Exam 4 - IBD meds

Question 1

Where does Pentasa work?

Answer 1

Entire GI tract, from Duodenum to Rectum.

Question 2

What class is Pentasa?

Answer 2

Aminosalicylates 5-ASA Mesalamine

Question 3

What route is Pentasa? What not to do?

Answer 3

PO. Do not crush!

Question 4

CI for Pentasa?

Answer 4

Salicylate allergy

Question 5

Where does Budesonide work?

Answer 5

Right/ascending colon and ileum.

Question 6

What is DOC for IBD of ascending/right colon or ileum?

Answer 6

Budesonide

Question 7

Can Budenoside help induce remission in UC?

Answer 7

Yes

Question 8

Where do all the “-salazines” work?

Answer 8

Colon and rectum. LI only.

Question 9

Which is only IBD drug to work in the Jenunum and Duodenum?

Answer 9

Pentasa

Question 10

Canasa is a suppository which only works where?

Answer 10

Rectum

Question 11

Enemas work in which two locations?

Answer 11

Rectum and sigmoid colon

Question 12

What happens to Sulfasalazine in the gut?

Answer 12

Bacteria cleave and becomes active Mesalamine

Question 13

ADRs of Sulfasalazine?

Answer 13

• Skin/urine organge-yellow
• Folic acid malabsorption
• Hemolytic anemia in G6PD decifiency

Question 14

CIs of Sulfasalazine?

Answer 14

Sulfa and Salicylate drugs.

Question 15

MOA for AZA?

Answer 15

AZA -> 6-MP

Question 16

What does AZA inhibit?

Answer 16

T-lymphocytes

Question 17

What does 6-MP inhibit?

Answer 17

DNA synthesis

Question 18

How long does AZA/6-MP take to work?

Answer 18

3 months to 1 year.

Question 19

AZA/6-MP for induction or maintenance of remission?

Answer 19

Maintenance only! Takes 3 months to 1 year to work!

Question 20

AZA and bone marrow suppression- how?

Answer 20

TMPT gene produces enzyme to convert AZA to 6-MP. Lack of enzyme causes increased AZA resulting in leukopenia.

Question 21

Can AZA cause lymphoma?

Answer 21

Yes. Skin cancer from long-term use of AZA.

Question 22

AZA causes which organ to become toxic?

Answer 22

Hepatotoxicity

Question 23

MOA of MTX (immunomodulator)? (hint: 2)

Answer 23

Inhibit dihydrofolate reductase and DNA synthesis

Question 24

MTX in CD or UC

Answer 24

CD only!!

Question 25

MTX dosed how often? Route?

Answer 25

IM q week

Question 26

What else to give with MTX?

Answer 26

Folic acid

Question 27

3 ADRs of MTX?

Answer 27

Myelosuppression, hepatotoxic, nausea

Question 28

MOA of Cyclosporine (immunomodulator)?

Answer 28

Calcineurin-inhibitor

Question 29

Cyclosporine reserved for when in IBD?

Answer 29

Severe, refractory cases

Question 30

Cyclosporine IV vs PO does what?

Answer 30

IV=induce remission | PO=w/AZA for maintenance

Question 31

ADR of Cyclosporine?

Answer 31

Nephrotoxic

Question 32

TNF inhibitors used for which IBD more than the other?

Answer 32

CD >> UC

Question 33

TNF inhibitors end in what"

Answer 33

"-mab"

Question 34

What stage of IBD to use TNF inhibitors?

Answer 34

Moderate to Severe is conventional therapy fails

Question 35

Which TNF-inhib is IV only? Other route?

Answer 35

Remicade IV only. Rest are SC.

Question 36

Simpuni is for which moderate-to-severe IBD?

Answer 36

UC

Question 37

What can TNF inhibitors reactivate?

Answer 37

Latent TB and Hep B.

Question 38

TNF Inhib caution with which condition?

Answer 38

III/IV HF

Question 39

TNF Inhib can develop antibodies which which med?

Answer 39

AZA

Question 40

What sort of reactions with TNF Inhib?

Answer 40

Hypersensitivity

Question 41

What are the two classes of "biologics"?

Answer 41

1. TNF-inhibitors | 2. Anti-Alpha 4 Integrin

Question 42

Entyvio (vedolizumab) MOA? Route?

Answer 42

Anti-alpha 4 integrin. IV.

Question 43

Entyvio (vedolizumab) use?

Answer 43

Moderate to severe UC/CD if conventional therapy fails.

Question 44

Entyvio (vedolizumab) and JC virus?

Answer 44

If positive for JC virus only use 9-12 months before using Tysabri.

Question 45

PML and Entyvio (vedolizumab)?

Answer 45

Rare

Question 46

Tysabri (natalizumab) MOA? Route?

Answer 46

Anti-alpha 4 Integrin. IV.

Question 47

Tysabri (natalizumab) use?

Answer 47

Moderate to severe CD (only!) in PT w/o response to conventional tx or other anti-TNF.

Question 48

PML and Tysabri (natalizumab)?

Answer 48

Big problem. Enroll in TOUCH program. Risk increases with # of infusions.