Talked about aminosalicylic acid; topical rectal, oral, IV corticosteroids;
Amino modulators, azathioprine, 6 mercaptopurine; anti-TNF therapy,
but you are always worried about reactivation TB;
antibiotics? Levaquin, Flagyl; total parenteral nutrition,
especially for Crohn?s but due to malnutrition; surgery, be very careful with Crohn?s,
because of the delicate nature of the disease with Crohn?s
that you might actually cause more harm than good.
The aminosalicylic acid, what is it? Local anti-inflammatory.
What it does is inhibition of the cox pathway.
More effective in colonic than ileal disease, can induce and maintain remission,
usually used for ulcerative colitis. Why? Why? Ulcerative colitis only involves the colon,
and so therefore, when you give an enema, or you give a rectal type of administration,
understand that you are more effective in the colon that you would be in the ileum,
therefore more effective with ulcerative colitis.
Side effects occur in 30%, sulfasalazine much more so than mesalamine.
Nausea, rash, hair loss, hemolysis, pancreatitis, hepatitis, aplastic anemia,
are things that you want to keep in mind. Sulfasalazine.
Corticosteroids. Topical preparation, or preparation needed for more proximal extensive disease,
especially if it is Crohn?s. IV preparation for the severely ill,
useful for induction but not for maintenance,
the significance side effects of long term?we have talked about this quite a bit.
The fact that you might be lymphopenic,
the fact that you might then cause a vast necrosis of the bone
resulting in destruction and fractures.
Corticosteroids, of course, over long period of time,
a common cause of iatrogenic type of Cushing?s.