IBD Therapeutics Flashcards by Madelynn Packer

What are the ASAs for IBD

sulfasalazine, mesalamine

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What steroids are used for IBD

local and systemic

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what are the immunomodulators used for IBD

azathioprine, mercaptopurine, cyclosporine, methotrexate

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what are the anti-tnf-a agents used in IBD

infliximab, adalimumab, certolizumab, golimumab

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what are the other anti inflammatory agents for IBD

natalizumab, vedolizumab, ustekinumab

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what is the active component of sulfasalzine

5-ASA
exerts actions locally

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mesalamine is absorbed where in the GI

rapidly absorbed in small intestine but not colon

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formulations of mesalamine

topical
suppository
oral

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ADRs of sulfasalazine

N/V, headache, anorexia, rash, anemia, hypersensitivity

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what is the major DDI with sulfasalazine

antiplatelet/anticoag/NSAIDs all may increase bleeding risk

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ADRs of mesalamine

more tolerated than sulfasalazine
N/V, headache, diarrhea, rash

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DDI with mesalamine

antiplatelet/anticoag/nsaids all may increase bleeding risk
PPI, H2RA, antacids could all influence release of drug

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Budesonide class and MOA

corticosteroids and anti inflammatory

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what is the budesonide formulation for IBD

PO in CR formulation

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how long can you use corticosteroids in IBD

8-16 weeks

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what are the DDIs with budesonide

CYP3A4 inhibitors (ketoconazole, grape fruit juice)

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what are the ADRs of all corticosteroids

short term: hyperglycemia, gastritis, mood changes, increased BP
long term: aseptic necrosis, cataracts, obesity, growth failure, HPA suppression, osteoporosis

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what other corticosteroids besides budesonide can be used for IBD

oral prednisone or prednisolone
IV methylprednisolone or hydrocortisone
can be used for disease flares or induction of remission

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when to use azathioprine (AZA) and mercaptopurine (MP, 6-MP)

Reserved for patients who fail 5-ASA or pts who are refractory to/dependent on steroids

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can you use AZA or MP for induction?

no but it can maintain remission

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can you use AZA/MP with other drugs

yes

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when can you see the benefit of AZA/MP

weeks to months

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What are the ADRs of AZA and 6-MP

N/V/D, anorexia, stomatitis
bone marrow suppression
hepatotoxicity
fever, rash, arthralgia, pancreatitis

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what is the monitoring for AZA/MP

TMPT must be taken prior to start
CBC
LFTs

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when to use cyclosporine

inducing remission in patients with refractory IBD *not an option for long term use*

ADRs of cyclosporine

nephrotoxicity neurotoxicity HTN, hyperlipidemia, hyperglycemia GI upset, hirsutism

monitoring of cyclosporine

BP, BUN/SCr, LFTs, trough concentration

what are the DDIs with cyclosporine

increase conc: azoles, anti-fungals, macrolide antibiotics, CCBs, grapefruit decrease conc: phenytoin, rifampin

When to use methotrexate

crohn's disease for maintenance

what are the ADRs of methotrexate

bone marrow suppression (add folic acid) N/V/D, stomatitis, mucositis cirrhosis, hepatitis, fibrosis hypersensitivity pneumonitis derm effects teratogenic (need contraception)

when is methotrexate contraindicated

pregnancy pleural effusions chronic liver disease immunodeficiency blood issues ClCr < 40 ml/min

monitoring for methotrexate

CXR CBC SCr LTFs

what is the class and indication for infliximab (remicade)

anti TNF-alpha CD and UC

what is the class and indication for adalimumab (humira)

anti TNF-alpha CD and US

what is the class and indication for golimumab (simponi)

anti TNF-alpha antibody UC

what is the class and indication for certolizumab pegol (Cimzia)

anti-TNF alpha CD

what is the class and indication for Natalizumab (Tysabri)

anti alpha integrin CD

what is the class and indication for vedolizumab (entyvio)

anti a4B7 integrin UC and CD

what is the class and indication for ustekinumab (stelara)

IL-12 and IL-23 antagonist CD and UC

what is the class and indication for risankizumab-rzaa (skyrizi)

IL-23 antagonist CD and UC

what is the class and indication for mirikizumab (Omvoh)

IL-23 antagonist UC

what is the class and indication for tofacitinib (xeljanz)

oral JAK inhibitor UC

what is the class and indication for upadacitinib (Rinvoq)

oral JAK 1 inhibitor UC and CD

What is the class and indication for ozanimod (Zeposia)

oral S1P receptor modulator UC

what is the class and indication for estrasimod (Velsipity)

oral s1p receptor modulator UC

What are the class ADRs of anti-TNF-alpha

-increased risk of infection -CI of live vaccines during tx and 3 months after -injection site rxn -risk of malignancy/lymphoma -demyelinating disease -exacerbation of CHF

baseline monitoring for Anti-TNF-alpha

-CXR, PPD -infection -UA -CBC -SCr, lytes -LFTs -Hep B, C

maintenance monitoring for anti-TNF-alpha

infections UA CBC SCr, Lytes LFTs inflammatory markers

when to use infliximab

mod-sev CD and UC induction and maintenance

how to prevent development of ADAs in biologics

combine with azathioprine, but could increase ADRs

when to use adalimumab

mod-sev CD and UC induction and maintenance therapy

when to use golimumab

mod-sev UC induction and maintenance

when to use certolizumab

mod-sev CD induction and maintenance

when to use natalizumab

CD induction and remission used in pts who fail or do not tolerate TNF-alpha

when do d/c natalizumab

d/c if not working

what is associated with natalizumab that is severe

Progressive Multifocal Leukoencephalopathy (PML)

when to use vedolizumab

UC and CD induction and remission

ADR of vedolizumab

biologic ADRs less association with PML TDM possible

when to use ustekinumab

CD and UC induction (IV) and maintenance (SQ)

severe ADR associated with ustekinumab

carcinomas of the skin (get regular skin exams)

when to use risankizumab (Skyrizi)

mod-sev CD and UC induction (IV) and maintenance (SQ)

ADRs of risankizumab

biologic ADRs increase of LFTs increase of lipids

when to use mirikizumab

UC induction and maintenance

ADRs of mirikizumab

biologic ADRs increase of LFTs and lipids

Why should TDM be tested

determines conc and drugs and ADA in body consider doing TDM if loss of treatment response

If there is subtherapeutic drug levels and detectable ADA, what is the cause and what should you do?

An immune mediated PK issue change to alternate drug within same class

If there is subtherapeutic drug levels and undetectable ADAs, what is the cause and what should you do?

Non-immune mediated PK issue increase the dose

If there are therapeutic drug levels and detectable ADAs, what is the cause and what should you do?

Either a false positive or mechanistic failure repeat TDM or switch to out of class biologic

If there are therapeutic drug levels and undetectable ADAs, what is the cause and what should you do?

Mechanistic failure Switch to out of class biologic agent

when to use tofacitinib

UC only for pts who have inadequate response to or intolerant to TNF blockers

what are ADRs for tofacitinib

common: diarrhea, elevated cholesterol, headache, shingles, rash rare: malignancy, infection, neutropenia

black box warning for tofacitinib

increased mortality for RA patients 50+ with at least one CV risk factor increased thrombosis for those patients

when to use upadacitinib

UC and CD for pts who have inadequate response to or intolerant to TNF blockers

black box warning for upadacitinib

same warning as tofacitinib

ADR for upadacitinib for young women

potentially teratogenic, excreted in breast milk

when to use ozanimod

mod-sev active UC used alone

what is the dosing catch with ozanimod

if a dose is missed in the first two weeks of tx, reinitiate titration regimen

what are the CI for ozanimod

MACE in last 6 months mobtiz type II severe or untreated sleep apnea taking MAO inhibitor

what are the ADRs of ozanimod

increased risk of infection bradycardia/AV conduction delays

when to use estrasimod

mod-sev UC

what are CI to estrasimod

MACE in last 6 months cardiac conduction abnormalities

IBD Therapeutics Flashcards

(81 cards)