Week 5 - Drugs used in IBD treatment

Question 1

Name the aminosalicylates used in treatment of IBD ( and its API)

Answer 1

• Sulfasalazine
• Mesalazine

Question 2

What are the contraindications of sulfasalazine and C&A ( cautionary + advisory)

Answer 2

• Hypersensitivity to sulfapyridines / aminosalicylates / salicylayes

Cautions
- Haematological toxicity
- Renal + hepatic impairement
-

Question 3

What are the side effects of sulfasalazine

Answer 3

• Headache
• nausea
• fever
• rash

Severe-
- Hepatitis
- pneumonitis
- skin reaction
- haemolysis
- kidney inflammation

Question 4

What are the monitoring test that should be done when on sulfasalazine

Answer 4

FBC- before starting medication + every 2 weeks for 3 months then every 3 monthly

LFT - monthly then every 3 months

Creatinine / eGFR - monthly then three monthly

Question 5

Name what side effects should be report when on aminosalicylates ( sulfasalazine)

Answer 5

• SOre throat
• fever
• Malaise
• Jaundice
• non-specific illness

Question 6

Describe the moa of aminosalicylates

Describe how a therapuetic effect is obtained

Answer 6

• Mesalazine bound to sulfapyridine
• bond is broken by ybacterial azoreductase
• Sulfapyridine absorbed by colon ( metabolised by liver and exxtreted in urine)

MEsalazine has topical effects on the mucosa layer which ias absorbed

Question 7

What is the difference between rectal enemas and suppositories

Answer 7

Rectal enemas -

Foam enemas - treat proximal sigmoid colon ( effective in proximal UC)

Suppositories - Used for rectosigmoid junction
Deliver drug more effectivly then enemas

Question 8

Name the thiopurines used in the treatment of IBD

Answer 8

Azathiopurine - dose 2-2.5mg/kg daily
Mercaptopurine - 1-1.5mg /kg daily

Question 9

What is the starting dose of azathioprine and mercaptopurine

Answer 9

Azathiopurine - dose 2-2.5mg/kg daily
Mercaptopurine - 1-1.5mg /kg daily

Question 10

What prior assessments must be done before starting azathiopurine or mercaptopurine ?

Answer 10

• FBC
• Urea & electrolytes
• LFT
• Vaccines ( influenza)
  *

Question 11

What ongoing maintaince assessments should be done when taking azathiopurine / mercaptopurine

Answer 11

• FBC
• Urea & electrolyytes
• LFT

Question 12

What are the contraindications of thiopurines and C&A

Answer 12

Hypersensitivity to thiopurines
- impaired bone marrow
- pancreatitis

Cautions -

• Renal + hepatic impairment
• reduce TPMT
• reduce exposure to sun

Question 13

What side effects should be reported

Answer 13

• ulceration of throat
• fever
• infection
• bruises
• bl;eeding
• myelosuppression