologics
- Educate about infection prevention and when to seek medical attention
Commonly Confused Concepts
| Crohn's Disease | Ulcerative Colitis |
|---|
| Affects entire GI tract | Limited to colon and rectum |
| Skip lesions (patchy) | Continuous inflammation |
| Transmural inflammation | Mucosal/submucosal only |
| Fistulas common | Fistulas rare |
Clinical Scenario
A 28-year-old patient with Crohn's disease is prescribed azathioprine. What priority teaching should the nurse provide?
Answer: Emphasize the importance of regular blood monitoring (CBC, LFTs), infection prevention measures, and reporting signs of infection immediately due to immunosuppression risk.