IBD - Crohns and UC Drugs Flashcards

1
Q

What are the 4 main drug therapy types for IBD

A
  1. Aminosalicylates (ASAs)
  2. Corticosteroids
  3. Immunosuppressants
  4. Biological therapy = Monoclonal antibodies
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2
Q

What type of drug is Mesalazine

A

Aminosalycate (ASA)

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3
Q

What type of drug is Prednisolone

A

Corticosteroid

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4
Q

What type of drug is Hydrocortisone

A

Corticosteroid

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5
Q

What type of drug is Azathioprine

A

Thiopurine -Immunosuppressant

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6
Q

What type of drug is Ciclosporin

A

Immunosuppressant

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7
Q

What type of drug is Infliximab

A

Bio therapy / monoc. antibody

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8
Q

What type of drug is Adalimumab

A

Bio therapy / monoc. antibody

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9
Q

What is first line therapy in Ulcerative Colitis?

A

ASAs

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10
Q

What type of drug is Sulfasalazine

A

ASA

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11
Q

What are side affects of sulfasalazine (6)

A

Allergy - (may mimic hepatitis) Rash, fever, leucopenia, agranulocytosis, male infertility, orange secretions

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12
Q

Asacol, Pentasa, Mezavant are brand names of what type of drug

A

Mesalazine - ASAs

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13
Q

S/E of most ASAs (minimal) (4)

A

Diarrhoea
Headache
Rash
Nausea

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14
Q

Which type of steroid (Glucocortico or Mineralocortico) is anti-inflammatory and immunosuppressive? Name an example from the body

A

Glucocorticoid eg Cortisone / Hydrocortisone

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15
Q

Which type of steroid affects water & electroylte balance - give an eg from the body

A

Mineralocorticoid eg Aldosterone

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16
Q

Which type of steroid affects protien and carboyhydrate metabolism - give an eg from the body

A

Glucocorticoid eg Cortisone / Hydrocortisone

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17
Q

Why is osteoporosis a SE of steroid use (2)

A

Reduces Ca++ and Vit D absorb

Inhibits osteoblasts

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18
Q

What would you give with steroids to protect bones (2)

A

Bisphosphonates

Ca++ and Vit D

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19
Q

Why should you monitor for infection in steroid use

A

It is immunosuppressive

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20
Q

Why should you not stop steroid therapy immediately

A

The body stops producing its own steroids so need to taper off dose to allow body to restart prod steroids.

21
Q

3 examples of oral corticosteroids

A

Prednisolone
Budesonide
Beclometasone

22
Q

1 example of IV steroid

A

Hydrocortisone (“hydro” goes in fluid)

23
Q

2 examples of Topical steroids

A

Hydrocortisone

Prednisolone

24
Q

What form could topical steroids be given in (3)

A

Suppositories, foam, liquid enema

25
Q

Are ASAs good for UC, Crohns or both?

A

UC only - no evidence for CD

26
Q

Are corticosteroids used for UC, CD or both, and what stage of the treatment pathway would you use them for?

A

Both - only to induce remission, not for long term maintenance

27
Q

What are Thiopurines give 2 examples

A

Immunosuppressive drugs

  1. Azathioprine
  2. 6-mercaptopurine
28
Q

Are Thiopurines good for UC CD or both

A

Both

29
Q

When would you use Thiopurines

A

After relapse

Post-ciclosporin to induce remission in severe UC

30
Q

What is a side effect of azathioprine ( apart from allergy) (3)

A

Leukopenia (low WBCs)
Bone marrow suppression
Hepatotoxicity

31
Q

What are 3 main types of immunosuppressants for IBD

A
  1. Thiopurines (Azathioprine)
  2. Ciclosporin
  3. Methotrexate
32
Q

Is Ciclosporin good for UC, CD or both

A

UC (Ciclo - colo only)

33
Q

Is Ciclosporin a CYP450 inhibitor or inducer

A

Inhibitor

34
Q

Why does ciclosporin interact with erythromycin

A

Ciclosporin is metabolised by CYP450, Erythromycin is a CYP450 inhibitor, so it will incr the plasma levels of Ciclosporin

35
Q

Why does Rifampicin interact with Ciclosporin

A

Rifampicin is a CYP450 inducer - will increase the metabolism of Ciclosporin by the enzyme so red. the plasma levels of Ciclosporin (make it less effective)

36
Q

What drug causes these side effects: Hypertension
Infection
Renal impair
Gum hypertrophy & hirsuitism
Siezures (with hypocholest. or hypomagnes.)

A

Ciclosporin

37
Q

Is methotrexate good for UC CD or both

A

Crohns only

38
Q

How does methotrx work

A

Inhibits cytokine & eicosanoid synthesis

39
Q

SE of what drug: GI irrit, Naus,vom diarrhoea
Hepatotoxicity
Blood dyscrasias (disorders)
Drops folate

A

Methotrexate

40
Q

What do you give 2-3 days after methotrexate

A

Folic acid 5mg

41
Q

Should methotrexate ever be given daily

A

NO - once weekly only

42
Q

Biological therapy / Monoclonal antibodies - give 2 egs

A

Infliximab

Adalimumab

43
Q

Is infliximab good for CD UC or both - and when?

A

Both - CD if severe, not responsive to treatment and surgery not appropriate
UC - If Ciclosporin contraind.

44
Q

Why might infliximab cause allergy

A

It is part based on human antibody tissue

45
Q

What might infliximab re-activate in some (older) patients

A

TB - do a TB screen first

46
Q

Is Adalimumab good for CD UC or both

A

CD only

47
Q

What is the mech of action of infliximab and adalimumab

A

Inhibit TNF alpha cytokine

48
Q

What would be a treatment pathway for active UC (3)

A
  1. 5-ASA + corticosteroid
  2. Ciclosporin / Infliximab
  3. Colectomy
49
Q

What would be a treatment pathway for active CD (2)

A
  1. Corticosteroid

2. Azathioprine / Infliximab