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