IBD, UC and Crohns Drugs Flashcards Preview

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Flashcards in IBD, UC and Crohns Drugs Deck (16):
1

What are the drugs used in Crohn's disease and Ulcerative Colitis?

Aminosalicylates
Glucocorticoids
Immunosuppressants
Anti-TNF alpha drugs
Anti-integrins

2

First up are the aminosalicylates, what are these drugs?

Sulfasalazine, Balsalazide and Mesalamine
MOA of sulfasalazine:
--inhibits the pro inflammatory mediators like IL1 and TNF alpha
In GIT, sulfapyridine (abx) and 5-Aminosalicyclic Acid (5-ASA) (anti-inflammatory): released by sulfasalazine by colonic bacteria
Used in mild to moderate Crohn's disease or UC
Note: Sulfasalazine is used on proximal, distal colon and rectum (so UC for rectum) (Crohns for Anus)

3

What are adverse effects of Sulfasalazine?

N/V/D
Hypersensitivity and reversible oligospermia
Bone marrow suppression (Related to sulfapyridine release from sulfasalazine)

4

What is the MOA for Balsalazide?

Prodrug
--releases mesalamine (5-ASA) in the large intestine at the site of UC

5

Next drug for Crohns and UC are glucocorticoids. What are some features?

Hydrocortisone, Prednisone, Prednisolone, Budesonide
--Corticosteriods: are generalized anti-inflammatory drugs used in acute cases
--inhibit TNFalpha, IL-1, IL-8
Budesonide: controlled released formulation in the distal ileum and colon

6

Next drugs for Crohns and UC are Immunosuppressants. what are some features?

6-mercaptopurine (6-MP), Azathioprine (prodrug of 6-MP) and Methotrexate (MTX) --these are not first line agents
---6-MP may promote apoptosis of immune response. MTX blocks dihydrofolate reductase (DHFR)
--Used in moderately severe to severe Crohn;s Disease and UC
--Hepatotoxicity can occur with 6-MP

7

Next drugs for Crohns and UC are Anti-TNF alpha drugs called Infliximab and Adalimumab.What is the MOA?

MOA for Infliximab:
--monoclonal antibody targets TNFalpha, a principal mediator in Crohns Disease
--used in conditions associated with flare up of IBD: particularly in Crohns related fistulas and acute flares. It is also used in RA
MOA for Adalimumab:
--TNF alpha inhibitor

8

What are adverse effects of Infliximab?

Reactivation of latent TB and other infections
--given IV
Antibodies to infliximab may develop

9

Finally the last drug for Crohns and UC is Natalizumab, what is the MOA?

MOA:
--Natalizumab: blocks leukocyte integrins can produce multifocal leukoencephalopathy

10

Lastly are the drugs used for IBS, what are the features of IBS?

Irritable Bowel Syndrome:
--characterized by diarrhea or constipation or alternating
Chronic symptoms with no structural abnormalities
Frequent Abdominal Pain with:
altered stool frequency, pain gets better after defecation, alteration in stool appearance

11

What are the drug treatment of IBS?

Anticholinergics
5-HT3 antagonists
Opioid Agonists
Chloride Channel Activators

12

What are the anticholinergics used in IBS?

Hyoscyamine, Dicyclomine, Glycopyrrolate and Methscopalamine
--non selective action on the gut
--anti-cholinergic effects on GI, UT, RT, eye, secretions and on heart

13

What is the 5-HT3 antagonist in IBS?

Alosetron
--with long duration of action, has high potency
--reduces smooth muscle activity in the gut
--recommended for severe diarrhea associated with IBS
--rare, serious constipation; ischemic colitis and infarction may occur

14

What is the opioid agonist in IBS?

Loperamide
--acts via GI mu-opioid receptors
Inhibits acetylcholine release and decrease peristalsis
--used in IBS with diarrhea

15

What is the chloride channel activator in IBS?

Lubiprostone
--used in constipation associated IBS

16

Finally there are two drugs used in Pancreatic Insufficiency, the first is Pancrelipase, what are some features of this drug?

A replacement enzyme from animal pancreatic extract
--improve the digestion of dietary fat, protein and carbs. and increases A,D,E,K vit absorption
Use:
patients with chronic pancreatitis, after pancreatectomy, steatorrhea and CF associated insufficiencies

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