Week 2: GI Tract - Pharmacology for IBD

Question 1

What 4 drug classes are used for inflammatory bowel disease? (4)

Answer 1

• 5-aminosalicylates
• Glucocorticoids
• Immunomodulatora
• Immunosuppressants

Question 2

Which medication is an example of a 5-aminosalicylate?

Answer 2

sulfasalazine

Question 3

What are the indications for sulfasalazine? (2)

Answer 3

• Mild to moderate IBD
• maintain remission after symptoms have improved

Question 4

What is the MOA of sulfasalazine?

Answer 4

• Action on prostaglandin synthesis and suppression of migration of inflammatory cells into the affected region

Question 5

What are nursing considerations for sulfasalazine?

Answer 5

• Monitor CBC periodically because it can cause hematological disorders

Question 6

What are adverse effects of sulfasalazine?

Answer 6

• nausea
• fever
• rash
• arthralgia (sore joints)

Question 7

Which medication is an example of a glucocorticoid for IBD?

Answer 7

budeosonide

Question 8

What are the indications for budesonide?

Answer 8

1. Mild to moderate ulcerative colitis
   - works locally within ileum and ascending colon
   - Use is to induce remission, not for long term maintenance

Question 9

What is the MOA of budesonide?

Answer 9

Anti-inflammatory action

Question 10

What are the routes of admin for budesonide? (2)

Answer 10

• IV
• PO (enteric coated capsule)

Question 11

What are nursing considerations for budesonide? (4)

Answer 11

Prolonged use of glucocorticoids can cause severe adverse effects like:
- adrenal suppression
- Osteoporosis
- Increased risk for infection
- Cushing’s syndrome

Question 12

Which medication for PUD is an example of an immunomodulator?

Answer 12

Infliximab

Question 13

What is the MOA of infliximab? (2)

Answer 13

• Monoclonal antibodies
• Designed to neutralize TNF, a key immuno-inflammatory modulator

Question 14

What are the indications of infliximab? (2)

Answer 14

• Moderate to severe ulcerative colitis and Crohn’s

Question 15

What are the adverse effects of infliximab? (3, 9)

Answer 15

1. Infections
   - TB and other opportunistic infections are most common
2. Infusion reactions
   - fever
   - chills
   - pruritis
   - urticaria
   - cardiopulmonary reactions (chest pain, HTN, hypotension)
3. Increased risk of lymphoma

Question 16

What is the regimen for infliximab?

Answer 16

• 6 week regimen followed by maintenance infusions every 8 weeks after

note that it is considered 2nd line for IBD because of pros vs cons

Question 17

Which medication for PUD is an example of an immunosuppressant?

Answer 17

cyclosporine

Question 18

What is the MOA of cyclosporine? (2)

Answer 18

• calcineurin inhibitory and is a very strong immunosuppressant
• faster acting and stronger than other immunosypressants

Question 19

How is cyclosporine administered? (3)

Answer 19

• Long term therapy
• Continuous IV infusion
• Can also be administered orally in low doses to maintain remission

Question 20

What are adverse effects of cyclosporine?

Answer 20

• Increased lymphoma risk. further increased when used with other immunosuppressants

Question 21

What are nursing considerations for cyclosporine? (3)

Answer 21

Potentially toxic compound
- can cause renal impairment (check urine output)
- neurotoxicity
- generalized suppression of the immune system = increased risk of infection

Question 22

What are indications for cyclosporine?

Answer 22

• Severe disease that has not responded to other therapies, both UC and Crohns

usually taken by organ transplant pts to reduce inflammation