Pharmacology for Lower GI Disorders Flashcards
1
Q
Vedolizumab
A
- Gut-selective blockade of lymphocyte trafficking
- Efficacy in UC > CD
- Efficacy for both induction and maintenance therapy
- Differs from natalizumab, which is associated with PML
2
Q
Infliximab
A
- Useful in reducing/closing fistulae in CD
- Chimeric anti-TNF mAb
- Combination therapy with 6-MP is better than either drug alone
3
Q
Adalimumab
A
- Humanized anti-TNF mAb
2. Effective in pts refractory to infliximab
4
Q
Minor side effects of corticosteroids
A
- Moon facies
- Acne
- Striae
- Hirsutism
- Vascular fragility
- Insomnia
- Weight gain
5
Q
Major side effects of corticosteroids
A
- Infection
- Hypertension
- Psychosis
- Hypokalemia
- Growth retardation in children
- Hyperglycemia
- Glaucoma
- Posterior subcapsular cataracts
- Myopathy
- Osteoporosis
- Avascular necrosis
- Adrenal insufficiency
6
Q
Treatment for unresectable VIPoma
A
Somatostatin analog (e.g., octreotide) – inhibits hormone-mediated diarrhea by decreasing plasma secretagogue levels
7
Q
Indications for colectomy in UC
A
- Fulminant disease
- Carcinoma
- Chronic refractory disease
8
Q
GI effects of opioid drugs
A
- Delayed gastric emptying
- Increased absorption and decreased secretion of fluid and electrolytes
- Induction of segmenting contractions that retard propulsion
9
Q
Surgical options for UC treatment
A
- Conventional (Brooke) ileostomy
- Continent ileostomy (Kock pouch)
- Ileo-anal reservoir (J-pouch)
10
Q
5-ASA (mesalamine) preparations used to treat CD
A
- Sulfasalazine – 5-ASA linked to sulfapyridine; hydrolyzed by colonic bacteria to release 5-ASA
- Pro-drug form (Dipentum)
- Delayed release form (Asacol)
- Sustained release form (Pentasa)
11
Q
Antidiarrheal drugs that enhance fluid absorption
A
- Glucose (oral rehydration salts) – increase Na+ cotransport
- Alpha2 adrenergic agonists – increase electroneutral NaCl absorption
- Glucocorticoids – increase electrogenic Na+ absorption and decrease release of immune products from cells of lamina propria
- Opiates – prolong intestinal transit time
12
Q
Mechanism of loperamide action
A
Increases intestinal transit time and thus efficiency of absorption
13
Q
Azathioprine/6-MP adverse effects
A
- Hypersensitivity reaction – fever, rash, pancreatitis, hepatitis
- Bone marrow suppression
- Opportunistic infection
14
Q
Use of glucocorticoids in treatment of IBD
A
- Induce remission, but do not prevent exacerbations
2. Use in CD in controversial
15
Q
Azathioprine
A
- Converted to 6-MP by RBCs
2. Used as maintenance therapy in CD
