23. IBD Treatment and Risk/Benefit Flashcards
What are the 5 general categories of meds that we can use to treat IBD?
- 5-Aminosalycilates (5-ASAs)
- Antibiotics
- Corticosteroids
- Immunomodulators
- Biologics
what meds fall into the category of innumomodulators?
azathioprine
6-mercaptopurine
methotrexate
what meds fall into the category of biologics? what is this category also known as?
infliximab
adalimumab (humira)
AKA anti-TNF drugs
what meds are in the category of 5-aminosalycilates?
sulfasalazine
mesalamine
balsalazide
what are the 3 elements needed to cause IBD, and which one is the target of our treatment?
overlap between genetic predisposition, environmental triggers, and mucosal immune system defect
we target our treatment to the mucosal immune system defects
The three main actions of the immune system in the gut that cause IBD are trafficking, proliferation, and T cell regulation. What is meant by each of these, and which drug type targets each?
Trafficking: Leukocytes movement to site of inflammation. If we can block the receptors that allow this using STEROIDS, then leuks cannot get to the site of inflammation. receptor Anti-a4 are found only in the gut so this is a good target for IBS drugs.
Proliferation: IL-2 mediated increase of immune cells? not totally sure, but we use IMMUNE MODULATORS to control it (6-MP, AZA, methotrexate)
T cell regulation: causes increase of cytokines. we use BIOLOGICS to target one cytokine in particular.
Generally, how do 5-ASA drugs work? are they available as only one formulation, or are there options?
From wiki: reduce the synthesis of inflammatory mediators known as eicosanoids and inflammatory cytokines.
from lect: available in a variety of formulations and delivery systems, based on the timing, pH required to treat your disease)
Mesalamine (5-ASA drug): does it work for Crohn’s? Ulcerative colitis?
Doesn’t work for Crohn’s
Does work for UC
For Crohn’s disease, what works best: immunomodulator (AZA) or IFX (biologic/Anti-TNF) or the two together?
the two of them together works best. With this, we can get remission from Crohn’s without using steroids in half of patients.
For Ulcerative Colitis, what works best: immunomodulator (AZA) or IFX (biologic/Anti-TNF) or the two together?
the two of them together works best.
What are the main side effects of 6MP/azathioprine? (immunomodulators)
allergic reactions
nausea
hepatitis
pancreatitis
serious infections
lymphoma
How often do immunomodulators (6MP/azathioprine) cause pancreatitis?
3% of the time!
need to tell your patients about this side effect
How often do immunomodulators (6MP/azathioprine) cause lymphoma?
0.04% of the time (4/10,000)
Adverse events associted with anti-TNF treatment?
serious infections (3%)
non-hodgkin’s lymphoma (0.06%)
(TB, multiple sclerosis, heart failure, liver injury also on list but not highlighted)
how does the lecturer suggest that we present data on risks of side effects to our patients?
he uses a diagram with10,000 dots, each indicating a person, and with a box over the number of people who will statistically have that side effect.
most frequent side effects of Prednisone?
Acne (50%)
Facial swelling (35%)
osteoporosis (33%)
Diabetes (10x baseline risk)
increased intraocular pressure (22%)
what are some methods of clearly communicating risks to your patients?
- absolute risks are better than relative risks
- Avoid using decimals
- use common denominators for comparisons
- use visual aids (turn numbers into pictures)
- give perspective to other diseases and life risks (driving, lightning)
what category of medication works well for ulcerative colitis?
5-ASAs
For Crohn’s and UC, what kind of therapy is most effective?
Combination therapy (immunomodulators and biologics/anti-TNFs)
How would we state simply the risks of adverse effects with IMs and biologics?
IMs and biologics are assciated with real, but very small risks of serious adverse effects
which is higher: risks of everyday life, or risks of taking meds?
everyday life!
