IBD Pharmacology Flashcards
What is considered clinical remission of IBD?
achieving symptoms relief, getting rid of inflammation
in case of colonic UC- curing the disease
What are the drug classes available for treatment of IBD?
aminosalycilates immunomodulators biologics- TNF Non-TNF biologics including anti-adhesion therapy steroids
What drugs are acceptable for induction therapy?
aminosalycilates (slow onset)
steroids
anti-TNF agents (biologics)
What drugs are acceptable for maintenance therapy?
aminosalyscillates
immunomodulators
anti-TNF agents (biologics)
non-TNF biologics/ anti-adhesion drugs
Contrast the clinical criteria of Crohn’s disease severity: mild, moderate and severe.
mild-moderate: ambulatory; no abdominal tenderness, painful mass, or obstruction
moderate-severe: unresponsive to tx, with prominent fever, weight loss, anemia and abdominal pain, tenderness with intermittent nausea or vomiting
severe fulminant disease: persistent symptoms on corticosteroids or with high fever, rebound tenderness, caches or abscess
What drug options do you have for mild, moderate or severe crohn’s?
mild: aminosalycilates (induce and maintain)
moderate: AZA (maintenance), methotrexate (maintenance)
severe: anti-adhesion (maintenance) TNF inhibitor (induction or maintenance); steroids (induction only; surgical resection
What is the MOA of aminosalycilates?
act by altering inflammatory and chemotactic mediators
Give two examples of immunmodulators and their MOA.
methotrexate: inhibits folate metabolism
azathioprine: purine analog that inhibits DNA synthesis (maintenance)
both take while to work
What is the mechanism of action for TNF-a inhibitors?
TNF plays a critical role in activation of innate and adaptive immune response so inhibition reduces inflammation by interfering with specific cytokine response
inhibtors bind and inhibit the action of TNF-a
note that the body can develop antibodies to the drug
e.g.: natalizumab, vedolizumab
What is the MOA of anti-adhesion therapy?
bind to intern subunits and affect leukocyte trafficking blocks, blocks inflammatory cells from entering the intestine and decreasing inflammation
Contrast the percent of people with UC and CD that will require surgery some time in their life time.
CD- at least 70% at least once, many multiple surgeries
UC- after 30yrs, ⅓ will require surgery, removal of the entire colon is considered curative
In those is UC, what are indications for colectomy?
toxic megacolon, severe hemorrhage, lack of response to therapy and cancer or dysplasia
What are the two outcomes from colectomy?
most commonly colectomy and ill pouch anastomosis
OR
total removal of colon and rectum with permanent ileostomy
Describe the change of paradigm in treating those with severe CD.
formally you had to fail less aggressive treatments before progressing to newer, stronger treatments, today patients presenting with aggressive disease are put on strongest treatments
