Pharm of IBD and IBS - Segars Flashcards Preview

GI 2 Final > Pharm of IBD and IBS - Segars > Flashcards

Flashcards in Pharm of IBD and IBS - Segars Deck (44):
1

what is the primary goal of IBD therapy?

achieve and maintain remission (few to no symptoms)

2

what is the secondary goal of IBD therapy?

- preserve intestinal function
- resolve presence of fistulizing disease (CD)
- decrease risk of surgery
- maintain steroid-free remission

3

what are the major class of drugs used for UC?

- 5ASA
- Corticosteroids
- TNF-a Inhibitors
- a-4 integrin inhibitors

4

what drugs have --sala- in the middle

5-ASA drugs used for UC

5

What are the TNF-a inhibitors used for UC

All end in mab
- Adalimumab
- golimumab
- infliximab

6

what is the a-4 integrin inhibitor used for UC

Vedolizumab

7

what catregories of drugs are used for Crohns disease?

- IL-12/23 inhibitors
- Corticosteroids
- TNF-a inhibitors
- a-4 integrin inhibitors

8

What is the IL-12/23 inhibitor used for Crohns

Ustekinumab

9

What TNF-a inhibitors are used for Crohns

- adalimumab
- certolizumab
- Infliximab

Adalimumab and infiximab are also used for (UC)

10

what a-4 integrin inhibitors are used for Crohns

Natalizumab and vedolizumab.

(vedolizumab is also used for UC)

11

what is the MOA of 5-ASA?

Inhibition of PG and LT (tx-A) production via arachidonic acid pathway (similar to aspirin)
- reduce PMN and macrophage chemotaxis (may also inhibit activatio of NF-kB )

12

what are the contraindications for 5-ASA as used in IBD

- contraindicated in ASA allergy
- Sulfasalazine contraindicated in sulfonamide-allergic pts

13

what is the indication of 5-ASA

mild to moderate active UC and Maintenance of remission of UC.

14

which 5-ASA agent is only used for maintenance of UC?

Olsalazine

15

which 5-ASA agent is used only for treatment of active disease?

Balsalazide

16

what is the MOA of TNF-a inhibitors?

- neutralize membrane-associated and soluble human TNF-a mediated proinflammatory cell signaling (inhibits TNF-a mediated actions)
- inhibit expression of pro-inflammatory genes

17

what is a serious potential side effect of TNF-a inhibitors?

- Infections (TB testing pre-therapy required)

18

what is the indication of TNF-a inhibitors?

- Adalimumab: UC and CD
- Infliximab: UC and CD- only one that's given IV. all other are SQ
-Golimumab: UC only
- Certolizumab: CD only

19

what is the MOA for a-4 integrin inhibitors?

- limits integrin-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue

20

Side effect of a-4 integrin inhibitors

Infection: PML - 3 risk factors: treatment >2 yrs; prior immunosuppressant, and anti-JC virus antibodies

21

what are the indication for a-4-integrin inhibitors?

Natalizumab: Moderate to severe treatment resistant CD and maintenance therapy to prevent relapse

Vedolizumab: Both UC and CD - moderate to severe treatment resistant and maintenance

22

what is the MOA of interluekin (Il12/23) inhibitors?

bind to specific subunit of IL-12/23 reeptor located on surface of T cells and natural killer cells and inhibit signal transduction-related activities and production of pro-inflammatory TH1 and 17

23

Side effect of Interleukin (IL12/23) inhibitors:

Infection: TB testing pre therapy recommended

24

what is Interluekin (IL12/23) inhibitor used for?

treatment resistant CD both active and maintenance

25

In pts with IBS, what drugs are used for abd pain?

antimuscarinic agents such as hyoscyamine, dicyclomine, clidnium/chlordiazepoxide

26

what is the MOA for antimuscuarinics used for IBS

competitively inhibit autonomic, post-ganglionic cholinergic recetprs (multiple sites)

27

Side effects of antimuscularinics

class anticholingeric based effects: dry mouth, urinary retenion, constipation, drowsiness, confusion, blurred vision etc

28

what group of drugs are used for diarrhea in IBS?

- Anti-diarrheals
-opioids agonists/antagonists
- Serotonin antagonists

29

what are the anti diarrheal drugs used in IBS

loperamide
diphenoxylate

30

what is the opioids used for diarrhea in IBS

eluxadoline

31

what is the serotonin antagonist used in iBS for diarrhea

alosetron

32

what is the MOA of loperamide?

- interferes with peristalsis by a direction action on circular and longitudinal muscles of intestinal wall, slowing motility
- also may directly inhibit fluid and electrolyte secretion and/or increase water absorption

33

what is the MOA of alosetron

selectively blocks GI-based 5HT3 receptors

34

what is a concerning side effect of alosetron

Ischemic colitis

35

what is the indication for alosetron?

- women with chronic severe IBS-D, not responsible to other conventional therapies

36

what is the MOA of Eluxadoline?

- agonist at opioid mu and kappa receptors in GI tract
- antagonist at delta opioid receptors in GI tract

37

Side effects of eluxadoline

GI-related
- hepatic/pancreatic toxicity
- CNS-related

38

what group of drugs are used for constipation in IBS

- Guanylate cyclase agonist (linaclotide)
- selective chloride channel activators (lubiprostone)

39

what is the MOA of linaclotide

binds to guanylate cyclase-C on luminal surface and increase cGMP --> stimulates secretion of Cl/bicarb into intestinal lumen via CFTR ion channel --> increased intestinal fluid and accelerated transit

40

Side effect of Linaclotide

- diarrhea
- Other GI issues

41

Indication of linaclotide

IBS-C
- chronic idiopathic constipation (not supported under 17)

42

what is the MOA of lubiprostone

activates specific CIC-2 chloride channel in luminal cells of intestinal epithelium --> produce Cl rich intesinal fluid secretion w/o altering serum electrolyte concentration

43

side effects of lubiprostone

Nausea, dyspepsia, dizziness

44

Indication of lubiprostone

IBS-C
- chronic idiopathic constipation (CIC) in adults