Agents for IBD (Segars) Flashcards
5 families for Ulcerative Colitis (UC)
5-ASA
Janus Kinase (JAK) Inhibitors
IL-12/23 Inhibitors
TNFa Inhibitors
a-4 Integrin Inhibitors
3 Agents/Families for Crohn Disease (CD)
(lose 5-ASA and JAK inhibitors of UC)
IL 12/23 Inhibitors
TNF-a Inhibitors
a-4 Integrin Inhibitors
5-ASA drugs all have the same naming convention….
Sulfasalazine*
Mesalamine
Olsalazine*
Balsalazide*
JAK Inhibitor drugs ex
Tofacitinib
IL-12/23 Inhibitors drug naming convention
Ustekinumab
TNF-a Inhibitor drug naming convention
Adalimumab
Golimu_mab_ (UC only)
Infliximab
Certolizumab (CD only)
a-4 Integrin Inhibitor drug naming convention
Vedolizu_mab_ (UC only)
Natalizumab (CD only)
What chemical property of Sulfasalazine causes side effects?
sulfapyridine gets absorbed and causes bad side effects
so they created mesalamine (single 5-ASA) and it works!
MOA of 5-ASA agents
inhibition of PG & LT production via arachidonic acid pathway
decreases pain and damage locally
5-ASA are contraindicated in which patients?
ASA-allergic pts (aspirin)
sulfasalamide-allergic pts to a lesser degree
5-ASA is indicated for which patient?
mild to moderate UC; acute and maintenance
TNFa inhibitors MOA
blocks leukocyte migration to site of inflammation
binds to and neutralizes membrane-associated and soluble human TNFa-mediated pro-inflammatory cell signaling
TNFa inhibitors
which ones are injectible?
which ones are given IV?
All are injectible
one is used IV, starts with an I: Infliximab
all are monoclonal ab
TNFa Inhibitors side effects:
Infections (TB testing pre-therapy)
less recruitment=less infection response=increased infection
TNFa inhibitors indications - given to which patients?
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)
a-4 Integrin Inhibitors MOA
limits integrin-associated cell adhesion (receptors on cell itself)
decrease trans-endothelial migration of leukocytes to inflammatory site
a-4 Integrin Inhibitor drug administration route
IV injection
a-4 Integrin Inhibitor drug side effects:
Infections : PML
3 risk factors for PML:
treatment >2 years
prior immunosuppressant treatment
anti-JC virus (JCV) ab
a-4 Integrin Inhibitors used in which patients?
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
IL 12/23 Inhibitors MOA
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
IL 12/23 Inhibitor drug administration
IV and SQ
fully human mab
IL 12/23 Inhibitors drug side effects
Infections: TB (TB pre-testing)
IL 12/23 Inhibitors indications/for which patients?
active and maintenance of moderate to severe UC/CD
for patients intolerant or inadequate response to conventional, immune modulators, steroids, or TNFa therapy
For which CD/UC drugs would you pre-test for TB?
TNFa Inhibitors
IL 12/23 Inhibitors
