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Pharmacology Week 2 Flashcards

(100 cards)

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1
Q

Classes of Treatment for IBD & IBS

A 
Aminosalicylates
Corticosteroids
Antibiotics
Immunosuppressive agents
Biological agents
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2
Q

Characteristics to determine which treatment should be used

A

Severity of disease
UC
Crohn’s lesions locations
Exacerbations vs. maintenance

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3
Q

Drugs used for Treatment of IBD

A 
Aminosalicylates
Corticosteroids
Immunosuppresive agents
IV cyclosporine
Antibiotics
Immune modifiers
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4
Q

When do you use aminosalicylates in the treatment of IBD?

A

Mild to moderate UC & CD exacerbations

Maintenance of remission

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5
Q

When do you use corticosteroids in the treatment of IBD?

A

Treatment of UC & CD exacerbations

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6
Q

When do you use immunosuppressive meds in the treatment of IBD?

A

Maintain remission

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7
Q

When do you use IV cyclosporine in the treatment of IBD?

A

Severe active refractory UC

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8
Q

When do you use antibiotics in the treatment of IBD?

A

Acute exacerbations

Maintenance of remission

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9
Q

When do you use immune modifiers in the treatment of IBD?

A

Maintain remission in steroid refractory UC & CD

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10
Q

Examples of Aminosalicylates

A

Sulfasalazine (Azulfidine)
Mesalamine (Asacol, Pentasa)
Olsalazine (Dipentum)
Basalazide (Colazal)

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11
Q

Clinical Uses for Aminosalicylates

A

Induce/maintain remission in UC

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12
Q

Routes of Administration of Aminosalicylates

A

PO
Enema
Suppository

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13
Q

Suflasalazine (Asulfidine)

A

Preg. B

Converted to mesalamine in the proximal colon

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14
Q

Contraindications of Sulfasalazine (Asulfidine)

A

Sulfa allergy

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15
Q

Mesalamine (Asacol, Pentasa)

A

Preg B

Works like a topical agent due to being poorly absorbed

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16
Q

Drug Release of Asacol Oral Tablets

A

Distal ileum & colon

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17
Q

Drug Release of Pentasa Oral Capsules

A

Proximal small intestine and throughout the colon

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18
Q

Routes of Administration of Melalamine

A

Oral tablets (Asacol)
Oral capsules (Pentasa)
Enema
Rectal suppositories

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19
Q

Where can a mesalamine enema reach?

A

Distal/sigmoid colon

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20
Q

When are melamine rectal suppositories primarily used?

A

UC proctitis

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21
Q

Why are the aminosalicylates banalized (Colazal) and olsalazine (Dipentum) not used frequently?

A

Increased cost

No extra efficacy

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22
Q

MOA of Aminosalicylates

A

Blocks prostaglandin production
Interferes with production of inflammatory cytokines
Inhibit NK cells, lymphocytes & macrophages

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23
Q

Contraindications of Aminosalicylates

A

Aspirin/salicylate allergy

G6PD deficiency

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24
Q

SE of Sulfasalazine

A 
N/V
Photosensitivity
Oligospermia
Skin discoloration
Decreased folate levels
SJS
Crystalluria
Pancreatitis
Hepatitis
Bone marrow suppression
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25
Labs to monitor with Sulfasalazine
CBC with diff | LFTs
26
SE of Mesalamine
Headache Malaise Abdominal pain Diarrhea
27
SE of Olsalazine
Headache Malaise Abdominal pain Severe secretory diarrhea
28
SE of Balsalazide
``` Headache Malaise Abdominal Pain Diarrhea Staining of teeth (capsule opened & sprinkled on food) ```
29
Monitoring of Mesalamine
Renal function CBC Hepatic function
30
Short Term SE of Steroids
``` Hyperglycemia Increased appetite Insomnia Anxiety Tremors Increased fluid retention Increased BP ```
31
Long Term SE of Steroids
``` Decreased bone mineral density Fat redistribution Ulcers from decreased prostaglandin production Hypertriglyceridemia Hirsutism ```
32
Examples of Oral Corticosteroids
Prednisone (Deltasone) Prednisolone (Prelone) Budesonide (Entocort)
33
What is the treatment of choice in patients with mild to moderate CD?
Budesonide (entocort)
34
Examples of Topical Corticosteroids
Cortenema Cortifoam Anusol-HC suppositories
35
Antibiotics used in IBD
Ciprofloxacin | Metronidazole
36
Duration of Ciprofloxacin Therapy in Crohn's Disease
Up to 6 weeks
37
Duration of Metronidazole (Flagyl) in Crohn's Disease
1-2 months for response | Up to 12 months total
38
Examples of Immune Modifiers
Azathioprine 6-mercaptopurine Methotrexate Infliximab
39
Clinical Use of Azathioprine & 6-Mercaptopurine
Induction/maintenance of remission UC & Crohn's Allow reduction of steroids
40
Pregnancy Category of Azathioprine & 6-Mercaptopurine
Preg D
41
MOA of Azathioprine & 6-Mercaptopurine
Inhibition of purine nucleotide metabolism & DNA synthesis & repair Inhibition of cell division/proliferation
42
SE of Azathioprine & 6-Mercaptopurine
``` N/V Diarrhea Fever, rash pancreatitis Bone marrow suppression Hepatic toxicity Arthralgias Malaise Drug toxicity ```
43
Routine labs for monitoring Azathioprine & 6-Mercaptopurine
CBC | LFTs
44
Dose changes and contraindications of Azathioprine & 6-Mercaptopurine
Contraindicated in pregnancy or active liver disease | Decreased dose of CrCl
45
Clinical Use of Methotrexate
Induction & maintenance of remission in patients with Crohn's disease
46
MOA of Methotrexate
Inhibits metabolism of folic acid Interferes with interleukin-1 inflammatory actions Stimulate apoptosis of activated T lymphocytes
47
Issues with Methotrexate
Preg X Adjust dose for altered renal clearance Contraindicated in pregnancy and liver disease
48
SE of Methotrexate
``` Alopecia Muscositis Bone marrow depression megaloblastic anemia Cirrhosis & liver fibrosis Pneumonitis Folic acid deficiency Rash Nausea Diarrhea ```
49
Indications for Cyclosporine
Acute treatment of severe, steroid refractory exacerbations of UC in hospitalized patients
50
SE of Cyclosporine
Nephrotoxicity Hypomagnesemia HTN
51
Clinical Use for TNF Inhibitors
Symptomatic improvement in 2/3 patients with moderately severe Crohn's Disease remission in 1/3 patients with moderately severe or fistulizing Crohn's Not responding to steroids, 6-mercaptopurine or methotrexate
52
Examples of TNF Inhibitors
Infliximab (Remicade) Adalimumab (Humira) Certolizumab Pegol (Cimzia)
53
MOA of Infliximab (Remicade)
Dysregulation of the TH1 cell response present in IBD Antibody to human TNF-alpha Neutralizes membrane bound TNF
54
Pregnancy Category of Infliximab (Remicade)
B
55
SE of Immediate Infusion Reaction to Infliximab (Remicade)
Fever, chills Pruritis, urticaria Chest pain, dyspnea Hemodynamic instability
56
SE of Delayed Infusion Reaction to Infliximab (Remicade)
Myalgia, arthralgia Fever Rash, urticaria Facial, hand, & lip edema
57
How to treat immediate infusion reaction to Infliximab (Remicade)
Prophylactic Tylenol & Benadryl
58
How to treat delayed infusion reaction to Infliximab (Remicade)
Antihistamines | Corticosteroids
59
Black Box Warning of TNF Inhibitors
Reactivation of latent TB
60
Treatment of Mild Distal UC
Oral/rectal aminosalicylate | Rectal corticosteroid
61
Treatment of Mild Extensive UC
Oral aminosalicylate
62
Treatment of Mild CD
Oral aminosalicylate | Antibiotics
63
Treatment of Moderate Distal UC
Oral aminosalicylate | Oral/rectal steroids and/or immunosuppressive
64
Treatment of Moderate Extensive UC
Oral aminosalicylate | Oral steroids and/or immunosuppressive
65
Treatment of Moderate CD
Oral aminosalicylate | Oral steroid and/or immunosuppressive
66
Treatment of Severe Distal UC
IV corticosteroids | IV cyclosporine
67
Treatment of Severe Extensive UC
IV corticosteroids | IV cyclosporine
68
Treatment of Severe CD
IV corticosteroids | IV cyclosporine
69
Treatment of Remission of Distal UC
Oral/rectal aminosalicylate | Oral immunosuppressive
70
Treatment of Remission of Extensive UC
Oral/rectal aminosalicylate | Oral immunosuppressive
71
Treatment of Remission of CD
Oral aminosalicylate | Oral immunosuppressive
72
Pharmacologic Therapy for IBS
``` Antispasmodic agents Antidiarrheal agents Anticonstipation agents Psychotropic agents Serotonin receptor agonists & antagonists Nonabsorbable antibiotics Probiotics ```
73
Pharmacotherapy for Constipation in IBS
``` Increase fluids, fiber TCAs or SSRIs Peppermint oil Osmotic laxatives Lubiprostone ```
74
Pharmacotherapy for Pain in IBS
Antispasmodics- anticholinergics TCAs SSRIs Peppermint oil
75
Pharmacotherapy for Diarrhea in IBS
``` Fiber Loperamide Cholestramine TCAs Lotronex SSRIs ```
76
Types of Antispasmodics
Anticholinergics | Belladonna alkaloids
77
Examples of Anticholinergic Antispasmodics
Hyoscyamine (Levbid, Levsin SL) | Dicyclomine (Bentyl)
78
Examples of Belladonna Alkaloid Antispasmodics
Donnatol | Clidinium (Librax
79
Pregnancy Category of Dicyclomine (Bentyl) and Hyoscyamine (Levsin, Levbid)
Pregnancy C | Pregnancy C
80
MOA of Antispasmodics
Block acetylcholine at muscarinic cholinergic receptors
81
Cautions of Antispasmodics
``` Anticholinergic SE Elderly BPH HTN Hyperthyroidism ```
82
Contraindications for Antispasmodics
``` Peptic ulcer Arrhythmias CHF Sever UC Glaucoma Myasthenia gravis COPD Infants ```
83
First line Antispasmodic
Dicyclomine (Bentyl)
84
Second-line Antispasmodic
Hyoscyamine Sulfate (Levbid, Levsin SL)
85
What does antispasmodics treat in IBS?
Postprandial abdominal pain Gas Bloating Fecal urgency
86
Anticonstipation Agents in IBS
Miralax (polyethylene glycol) Lubiprostone (Amitiza) Linaclotide (Linzess)
87
Which anti-constipation medication is an osmotic laxative?
Miralax (Polyethylene glycol)
88
Which anti-constipation medications increase intestinal chloride & fluid secretion?
Lubiprostone (Amitiza) | Linaclotide (Linzess)
89
MOA of Lubiprostone (Amitiza)
Locally acting calcium channel activator that increases intestinal fluid secretion
90
SE of Lubiprostone (Amitiza)
Nausea Diarrhea Abdominal pain Abdominal distention
91
MOA of LInaclotide (Linzess)
Binds to GC-C receptor on luminal surface of the intestinal epithelium Affects the chloride and bicarbonate levels in the intestine Increases intestinal fluid & causes accelerated intestinal transit
92
Examples of TCA's for Treatment of IBS
Amitryptyline (Elavil) Desipramine (Norpramin) Imipramine (Tofranil)
93
Examples of SSRI's for Treatment of IBS
``` Escitalopram (Lexapro) Citalopram (Celexa) Sertraline (Zoloft) Paroxetine (Paxil) Fluoxetine (Prozac) ```
94
MOA of TCA's
Increasing pain threshold in the gut | Prolongs oral0cecal transit time
95
Pregnancy Category of Imipramine, Amitriptyline, Desipramine
Pregnancy C Pregnancy C Pregnancy C
96
Contraindications for TCA's
Narrow angle glaucoma Recent MI MAOI's or Fluoxetine (Prozac)
97
Reason of SSRI's in treatment of IBS
Lead to improvement in overall sense of well being | Little impact on abdominal pain or bowel symptoms
98
Contraindications of Alosetron (Lotronex)
Hx of chronic/severe constipation or sequelae from thereof Hx of ileus, obstruction, stricture, toxic megacolon Hx of GI perforation, adhesions Hx of ischemic colitis, impaired intestinal circulation Hx of Crohn's or UC Hx of Diverticulitis or diverticulosis Hx of thrombophlebitis or a hypercoagulable state
99
Non-absorbable Antibiotics
Rifaximin (Xifaxan) | Refractory symptoms
100
Probiotics that has shown modest improvement in symptoms in small studies
Bifodobacterium infantis

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