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GI II Exam 3 > Pharm for IBD > Flashcards

Pharm for IBD Flashcards

1
Q

Drug types for IBD

A 
5-ASA
Corticosteroids
immunosuppressants
Anti-TNF alpha antibodies
alpha4-integrin monoclonal antibody
antibiotics (not FDA approved for IBD)
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2
Q

5-Aminosalicylic Acid (mesalamine, 5-ASA)

A

Delayed or extended release:
Apriso, Asacol, Lialda, Pentasa

Prodrug formulations:
Sulfasalazine, balsalazide, olsalazine

Rectal formulations:
Rowasa, Canasa

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3
Q

Corticosteroids

A

Prednisone
* Budesonide
Hydrocortisone

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4
Q

Immunosuppressants

A
  • Azathioprine
  • Mercaptopurine (6-MP)
    Methotrexate (MTX)
    Cyclosporine
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5
Q

Anti-TNFα Antibody

A
  • Infliximab (Remicade)
    Adalimumab (Humira)
    Certolizumab pegol (Cimzia)
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6
Q

α4-Integrin Monoclonal Antibody

A

Natalizumab (Tysabri)

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7
Q

Antibiotics (not FDA approved for IBD)

A

Metronidazole (Flagyl)

Ciprofloxacin (Cipro)

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8
Q

Drug List: IBS

A

Laxatives

  • Lubiprostone
  • Bulk-forming laxatives (psyllium, bran)

Antidiarrheal Agents

  • Loperamide (Imodium)
  • Diphenoxylate (Lomotil)

5-HT3 Antagonist
- Alosetron

Antispasmodic Agents (anticholinergics)

    • Dicyclomine (Bentyl)
    • Hyoscyamine sulfate

Antidepressants
- Amitriptyline

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9
Q

For the initial treatment of mild-to-moderate UC, an agent with which of the following mechanisms of action would be most appropriate? Inhibition of:

Inflammatory cytokine production
Local chemical mediators of inflammation 
Muscarinic cholinergic receptors 
Purine nucleotide synthesis
TNFα-mediated inflammatory responses
A

THe answer is LOCAL chem mediators (5ASA)

More about other answer choices:
muscarinic choinergic receptors- antispasmodics

purine nucleotide synth- mercaptopurine, etc.

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10
Q

step-up approach to IBD

A

mild- budesonide, topical corticosteroids, abx, 5-ASAs

moderate- TNF antagonists, oral corticosteroids, methotrexate, azathioprine/ 6-mercaptopurine

severe: surgery (curative in UC but not so much in crohn’s), natalizumab, cyclosporine, TNF antagonists, IV corticosteroids

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11
Q

for flares we use

A

oral corticosteroids

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12
Q

Aminosalicylates are:

A. Associated with insomnia and behavioral changes
B. Available only in oral formulations
C. Generally used first for induction and maintenance of remission in mild-to-moderate UC
D. Proven effective for induction and maintenance of remission in mild-to-moderate CD

A

C. generally used first for induction and maintenance of remission to mild-to- moderate UC

not proven to be effective in crohn’s but still used

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13
Q

what agents are Associated with insomnia and behavioral changes

A

corticosteroids

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14
Q

method of action of sulfa drugs?

A

folic acid inhibitors

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15
Q

pt with sulfa drug and UC.

Which one of the following drug therapies is best?
6-mercaptopurine
Hydrocortisone enema
Mesalamine
Sulfasalazine
A

likely mesalamine after ruling out sulfasalazine

6-mercaptopurine would be further down the road if this is ineffective

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16
Q

Since initiation of a new drug, the patient has required additional blood pressure, serum glucose, and weight monitoring. What was most likely begun one year ago?

A

Budesonide

17
Q

azothiaprine, infliximab, mercaptopurine– monitor for what?

A

immunosuppression

infliximab– rule out infectious diseases

18
Q

mesalamine can cause what kind of side effects?

A

potentially some GI issues

19
Q

corticosteroids MOA

A

Available agents: prednisone, budesonide, hydrocortisone

MOA:
Inhibits production of inflammatory cytokines (TNF-α, IL-1) and chemokines (IL-8)
Reduces expression of inflammatory cell adhesion molecules
Inhibits gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2, and NF-κβ

20
Q

After dose reduction of budesonide, the patient experiences fever, abdominal pain, and 5-6 bloody bowel movements per day.

What is this?

A

flare in a steroid-dependent patient

21
Q

what should we do for the steroid-dependent patient?

A

Initiate azathioprine and attempt to taper the budesonide

or

Initiate infliximab and attempt to taper the budesonide

22
Q

Anti-TNFα Antibodies MOA

A

Available agents: infliximab, adalimumab, certolizumab
MOA: bind soluble and membrane bound TNF with high affinity
Prevents receptor binding
Causes reverse signaling and suppresses cytokine release

23
Q

The decision is made to begin infliximab. Which of the following must be ruled out before initiating therapy? what are the dangers of the other classes?

Allopurinol
Diabetes
Progressive multifocal leukoencephalopathy  
Psychiatric disorders
Tuberculosis
A

TB!

allopurinol- watch out for 6MP
diabetes- corticosteroids- watch glucose leveles
Progressive multifocal leukoencephalopathy- mataluzimab
psychiatric disorders- steroids

24
Q

Purine Analogs MOA

A

Available agents: azathioprine, 6-mercaptopurine
MOA: azathioprine  6-MP  active metabolites which suppress nucleotide synthesis, B-cell and T-cell function, immunoglobulin production, and IL-2 secretion

25
Q

Which of the following is not a dose-dependent side effect of sulfasalazine?

Dyspepsia
Headache
Malaise
Nausea
Skin rash
A

all of these are potential side effects, but the rash can’t be helped with changing the drug dose

26
Q

Crohn’s disease, mesalamine and bedesonide no longer working. What should we do?

A

corticosteroids short term

TNF-alpha, 6MP are some other choices, or in combination

27
Q

Irritable Bowel Syndrome (IBS)

A

Occurs ~15% of U.S. population, 2:1 female to male
Idiopathic disorder
Abdominal discomfort with alterations in bowel habits
Pathophysiology:
Enteric nervous system contains a significant number of serotonin receptors which have become an area of focused research

28
Q

IBS Goals of Therapy

A

Relieve abdominal pain and improve bowel function
First step = dietary change
Chronic abdominal pain
Low doses of tricyclic antidepressants
- No effect on mood but may alter central processing of visceral information
- Anticholinergic effects – GI motility, reduce stool frequency

29
Q

Chloride Channel Activator

A

Lubiprostone

MOA: stimulates type 2 chloride channels, stimulates intestinal fluid secretion, decreases colonic transit time

Therapeutic Use:
Women with constipation predominant IBS

ADRs: nausea (delayed gastric emptying)

30
Q

5-HT4 Partial Agonist

A

Agent: tegaserod

MOA: activates 5-HT4, increases GI motility, and decreases visceral sensations

Therapeutic Use:
Women with severe constipation predominant IBS
Improves symptoms within 1st week of therapy

ADRs: diarrhea
Increased risk of ischemic events

31
Q

5-HT3 Antagonist

A

Agent: alosetron

MOA: inhibits afferent receptors reducing unpleasant sensations including bloating, nausea, and pain
Inhibits colonic motility, increases transit time

Therapeutic Use:
Women with severe diarrhea predominant IBS

ADRs: constipation

32
Q

Antispasmodics

A

Available agents: dicyclomine, hyoscyamine

MOA: inhibit muscarinic cholinergic receptors

ADRs: anticholinergic side effects – dry mouth, visual disturbances, urinary retention, constipation
- Not routinely used

GI II Exam 3 (14 decks)

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