在慢性病中处方炎症性肠病药物:实用指南
Lynna Chen1,2, Ashish Srinivasan1,2,3, Suet-Wan Choy2,3,4
1Department of Gastroenterology, Eastern Health, Melbourne, Victoria, Australia.
Alimentary pharmacology & therapeutics
|July 2, 2025
概括
大多数炎症性肠病 (IBD) 疗法,特别是生物药物,对于慢性病 (CKD) 患者来说是安全的. 传统的治疗和Janus激酶 (JAK) 抑制剂需要仔细考虑和剂量调整在先进的CKD.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在炎症性肠病 (IBD) 患者中,慢性病 (CKD) 的患病率增加.
- 在晚期CKD中,IBD药物的有限的药理动力学数据.
研究的目的:
- 提供基于证据的指导,用于管理患有慢性病的IBD患者.
- 专注于晚期病的医学疗法和置换疗法.
主要方法:
- 叙事文献审查至2025年3月.
- 专注于IBD治疗方法在CKD和脏替代疗法的背景下.
主要成果:
- 梅萨拉和氨酸抑制剂携带脏风险.
- 在晚期脏疾病中,甲索特雷克萨酸是禁忌的; 提奥普林需要调整剂量.
- 生物药物 (抗TNF,抗整体素,抗IL-12/23) 在CKD中似乎是安全的,包括血液透析.
- 小分子疗法通常是安全的; JAK 抑制剂 (托法西提尼布,乌帕达西提尼布) 在晚期CKD中需要减少剂量.
结论:
- 生物疗法在很大程度上对患有慢性病的IBD患者安全有效,包括接受脏替代疗法的患者.
- 传统疗法和JAK抑制剂在CKD患者中需要谨慎和潜在的剂量修改.
相关概念视频
Inflammatory Bowel Disease IV: Pharmacological Management
204
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
204
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
277
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
277
Chronic Kidney Disease III: Interprofessional Care
82
Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
82
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
208
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
208
Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
430
Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
430
Chronic Kidney Disease IV: Nursing Management
60
Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of...
60


