Agents For IBD - Dr. Segars

Question 1

5 classes of drugs for UC

Answer 1

1. 5-ASA
2. Janus Kinase
3. IL-12/23 Inhibitors
4. TNF-a inhibitors
5. a-4 Integrin Inhibitors

Question 2

3 classes of drugs for CD

Answer 2

1. IL-12/23 Inhibitors
2. TNF-a inhibitors
3. a-4 Integrin Inhibitors

Question 3

4 5-ASA agents

Answer 3

1. Sulfasalazine
2. Mesalamine (the main active compound 5-ASA that the others break down to)
3. Olsalazine
4. Balsalazide

Question 4

1 Janus Kinase (JAK) inhibitor

Answer 4

Tofacitinib

Question 5

1 IL-12/23 Inhibitors

Answer 5

Ustekinumab

Question 6

4 TNF-a inhibitors

Answer 6

1. Adalimumab
2. Infliximab
3. Golimumab (UC)
4. Certolizumab (CD)

Question 7

2 a-4 Integrin Inhibitors

Answer 7

1. Vedolizumab

2. Natalizumab (CD)

Question 8

5- ASA is what

Answer 8

AcetylSalicylic Acid (ASPRIN) product

Question 9

Components of 
Sulfasalazine 
Mesalamine
Olsalazine
Balsalazide

Answer 9

Sulfasalazine : sulfapyridine + 5-ASA
Mesalamine : 5-ASA
Olsalazine : 2 5-ASAs
Balsalazide : inert carrier + 5-ASA

Question 10

Side effects from 5-ASA is what

Answer 10

Sulfapyridine (sulfasalazine is not the one we give anymore)

Question 11

5-ASA MOA

Answer 11

1. Inhibits COX and LIPOX pathways = ——I progesterone and leukotriene
2. M decrease

Question 12

5-ASA side effects

Answer 12

1. Anaphylaxis from aspirin allergy (NEVER GIVE)

2. Sulfasalazine dont give to sulfonamide allergic pts, + overall has more side effects

Question 13

5-ASA is sued for what

Answer 13

Maintenance and ACUTE*
= mild to moderate ulcers
= Olsalazine only maintenance
= Balsalazide only acute active UC

Question 14

TNF-a inhibitors

MOA

Answer 14

TNF-a = Cytokine that increases surface adhesion (VCAM, E-selectin, for N and leukocyte adhesion)
1. This drug inhibits leukocyte migration and adhesion

Question 15

Drug ending in -mab means what

Answer 15

It is a monoclonal Ab (usually IgG)

All are injectable (SQ, except infliximab is by IV)

Question 16

TNF-a inhibitors side effects

Answer 16

High infection risk

• latent TB and come back (so do TB test first)
• BACK BOX : sepsis, high infection risk (esp with steroid drugs), monitor closely

Question 17

TNF-a inhibitors

Used for what

Answer 17

1. Adalimumab : moderate to severe (due to side effects), UC + CD
2. Infliximab : moderate to severe CD, Severe UC
3. Golimumab : moderate to severe UC
4. Certolizumab : moderate to severe CD

Question 18

a-4 Integrin inhibitors MOA

Answer 18

a-4 Integrins : receptor on leukotriens and N to bind to VCAMs and binding sites for adhesion and migration
= this drug blocks this

Question 19

a-4 Integrin inhibitors is given how

Answer 19

By IV injection

Also IgG monoclonal AB

Question 20

a-4 Integrin inhibitors side effects

Major one

Answer 20

BLACK BOX : Risk of infections (especially PML = John Cunningham Virus** when taking Natalizumab)

• treatment over 2ys
• prior immunosuppression tx
• have anti-JC virus ABs

Question 21

a-4 Integrin inhibitors side effects

Minor ones

Answer 21

1. Infusion related problems
2. Increase malignancy risk (Vedolizumab)
3. Can make anti-medication ABs

Question 22

a-4 Integrin inhibitors used when

Answer 22

1. Natalizumab : moderate to severe CD, dont use with another immunosuppressant
2. Vedolizumab : moderate to severe UC + CD

Question 23

a-4 Integrin inhibitors should be given when

Answer 23

After pt does not respond to other drugs or TNF-a inhibitors therapy

Question 24

IL12/23 inhibitors MOA

Answer 24

Inhibits these pro inflammatory cytokines

= drug binds to P40 of IL12/IL23 which blocks T-cell + NK-cell activation

Question 25

IL12/23 is given how

Answer 25

IV or SubQ injections (also IgG monoclonal AB)

Question 26

IL12/23 inhibitors side effects

Answer 26

Infections (monitor health) - get TB test before giving drug - injection related allergic reactions - rare increase in malignancy

Question 27

IL12/23 inhibitors is used for what

Answer 27

Ustemumab : Moderate to severe UC + CD

Question 28

IL12/23 inhibitors when would you give this to a patient

Answer 28

Then intolerant or not working with other conventional drugs, steroids, or TNF-a therapy

Question 29

JAK inhibitors MOA

Answer 29

When phosphorylated they transcribe more pro inflammatory genes = the drug inhibit free floating JAK1 + JAK3 so they can’t dimerize and be phosphorylated

Question 30

IL12/23 inhibitors side effects

Answer 30

BLACK BOX : increased risk of cardiac events, MI, clots, death 1. Lymphopenia/ Lymphocytosis 2. Neutropenia, anemia 3. Increase LDL, HDL 4. Rare risk in malignancy + infection

Question 31

IL12/23 inhibitors is used for what

Answer 31

Tofacitinib : moderate to severe UC (Also psoriasis, and RA) * dont use with other therapies or immunosuppressants

Question 32

Glucocorticosteroids used when

Answer 32

1. N/V 2. Acute and severe UC + CD (for most fast acting drug), usually not for maintenance (for needed fast reduction in pro inflammation)