Therapeutics of IBD, IBS

Question 1

What is the difference between IBS and IBD?

Answer 1

IBS - disorder of normal physiology

IBD - inflammatory pathological process

Question 2

What are symptoms of IBS? What are 4 types of IBS?

Answer 2

1. Abdominal pain
2. Altered bowel habits
   IBS-Alternating, IBS-Mixed = alternating constipation and diarrhea
   IBS-D - predominantly diarrhea
   IBS-C - predominantly constipation

Question 3

What are 2 Antispasmodics/Anticholinergics used for IBS-Diarrhea

Answer 3

Donnatal - hyoscyamin, atropine, scopolamine, phenobarbital

Dicyclomine

Question 4

What are contraindications for Antispasmodics (Donnatal, Dicyclomine)

Answer 4

1. A-fib
2. Glaucoma
3. Urinary hesitancy

Question 5

What are the opioid options that are used as Anti-diarrheals? what are they not suited for?

Answer 5

1. Lopermide
2. Diphenoxylate
3. Eluxadoline

not appropriate for infectious diarrhea (want to get rid of infections faster)

Question 6

What are the two categories of Antidepressant drugs used in IBS-D? what are they not effective in?

Answer 6

Tricyclic - Imipramine
SSRIs - Citalopram, Paroxetine

not effective in IBS-C

Question 7

What abx are used in IBS-D

Answer 7

Neomycin
Rifaximin

modulate gut flora

Question 8

What Chloride Channel Activator is used in IBS-Constipation? What is the mechanism of action? contraindications?

Answer 8

Lubiprostone

prostaglandin analog that increases chloride-water secretion into intestines - used on chronic basis

contraindicated in pregnancy

Question 9

What Guanylate Cyclase C Agonist is used in IBS-C? What is the mechanism of action?

Answer 9

Linaclotide

1. increase bicarb and chloride ion secretion into lumen by CFTR channel
2. Activates colonic motor neurons

Question 10

What are 5-ASA agents used in IBD? what is the mechanism of action?

Answer 10

1. Mesalamine
2. Sulfasalazine (sulfapyridine, 5-aminosalicylic acid)

mechanism:

• inhibit cytokine synthesis
• inhibition of prostaglandin/leukotriene synthesis
• immunosuppressive activity

Question 11

What are 4 glucocorticoids used for IBD?

Answer 11

1. Budesonide oral
2. Prednisone oral
3. Methylprednisolone - most common IV drug
4. Hydrocortisone

Question 12

What Immunomodulatory drugs are used in Ulcerative Colitis?

Answer 12

1. Methotrexate
2. Cyclosporine
3. tacrolimus

Question 13

What is the mechanism and adverse fx of methotrexate?

Answer 13

dihydrofolate reductase inhibitor (inhibits DNA/RNA synthesis)

adverse fx: chronic hepatic fibrosis, increased skin cancer and lymphoma risk

Question 14

What is the mechanism and side fx of:

Cyclosporin and Tacrolimus

Answer 14

Both: bind to cyclophillin - inactivates calcineurin, a Ca-activated phosphatase responsible for IL-2 formation

Cyclosporine adverse fx: hyperlipidemia, anemia, thrombocytopenia, cancer risk, renal failure

Tacrolimuc adverse fx: anemia, thrombocytopenia, cancer risk, hepatic disease - CYP3A4 inhibition

Question 15

What are the Anti-TNF Abs used in IBD?

Answer 15

Infliximab - chimeric human IgG

Certolizumab - FAB attached to polyethylene glycol

Question 16

What are the Anti-integrin Ab’s used in IBD?

Answer 16

Natalizumab
Vedolizumab

block lymphocyte trafficking to gut mucosa

Question 17

What is the stepped care for Crohns disease (Mild/moderate and Severe)?

Answer 17

mild/moderate: Budesonide - sulfasalazine - oral prednisone - antimetabolites - antibodies

severe: antimetabolites, antibodies, IV glucocorticoirds, Total parenteral nutrition

Question 18

Whare is the stepped care of Ulcerative Colitis (mild/moderate and Severe)?

Answer 18

mild/moderate: 5-asa, glucocorticoid, oral prednisone, antimetabolites, antibodies

severe: prednisone, IV glucocorticoids - antimetabolites - cyclosporin