Treating IBD Flashcards
(42 cards)
What are the 4 main groups of pharmacotherapies for the treatment of IBD?
Aminosalicylates
Corticosteroids
Immunosuppressants
Biological therapy
What are the 3 key principles behind treating IBD?
1) induce remission
2) maintain remission
3) prevent secondary effects
What is the main therapeutic quality of corticosteroids and aminosalicylates?
They are anti-inflammatories
What is considered the first line treatment for Ulcerative Colitis?
Aminosalicylates
What 3 therapeutic effects do aminosalicylates have in the treatment of UC?
Induce remission
Maintain remission
Prevent colonic cancer
What is currently the first line aminosalicylate prescribed in UC?
Mesalazine
What two methods of administration are used for mesalazine?
Oral and PR (pr can be more effective in rectal limited UC)
What are the 3 main brand names for mesalazine?
Asacol
Pentasa
Mezavant
Why might Pentasa be selected for prescription in UC over Asacol?
It has a pH independent coating and so is released more slowly, working throughout the GI tract and not just in ileum and proximal colon
How do aminosalicylates (Asacol and Pentasa) have their anti-inflammatory impact?
By inhibiting the synthesis of inflammatory mediators:
- prostaglandins
- thromboxane
- platelet-activating factor
What was the first aminosalicylate on the market?
Sulfasalazine
What side effects does sulfasalazine have?
Allergic reactions - rash, fever, leukopenia, agranulocytosis
Male infertility
Orange bodily fluid secretions
(Hence not first line - mesalazine is far better tolerated)
If aminosalicylates alone are found to be ineffective what might you add to them?
Corticosteroids
What is the main aim of treating IBD with corticosteroids?
To induce remission (NOT used for maintenance as significant side effects if used long term)
What is the mechanism of action behind corticosteroids?
Potent anti-inflammatory agent
Inhibit inflammatory processes (immunosuppressant)
How do steroids immunosuppress?
Inactivate pro-inflammatory transcription factors: NF-KB and AP-1
What inflammatory mediators do steroids suppress?
Prostaglandins
Leukotrienes
Cytokines
Platelet activating factor
What is the main steroid we produce naturally in our adrenal cortex which contributes to the immune response?
Cortisol (a glucocorticoid - a natural anti-inflam and immunosuppressant)
(Aldosterone is the principle mineralcorticoid produced in the adrenal cortex; androgens are anabolic steroids both of which are not involved in immunity)
List some steroid side effects.
- Cushing’s-like symptoms: thinning skin, easy bruising, moon face with red cheeks, poor wound healing, increased abdominal fat /obesity
- HTN; Euphoria; Cataracts; increased appetite
- Osteoporosis (inc. osteoclastic activity, dec. osteoblastic activity)
- Increased susceptibility to infection
What would you prescribe alongside steroids as prophylactic treatment for osteoporosis?
Bisphosphonates
Calcium / Vit D
Why must you NOT withdraw corticosteroids suddenly after several weeks use?
Your body stops releasing ACTH in response to the additional steroids so you need to give it time to being production again - risk ‘cortisone crisis’
What are the 3 main oral corticosteroids?
Prednisolone (at moment most commonly used)
Budesonide (CD, mucosal anti-inflam. Not as well absorbed)
Beclometasone (beginning to be used more in UC now)
What 2 forms does hydrocortisone come in?
IV and topical (suppository)
What group of drug would be recommended if aminosalicylates are ineffective or not tolerated or if a patients UC was becoming steroid dependent (requiring 2 or more courses in 12 month period) - despite not being licensed for use in IBD?
Thiopurines (Azathioprine or 6-mercaptopurine
Used in CD remission maintenance as 1st line also
