IBD Therapies Flashcards by Kim Nguyen

5-aminosalicylates MoA

Act topically to decrease GI tract inflammation

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Frequency of 5-ASA dosing

Most require multiple daily dosages

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5-ASA drugs

Sulfasalazine, mesalamine, olsalazine, balsalazide

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Sulfasalazine is cleaved by gut bacteria into what molecules?

5-ASA and sulfapyridine

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What is the carrier and what is the active component in sulfasalazine

Carrier: sulfapyridine

Active component: 5-ASA

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What is responsible for the ADEs in sulfasalazine?

Sulfa moiety

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ADEs of sulfasalazine

GI symptoms, rash, photosensitivity, blood dyscrasias

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Sulfasalazine dosing

500-1500mg PO q6h

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Where are 5-ASAs used in IBD treatment?

UC!

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Mesalamine routes of administration

PO and PR

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Mesalamine PR products

Rowasa is an enema

Canasa is a suppository

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Where does Rowasa deliver drug to?

Rectum and distal colon

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Where does Canasa deliver drug to?

Rectum only

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PO formulation of mesalamine comes in what kind of duration?

Delayed/controlled release

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Olsalazine (Dipentum) is cleaved by gut bacteria into what?

2 5-ASA molecules

2=Di, brand name is Dipentum!

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Olsalazine/Dipentum dosing

500-1000mg PO BID

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Olsalazine/Dipentum ADE

Diarrhea

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Feature of balsalazide (Colazal)

It’s basically sulfasalazine without the sulfa

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What is balsalazide cleaved into?

5-ASA and 4-aminobenzyol-beta-alanine

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What are the active and carrier components of balsalazide?

Active: 5-ASA
Carrier: 4-aminobenzoyl-beta-alanine

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Balsalazide (Colazal) dosing

3, 750mg capsules PO TID

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What are immunomodulators used to do in IBD treatment?

Maintain treatment remission

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Immunomodulators used in IBD treatment

Azathioprine, 6-MP, methotrexate, cyclosporine and tacrolimus have also been used

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Azathioprine is a prodrug for what drug?

6-MP

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Azathioprine dosing

2-2.5mg/kg/day

What can you use AZA in combo with?

Biologics (but can also use alone)

What disease states can you use AZA in?

Both Crohn's and UC

6-MP dosing

1-1.5mg/kg/day

Methotrexate dosing

15-25mg/week IM or SQ, but can switch to PO after being on IM or SQ treatment for a long time

What disease state can you use methotrexate in?

Crohn's

Immunomodulator monitoring

CBC at least q3 months Check LFTs and pancreatic enzymes **Watch out for lymphomas**

ABX are used in what disease state?

Best for perianal Crohn's

ABX used in IBD

Metronidazole and ciprofloxacin

Metronidazole dosing

500mg TID or 20mg/kg/day

Ciprofloxacin dosing

400mg IV or 500mg PO BID

What do corticosteroids do in IBD therapy?

Work quickly to reduce inflammation

Corticosteroids used in IBD

Prednisone, methylprednisolone, hydrocortisone, budesonide

Prednisone dosing

20-60mg PO QD

Methylprednisolone formulation/route of administration

Hydrocortisone topical formulations

10mg enema, 25mg suppository, 10% foam

Hydrocortisone also comes in what formulation?

Budesonide formulation

EC capsule

Budesonide dosing to induce remission

9mg PO QD up to 8 weeks; recurring episodes can be treated with repeated courses

Budesonide dosing to maintain remission in Crohn's

After 8 weeks, can continue at 6mg PO QD with a down taper if needed

Budesonide brand for Crohn's

Entocort

Where does Entocort release?

Terminal ileum

Budesonide brand for UC

Uceris

Where does Uceris release?

Throughout the colon

Role of biologics in IBD

Induce and maintain remission

Anti-TNFs for IBD

Infliximab (Remicade) Adalimumab (Humira) Certolizumab (Cimzia) Golimumab (Simponi)

Selective adhesion molecules inhibitors for IBD

Natalizumab (Tysabri) | Vedolizumab (Entyvia)

IL-12, IL-23 inhibitor for IBD

Ustekinumab (Stelara)

JAK inhibitors for IBD

Tofacitinib (Xeljanz) | Upadacitinib (Rinvoq)

Biologics used in BOTH Crohn's and UC

Infliximab (Remicade) Adalimumab (Humira) Vedolizumab (Entyvia) Ustekinumab (Stelara)

Biologics used in Crohn's only

Natalizumab (Tysabri) | Certolizumab (Cimzia)

Biologics used in UC only

Golimumab (Simponi) Tofacitinib (Xeljanz) Upadacitinib (Rinvoq)

Biologics with IV route of administration

Infliximab (Remicade) Natalizumab (Tysabri) Vedolizumab (Entyvia) Ustekinumab (Stelara) when used as induction Tx

Biologics with SQ route of administration

Adalimumab (Humira) Certolizumab (Cimzia) Golimumab (Simponi) Ustekinumab (Stelara) when used as maintenance Tx

Biologics with PO route of administration

Tofacitinib (Xeljanz) | Upadacitinib (Rinvoq)

ADRs of biologics: acute infusion-related reactions

Headache, dizziness, nausea, flushing, fever, chest pain, cough, dyspnea, pruritus

How to control acute infusion-related reactions

Decrease infusion rate, pre-medicate with 1000mg APAP, 50mg IV/PO diphenhydramine +/- 50mg IV hydrocortisone

ADRs of biologics: delayed infusion-related reactions

Myalgias, arthralgias, fever, rash, pruritis, urticaria, headaches

How long does it take for delayed infusion-related reactions to take place?

3-14 days

How to manage delayed infusion-related reactions

Can go away on its own or require a short course of steroids

ADRs of biologics: injection site reactions

Pain and redness at the site of injection

BBWs on TNFis and JAKis

Infections, malignancy

Kinds of infections that are possible while on TNFis and JAKis

Active TB, invasive fungal infections, bacterial, viral, or other opportunistic infections

How to monitor for infections while on TNFis and JAKis

Monitor for signs/symptoms of infection | D/C when there's a serious infection or sepsis

What should patients be tested for before starting TNFis or JAKis therapy?

TB skin test, chest x-ray, must be vaccinated or treated for HBV

What vaccines can you not get while on a TNFi or JAKi?

Live attenuated vaccines

ADE of natalizumab

Progressive multifocal leukoencephalopathy BBW on natalizumab, cautionary for vedolizumab

What causes progressive multifocal leukoencephalopathy?

Reactivation of the JC polyomavirus which can lead to CNS infection and death

Due to its ADE/BBW, how must natalizumab be administered?

As monotherapy

How do you get natalizumab?

Patients and prescribers must enroll in the TOUCH program

The safety review for JAKis found that there was an increased risk of what?

Cancer, CV-related events, thrombosis, and death

The increased risks of cancer, CV-related events, thrombosis, and death while taking JAKis are more likely to happen to what kinds of patients?

>50 years old with at least 1 CV risk factor (smoking, HTN, HLD, etc.)

The FDA has limited the use of JAKis to what?

Patients who haven't responded or can't tolerate 1 or more TNFIs

IBD Therapies Flashcards

(77 cards)