Agents for Inflammatory Bowel Disease (IBD)

Question 1

what are the 5 family classes of agents used for ulcerative colitis?

Answer 1

5-ASA, Janus Kinase (JAK) Inhibitors, IL-12/23 Inhibitors, TNF-alpha inhibitors, and alpha-4 integrin inhibitors

Question 2

what are the four drugs in the 5-ASA drug class?

Answer 2

Sulfasalazine, Mesalamine, Olsalazine, and Balsalazide

Question 3

what is the drug in the Janus Kinase (JAK) Inhibitors class?

Answer 3

Tofacitinib

Question 4

what is the drug in the IL-12/23 Inhibitors class for Ulcerative Colitis?

Answer 4

Ustekinumab

Question 5

what are the 3 drugs in the TNF-alpha inhibitors class for ulcerative colitis?

Answer 5

Adalimumab, Golimumab, and Infliximab

Question 6

what is the drug in the alpha-4 integrin inhibitor class for ulcerative colitis?

Answer 6

Vedolizumab

Question 7

what are the 3 family classes of drugs used for crohn disease?

Answer 7

IL-12/23 inhibitors, TNF-alpha inhibitors, and alpha-4 integrin inhibitors

Question 8

what is the IL-12/23 inhibitor used for crohn disease?

Answer 8

Ustekinumab

Question 9

what are the 3 TNF-alpha inhibitors used for Crohn Disease?

Answer 9

Adalimumab, Certolizumab, and Infliximab

Question 10

what are the 2 alpha-4 integrin inhibitors used for crohn disease?

Answer 10

Natalizumab and Vedolizumab

Question 11

what is the MOA of the 5-ASA agents?

Answer 11

inhibition of PG (prostaglandin) and LT (leukotriene) production via arachidonic acid pathway–> COX and LIPOX; reduction in PMN and macrophage chemotaxis

Question 12

what are the different routes of administration of 5-ASA?

Answer 12

oral, rectal enemas, and rectal suppositories

Question 13

where do the oral 5-ASA agents reach?

Answer 13

varies by agent; may be released in the distal/terminal ileum, colon, or throughout the GI tract

Question 14

where do the rectal enemas 5-ASA agents reach?

Answer 14

may reach the splenic flexure; do not frequently concentrate in the rectum

Question 15

where do the rectal suppositories 5-ASA agents reach?

Answer 15

reach the upper rectum (15-20 cm beyond the anal verge)

Question 16

what are the common side effects associated with the 5-ASA agents?

Answer 16

primarily GI related and some CNS related; there are fewer systemic side effects with pure 5-ASA products and topical formulations

Question 17

what are the absolute contraindications of all 5-ASA compounds?

Answer 17

in ASA-allergic patients

Question 18

when is sulfasalazine contraindicated?

Answer 18

in sulfonamide-allergic patients

Question 19

when is the use of 5-ASA agents indicated?

Answer 19

with cases of mild to moderate UC (except olsalazine and Balsalazide)

Question 20

when should Olsalazine be used?

Answer 20

only for maintenance of remission of UC

Question 21

when should Balsalazide be used?

Answer 21

only for active disease of UC

Question 22

what is the role of TNF-alpha?

Answer 22

binding to the TNF receptors and mediating upregulation of surface adhesion molecules (VCAM-1, E-selectin, MAdCAM-1 for leukocyte adhesion)

Question 23

what is the mechanism of action of TNF-alpha inhibitors?

Answer 23

binds to and neutralizes membrane-associated and soluble human TNF-alpha-mediated pro-inflammatory cell signaling, ultimately blocking leukocyte migration to site of inflammation

Question 24

what is the TNF-alpha inhibitor that is IV injection only?

Answer 24

Infliximab

Question 25

what are the side effects of TNF-alpha inhibitors?

Answer 25

infections (TB testing pre-therapy needed); liver toxicity (increased AST/ALT enzymes)

Question 26

what are the rare but severe side effects associated with TNF-alpha inhibitors?

Answer 26

dermatologic-related (EM,SJS, TEN) and malignancies (various)