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