GI Pharm Test #2 Flashcards
Antibiotic use with IBD
Beneficial for CD only
Use 2nd line after failure of aminosalicylates
Aminosalicylates Indication and Drugs
For mild/moderate UC and CD exacerbation or maintenance
Sulfasalazine (mesalamine pro-drug): works in proximal colon
-sulfa allergy, worst SE profile (SJS, immunosuppression)
Mesalamine: poor absorption - works as a topical agent
Mesalamine route - locations of efficacy
Oral Tablet: released in distal ileum and colon
Oral Capsules: proximal small intestine and colon
Enema: distal and sigmoid colon
Rectal: primary for UC proctitis
Aminosalicylate MOA and SE
MOA: Block prostaglandins, inhibit inflammatory cytokines and immune response
CI: ASA allergy, G6PD deficiency, Sulfa allergy (sulfasalazine)
SE (Mesalamine): HA, malaise, abdominal pain, diarrhea
Monitor CBC, LFTs, Renal function
Corticosteroid indication and drugs
Used for UC & CD exacerbations, not for maintenance
Prednisone: taper w/ pt response
Budesonide: Inhaled, poor systemic absorption (Ideal)
Also topical strains for IBD in rectum/sigmoid colon
Antibiotics
Used for severe CD exacerbations when ASA haven’t worked for 3-4 weeks
Ciprofloxacin and Metronidazole
Immune Modifier Indications and drugs
Maintain remission with steroid-refractory UC/CD
Azathioprine & 6-mercaptopurine
Methotrexate (UC effects uncertain)
Azathioprine and 6-Mercaptopurine
MOA: inhibit purine metabolism, DNA synthesis, and repair
- no cellular division or proliferation
SE: dose related - N/V/D, fever, rash, Bone marrow suppression, hepatic toxicity
Monitor CBC and LFTs, decrease dose w/ CrCl<50
CI: pregnancy, active liver disease
Methotrexate
Works best with Crohn’s
Inhibits folic acid metabolism, interferes w/ IL-1, apoptosis in T cells
CI: pregnancy and liver disease, adjust for CrCl
SE: Alopecia, bone marrow suppression, megaloblastic anemia, cirrhosis, rash
IV Cyclosporin
Acute treatment for severe, steroid-refractory UC in hospitalized pt
Improvement in 2-3 days
SE: Nephrotoxicity, hypomagnesemia, hypertension
TNF Inhibitors
Severe, steroid-refractory CD
Infliximab (UC also), Adalimumab (Humira)
BBW: latent TB reactivation - must have PPD 1st
SE: early or late infusion reaction
- early: fever, chills, pruritus, chest pain - tx w/ Benadryl
- late: (1-2 wks) arthralgia, face/hand/lip edema - tx antihistamines or steroids
IBS Constipation-predominant Treatment
Increase fluids, fiber
TCA, SSRI
Peppermint oil, osmotic laxative (Miralax)
Lubiprostone - Increases intestinal fluid secreation
IBS Pain-predominant Treatment
Antispasmodics (Dicyclomine 1st line)
TCAs
SSRI
Peppermint Oil
IBS Diarrhea-predominant Treatment
Fiber
Loperamide
Cholestyramine
TCA, SSRI
Lotronex (never for constipation -> ischemic colitis)
Antispasmodics
Help with pain, dosed PRN
Anticholinergics - Dicyclomine (Bentyl) 1st line
Caution with elderly, BPH, HTN, hyperthyroid
