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DIG: Biweekly 3 > Al-Mehdi: Rx of IBD > Flashcards

Al-Mehdi: Rx of IBD Flashcards

1
Q

pathogenesis behind IBD summed up

A

loss of tolerance of mucosal immune system leading to attack of one’s own microbiota

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2
Q

how are naiive Th0 (CD4) T cells activated

A

dendritic cells present antigen
co-stimulation from CD80/86 binding to CD28

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3
Q

activation of T cell allows for what to be produced and what effect

A

IL-2; clonal expansion of T cells

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4
Q

normally, _____ takes off phosphate group of NFAT when influx of Ca2+ binds to calmodulin in T cell

A

calcineurin

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5
Q

what happens when IL-2 autocrine signaling happens in T cell

A

activates mTOR, cytokines produced, clonal expansion of cells

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6
Q

cytokine that activates Th1 cell

A

IL-12

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7
Q

T cell that activates macrophages and CD8+ T cells

A

Th1

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8
Q

cytokines that activate Th17 T cell

A

IL-1, 6, 23

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9
Q

this T cell attracts neutrophils to infection site

A

Th17

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10
Q

T cells involved in Crohn’s disease

A

Th1 and Th17

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11
Q

cytokines that activate Th2 T cell

A

IL-4, IL-25

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12
Q

cytokine that Th2 cell makes that activates eosinophils

A

IL-5

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13
Q

cytokine that Th2 cell makes that activates mast cells

A

IL-9

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14
Q

cytokines from Th2 T cell involved in elimination of helminths, atopy, eosinophilic esophagitis

A

IL-5 and IL-9

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15
Q

T cell involved in Ulcerative colitis

A

Th2

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16
Q

cytokine that activates Treg cell

A

IFN-a

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17
Q

T cell that produces IL-10 and TGF-b to prevent autoimmune disease and inflammation

A

Treg

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18
Q

cytokines that activate Tfh (T follicular helper cell)

A

IL-4, IL-21

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19
Q

T cell that produces IL-21 that activates B cells

A

Tfh (T follicular helper) cell

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20
Q

Which T cell and which cytokines reduce inflammation and disease severity in autoimmune diseases?

A

Treg; IL-10 and TGF-beta

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21
Q

drugs that block lymphocyte egress from lymph nodes and peyer’s patches (used for UC)

A

OZANIMOD
FINGOLIMOD
(-IMODs)

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22
Q

these drugs are irreversible agonists of sphingosine-1-phosphate receptor (block lymphocyte egress)

A

OZANIMOD
FINGOLIMOD

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23
Q

drugs used for UC and CD that block lymphocyte transmigration out of endothelium and their MoA

A

VEDOLIZUMAB
ETROLIZUMAB
(-LIZUMABs)
MoA: anti-a4b7 in the gut

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24
Q

integrin on lymphocyte that VEDOLIZUMAB and ETROLIZUMAB block

A

a4b7

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25
on EC of gut that a4b7 bind to
MAdCAM
26
anti-a4b7 and anti-a4b1 MoA (blocks lymphocyte transmigration out of endothelium)
NATALIZUMAB
27
drug that can cause progressive multifocal leukoencephalopathy (PML) due to binding of a4b1 that is found on EC everywhere in body
NATALIZUMAB
28
used for CD and MS that has SE of PML
NATALIZUMAB
29
drugs that block mucosal cytokine release and used for UC
SULFASALAZINE MESALAMINE OLSALAZINE BALSALAZIDE
30
drugs used for UC that have anti-inflammatory effect and block mucosal cytokine release
MESALAMINE OLSALAZINE BALSALAZIDE SULFASALAZINE
31
What 2 components make up SULFASALAZINE
sulfapyridine 5-ASA
32
component of SULFASALAZINE that has all the side effects
sulfapyridine
33
enzyme produced by bacteria that cleaves N=N bond of sulfasalazine (splitting up 5-ASA and sulfapyridine)
azoreductase
34
2 different actions of glucocorticoids that are used for IBD
anti-inflammatory immunosuppressant-----genomic (block inflammatory gene expression)
35
glucocorticoids used in CD and UC
BUDESONIDE PREDNISONE METHYLPRENISOLONE
36
preferred glucocorticoid to use in IBD due to its metabolism by CYP34A so less SE's
BUDESONIDE
37
SE's of this type of drug include: neuropsychiatric (mood) cosmetic (acne, hair loss) metabolic (bone loss) infectious
glucocorticoids
38
chemoattractants for leukocytes to sites of infection/inflammation
IL-17 IL-22 IL-8 CXCL8
39
cytokine produced from activated macrophages that induces acute-phase protein production by the liver (CRP)
IL-6
40
2 anti-TNF drugs used to treat CD and UC
INFLIXIMAB ADALIMUMAB
41
anti-TNF drug used in CD that is safe in pregnancy
CERTOLIZUMAB pegot
42
anti-TNF drug used only in UC
GOLIMUMAB
43
adverse effects of immunosuppressant therapy
infection
44
Why do you do a PPD test before starting anti-TNF type biologics?
reactivation of TB
45
Why do patients need to obstain from alcohol during Rx with metronidazole?
inhibits aldehyde dehydrogenase (enzyme used by the liver to further break down alcohol) and causes flushing
46
MoA of Metronidazole
produces free radicals that damage bacterial DNA
47
inhibitors of purine de novo synthesis (used for both CD and UC)
6-MP Azathioprine
48
Activation of Ebstein-Barr Virus Pancreatitis Hepatitis LEUKOPENIA
SE's of 6-MP and AZA
49
Co-administration of which drugs or mutation of which gene will cause leukopenia in a patient on 6-MP/AZA?
6-MP/AZA + Allopurinol/febuxostat TPMT mutation
50
_____ blocks xanthine oxidase (which makes 6-MP inactive); so if you use 6-MP + ____= toxicity
Allopurinol
51
blocks phosphatase (removal of phosphate group from NFAT); calcineurin inhibitor
Cyclosporine (for UC) Tacrolimus
52
blocks mTOR pathway
Sirolimus
53
Iron metabolism (ferroportin) Neurotransmitter synthesis (dopamine hydroxylase) Melanin synthesis (dopamine hydroxylase) Energy production (cytochrome c oxidase) Synthesis and cross-linking of elastin and collagen (lysyl oxidase) ROS (superoxide dismutase)
co-factor roles for copper
54
ATP7A mutation
Menkes
55
ATP7B mutation
Wilson's
56
Pathogenesis of acrodermatitis enteropathica in Zn deficiency
ZIP4 pathogenic variant (gene mutation)
57
clinical features of this include: alopecia diarrhea lethargy Acute eczematous periorificial and acral dermatitis
acrodermatitis enteropathica in Zn deficiency
58
antibiotics used for which IBD
CD
59
probiotics used for which IBD
UC
60
fecal microbiota transplantation used for what IBD
CD and UC
61
this IBD has goblet cell preservation
CD
62
this IBD has goblet cell depletion
UC
63
Uveitis, episcleritis, arthropathy, pyoderma gangrenosum, erythema nodosum, nephrolithiasis, PSC, thromboembolism
extra-manifestations for CD and UC
64
major side effect for Zn deficiency
diarrhea and dermatitis
65
Deficiency of ___ affects rapidly proliferating tissues
zinc
66
Infliximab
67
3 rapid agents effective for severe active UC
Infliximab cyclosporine methylprenisolone IV
68
effective for maintenance of remission for UC but NOT treatment of active disease
Azathioprine
69
effective for mild to moderate UC, NOT severe UC
MESALAMINE
70
what to check for in patient before starting them on 6-MP or AZA
TPMT mutation
71
folate antagonist that blocks purine synthesis and used for CD only
Methotrexate
72
continuous colonic inflammation
73
A.
74
B
75
C
76
C
77
A

DIG: Biweekly 3 (12 decks)

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