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GI 2 > Agents for IBD (Segars) > Flashcards

Agents for IBD (Segars) Flashcards

1
Q

5 families for Ulcerative Colitis (UC)

A

5-ASA
Janus Kinase (JAK) Inhibitors
IL-12/23 Inhibitors
TNFa Inhibitors
a-4 Integrin Inhibitors

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2
Q

3 Agents/Families for Crohn Disease (CD)

A

(lose 5-ASA and JAK inhibitors of UC)

IL 12/23 Inhibitors
TNF-a Inhibitors
a-4 Integrin Inhibitors

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3
Q

5-ASA drugs all have the same naming convention….

A

Sulfasalazine*
Mesalamine
Olsalazine*
Balsalazide*

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4
Q

JAK Inhibitor drugs ex

A

Tofacitinib

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5
Q

IL-12/23 Inhibitors drug naming convention

A

Ustekinumab

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6
Q

TNF-a Inhibitor drug naming convention

A

Adalimumab
Golimu_mab_ (UC only)
Infliximab

Certolizumab (CD only)

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7
Q

a-4 Integrin Inhibitor drug naming convention

A

Vedolizu_mab_ (UC only)

Natalizumab (CD only)

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8
Q

What chemical property of Sulfasalazine causes side effects?

A

sulfapyridine gets absorbed and causes bad side effects

so they created mesalamine (single 5-ASA) and it works!

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9
Q

MOA of 5-ASA agents

A

inhibition of PG & LT production via arachidonic acid pathway

decreases pain and damage locally

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10
Q

5-ASA are contraindicated in which patients?

A

ASA-allergic pts (aspirin)

sulfasalamide-allergic pts to a lesser degree

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11
Q

5-ASA is indicated for which patient?

A

mild to moderate UC; acute and maintenance

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12
Q

TNFa inhibitors MOA

A

blocks leukocyte migration to site of inflammation

binds to and neutralizes membrane-associated and soluble human TNFa-mediated pro-inflammatory cell signaling

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13
Q

TNFa inhibitors

which ones are injectible?
which ones are given IV?

A

All are injectible

one is used IV, starts with an I: Infliximab

all are monoclonal ab

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14
Q

TNFa Inhibitors side effects:

A

Infections (TB testing pre-therapy)

less recruitment=less infection response=increased infection

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15
Q

TNFa inhibitors indications - given to which patients?

A

Moderate to severe!
Active and maintenance UC and CD

All TNFa inhibitors used after inadequate response to conventional or immunosuppressant therapy

adalimumab (UC/CD)
infliximab (UC/ severe CD)
golimumab (UC only)
Certolizumab (CD only)

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16
Q

a-4 Integrin Inhibitors MOA

A

limits integrin-associated cell adhesion (receptors on cell itself)

decrease trans-endothelial migration of leukocytes to inflammatory site

17
Q

a-4 Integrin Inhibitor drug administration route

A

IV injection

18
Q

a-4 Integrin Inhibitor drug side effects:

A

Infections : PML

3 risk factors for PML:
treatment >2 years
prior immunosuppressant treatment
anti-JC virus (JCV) ab

19
Q

a-4 Integrin Inhibitors used in which patients?

A

Active & Maintenance

Natalizumab: moderate to severe CD
Vedolizumab: moderate to severe CD/UC

all a-4 integrin inhibitors recommended for use after inadequate response to conventional or TNF-a therapy

20
Q

IL 12/23 Inhibitors MOA

A

IL 12/23 MOA: bind receptors on naive Tcells to induce differentiation and production of pro-inflammatory cytokines

inhibitor drugs MOA bind P40 subunit of IL12/23 to block activation/differentiation of naive t cells and NK cells

inhibit pro-inflammatory response

21
Q

IL 12/23 Inhibitor drug administration

A

IV and SQ

fully human mab

22
Q

IL 12/23 Inhibitors drug side effects

A

Infections: TB (TB pre-testing)

23
Q

IL 12/23 Inhibitors indications/for which patients?

A

active and maintenance of moderate to severe UC/CD

for patients intolerant or inadequate response to conventional, immune modulators, steroids, or TNFa therapy

24
Q

For which CD/UC drugs would you pre-test for TB?

A

TNFa Inhibitors
IL 12/23 Inhibitors

25
Q

For which CD/UC drugs would you watch out for PML?

A

a-4 integrin inhibitors

26
Q

Janus Kinases (JAKs) MOA

A

bind to and inhibit free-floating and bound JAK1 & JAK3 - inhibits gene transcription and more cytokine release

27
Q

Janus Kinases (JAKs) drug administration route?

A

Tofacitinib - oral
also indicated for psoriatic and rheumatoid arthritis

28
Q

Janus Kinases (JAKs) indications and contraindications?

A

Indications: Active and Maintenance for moderate to severe UC

contraindications: concomitant use of Biologic therapies of immunosuppressants

29
Q

Glucocorticosteroids indications in IBD?

A

acute and/or severe UC/CD that is uncontrolled by other conventional medications

not for maintenance unless absolutely required

30
Q

First step in IBD med regimen?

UC?
CD?

A

UC: 5-ASA, usually mesalamine (less side effects)

CD: short course of steroids or off label 5-ASA
relapse: a more “mod-to-sev” approach

GI 2 (19 decks)

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