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(J2) GI II Test 1 > IBD Pharm > Flashcards

IBD Pharm Flashcards

1
Q

What are the main classes of drugs used to threat IBD?

A
  • 5-ASA (aminosalicylates)
  • TNF-α inhibitors
  • α-4 integrin inhibitors
  • IL-12/23 inhibitors
  • JAK inhibitors
  • steroids/immune modulators and abx as well
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2
Q

What is the mechanism of action for 5-ASA?

A

inhibits both COX and LIPOX

-inhibit arachadonic acid -> prostaglandin and leukotriene -> decreased inflammation

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3
Q

What are the inidcations for 5-ASA drugs?

A

Active and maintenance of UC only (mild/moderate -> first line)

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4
Q

What suffix is associated with 5-ASA drugs?

A

“-sala-“

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5
Q

What is sulfasalazine?

(anything special?)

A

5-ASA drug (IBD -> UC only)

sulfapyridine carrier:

  • generates side effects
  • contraindicated in sulfa alergies
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6
Q

What is mesalamine?

(anything special?)

A

5-ASA (IBD -> UC only)

  • single 5-ASA, no carrier
  • multiple routes of administration (oral, rectal enema, suppositories)
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7
Q

What is olsalazine?

(anything special?)

A

5-ASA drug (IBD -> UC only)

-two 5-ASA

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8
Q

What is balsalazide?

(anything special?)

A

5-ASA drug (IBD -> UC only)

inert carrier

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9
Q

What side effects are associated with 5-ASA drugs?

A
  • mild CNS
  • mild GI
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10
Q

What are contrainidications for 5-ASA drugs?

A
  • ASA allergies
  • sulfa allergies (sulfasalazine only)
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11
Q

What is the mechanism of action for TNF-α inhibitors?

A

Binds TNF-α, inhibiting its pro-inflammatory effects and upregulation of surface adhesion molecules

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12
Q

What is the general indications for TNF-α inhibitors?

A

moderate to severe UC and/or CD (which one varies per drug)

used after inadequate response to other drugs

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13
Q

What is adalimumab?

(indications)

A

TNF-α inhibitor

indicated for:

-active/maintenance of UC and CD (moderate to severe -> doesn’t respond to others)

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14
Q

What is infliximab?

(indications)

A

TNF-α inhibitor

indicated for:

  • active/maintenance CD (moderate to severe)
  • active/maintenance UC (severe only)
  • only with inadequate response to other treatment
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15
Q

What is golimumab?

(indications)

A

TNF-α inhibitor

indicated for:

  • active/maintenance UC only (moderate to severe)
  • only with inadequate response to other treatment
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16
Q

What is certolizumab?

(indications)

A

TNF-α inhibitor

indicated for:

  • active/maintenance CD (moderate to severe)
  • only with inadequate response to other treatment

<strong>C</strong>erto… and <strong>C</strong>rohns both start with <strong>C</strong>

17
Q

What are side effects of TNF-α inhibitors?

A
  • TB reactivation
  • elevated LFTs
  • EM/TEN/SJS (rare)
18
Q

What is the mechanism of α-4 integrin inhibitors?

A

-bind and block α-4 integrins, inhibiting leukocytes migration

19
Q

What is natalizumab?

(inidcations)

A

α-4 integrin inhibitor

  • active/maintenance for CD only (moderate-to-severe)
  • inadequate response to other treatements
20
Q

What is vedolizumab?

(indications)

A

α-4 integrin inhibitor

  • active/maintenance for CD and UC (moderate-to-severe)
  • inadequate response to other treatements

make the letter ‘V’ with your finger, you are holding up the number two and this treats both UC/CD

21
Q

What black box warning is associated with α-4 integrin inhibitors?

A

PML (progressive multifocal leukoencephalopathy) from JCV virus reactivation

-specific monitoring and education is required to prescirbe/take (TOUCH program)

22
Q

What side effects are associated with α-4 integrin inhibitors?

A
  • infusion reactions
  • anti-medication Ab formation
  • increased risk for malignancy (rare)
23
Q

What is the mechanism of action for IL-12/23 inhibitors?

A

bind p-40 subunit that is common to IL-12 and IL-23 receptors, inhibiting their function

  • inhibits Th17 and NK differentiation
  • inhibits proinflammatory cytokine release
24
Q

What is ustekinumab?

(indications)

A

IL-12/23 inhibitor

  • active/maintenance of CD and UC (moderate-to-severe)
  • only with inadequate response to other treatment
25
Q

What are the side effects of IL-12/23 inhibitors?

A
  • TB reactivation
  • injection site reaction
  • increased risk of malignancy (rare)
26
Q

What is the mechanism of action for JAK inhibitors?

A

bind and inhibit intracellular JAKs (1 and 3) which are involved in cytokine signaling

-strong effect on JAK 3 which is involved in IL-4 signaling, particularly inhibiting Th2 differentiation (-> UC only)

27
Q

What is tofacitinib?

(indications)

A

JAK inhibitor

  • active and maintenance of UC only (moderate-to-severe)
  • only with inadequate response to other treatment
28
Q

What are side effects of JAK inhibitors?

A
  • lymphopenia/lymphocytosis
  • neutropenia/anemia
  • increased LDL and HDL
  • increased risk of malignancy (rare)
29
Q

What drugs should be avoided while taking biologics?

A

other biologic medications

30
Q

What is the order that drugs should be used with progressively treatment resistant IBD?

A

First line:

  • 5-ASA (UC only)
  • abx
  • steroids/immune modulators

Second line:

-TNF-α inhibtors

Third line:

  • JAK inhibitors (UC only)
  • IL-12/23 inhibitors (both)
  • α-4 integrin inhibitors (both)

(J2) GI II Test 1 (14 decks)

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