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Flashcards in IBD Pharm Deck (45):
1

Drug Classes for UC

-5-ASA**
-Corticosteroids
-TNF-alpha inhibitors
-alpha-4 integrin inhibitors

2

Drug Classes for CD

-IL-12/23 inhibitors**
-Corticosteroids
-TNF-alpha inhibitors
-alpha-4 integrin inhibitors

3

UC- 5-ASA- drugs

-SulfaSALAzine (sulfapyridine + 5-ASA)
-MeSALAmine (single 5-ASA)
-OlSALAzine (2 molecules of 5-ASA)
-BalSALAzide (inert carrier + 5-ASA)
(SMOB)

4

UC- TNF-alpha inhibitors- drugs

-AdalimuMAB
-GolimuMAB
-InflixiMAB

5

UC- alpha-4 integrin inhibitors- drugs

-VedolizuMAB

6

CD- IL-23 inhibitors- drug

-UstekinuMAB

7

CD- TNF-alpha inhibitors- drugs

(same as UC)
-AdalimuMAB
-GolimuMAB
-InflixiMAB

8

CD- alpha-4 integrin inhibitors- drugs

-NatalizuMAB
-VedolizuMAB (also in UC)

9

5-ASA- moa

-inhibition of PG and LT production via arachidonic acid pathway- COX and LIPOX

10

5-ASA- contraindications

-ALL contraindicated in ASA-allergic pts
-Sulfasalazine- contraindicated in sulfonamide-allergic pts!!!

11

5-ASA agents- indications

-mild to moderate Active UC
-maintenance (of remission) of UC
-except- Olsalazine- only maintenance
-except- Balsalazide- only for active

12

TNF-alpha inhibitors- moa

-neutralizes TNF-alpha-mediated pro-infl cell signaling
-inhibits expression of pro-infl genes

13

TNF-alpha inhibitors- SE

-infections!!!
-TB testing pre-therapy!!!

14

TNF-alpha inhibitors- indications

*all moderate to severe
-Adalimumab and Infliximab- UC and CD! (All and Inclusive)
-Golimumab- UC (doesnt start with C)
-Certolizumab- CD (starts with C)

15

TNF-alpha inhibitors- dosing

-Adalimumab- SQ- every other week
-Infliximab- IV (starts with I)- every 8 wks
-Golimumab- SQ- every 4 wks
-Certolizumab- SQ- every 4 wks

16

alpha integrins- role in what?

lymphocyte migration!!
-alpha4B7- esp migration into GI tract

17

alpha-4 integrin inhibitors- moa

-limits integrin's-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue

18

alpha-4 integrin inhibitors- SE

-infections
-PML(progressive multifocal leukoencephalopathy)!!! (esp natalizumab)- opportunistic infection of brain- risk factors: tx > 2yrs, prior immunosuppressant tx, anti-JC virus ab's
(doctor must be in TOUCH prescribing program)

19

alpha-4 integrin inhibitors- indications

*both moderate-to-severe and maintenance
-Natalizumab- CD
-Vedolizumab- CD and UD

20

alpha-4 integrin inhibitors- dosing

-Natalizumab- IV- 4 wks
-Vedolizumab- IV- 8 wks

21

Interleukin (IL-12/23) inhibitors- moa

-bind to IL-12/23 R- inhibit signal transduction activities and production of pro-infl Th1 and Th17 cells

22

Interleukin inhibitors- SE

-infections!!
-TB testing pre-therapy recommended

23

Interleukin inhibitors- indications

-moderate-to-severe treatment resistant CD! (active and maintenance)
-for pts intolerant or resistant to initial CD therapies, including TNF-alpha inhibitors

24

Interleukin inhibitors- dosing

-Ustekinumab
-IV (single infusion)- for induction
-SQ (every 8 wks)- for maintenance

25

Steroids- indications, dosing

-Acute and/or severe UC and CD uncontrolled by other conventional medications
-LOWEST dose for SHORTEST duration possible

26

IBS (irritable bowel syndrome)

-constipation
-diarrhea
-abd pain

27

Abdominal pain- use what drug class?

Antimuscarinic agents!
-Hyoscyamine
-Dicyclomine
-Clidinium/Chlordiazepoxide
(HDC)

28

Antimuscarinic agents- drugs

-Hyoscyamine
-Dicyclomine
-Clidinium/Chlordiazepoxide
(HDC)

29

Antimuscarinic agents- moa

-dec GI motility and spasms
*for Abd pain/spasms!

30

Antimuscarinics- SE

classic antimuscarinics

31

IBS- drug classes for diarrhea

-anti-diarrheals
-opioid agonists/antagonists
-serotonin (5HT3) antagonists

32

Anti-diarrheals- drugs

-Loperamide
-Diphenoxylate

33

Opioid Agonists/Antagonists- drug

-Eluxadoline

34

Serotonin antagonists drug

Alosetron

35

Loperamide- moa

-interferes with peristalsis- direct action of circular/longitudinal m's of intestinal wall

36

Diphenoxylate- moa

-locally and centrally on GI smooth m cells
-inhibits GI motility and slows excess GI propulsion
-atropine added to discourage abuse

37

Alosetron- moa

-blocks GI-based 5HT3 R's

38

Alosetron- SE

-ischemic colitis!!!

39

Alosetron- indication

-women with chronic, severe IBS-diarrhea, not responsive to other conventional therapies
-Dr's must enroll in prescribing program

40

Eluxadoline- moa

-agonist at opioid mu and K R's in GI tract (slows peristalsis/delays digestion)
-antagonist at delta opioid R's in GI tract- secretionsdecreased

41

Drug classes for Constipation

-Guanylate Cyclase-C agonists
-Selective Chloride (C2) Channel Activators

42

Guanylate Cyclase-C agonists- drug

-Linaclotide

43

Selective Chloride (C2) Channel Activators- drug

-Lubiprostone

44

Linaclotide- moa, indications

Guanylate Cyclase-C agonist
-for IBS-Constipation!

45

Lubiprostone- moa, drug

-selective Chloride (C2) Channel Activator
-IBS-Constipation (women)