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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
Q

on EC of gut that a4b7 bind to

A

MAdCAM

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26
Q

anti-a4b7 and anti-a4b1 MoA (blocks lymphocyte transmigration out of endothelium)

A

NATALIZUMAB

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27
Q

drug that can cause progressive multifocal leukoencephalopathy (PML) due to binding of a4b1 that is found on EC everywhere in body

A

NATALIZUMAB

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28
Q

used for CD and MS that has SE of PML

A

NATALIZUMAB

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29
Q

drugs that block mucosal cytokine release and used for UC

A

SULFASALAZINE
MESALAMINE
OLSALAZINE
BALSALAZIDE

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30
Q

drugs used for UC that have anti-inflammatory effect and block mucosal cytokine release

A

MESALAMINE
OLSALAZINE
BALSALAZIDE
SULFASALAZINE

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31
Q

What 2 components make up SULFASALAZINE

A

sulfapyridine
5-ASA

32
Q

component of SULFASALAZINE that has all the side effects

A

sulfapyridine

33
Q

enzyme produced by bacteria that cleaves N=N bond of sulfasalazine (splitting up 5-ASA and sulfapyridine)

A

azoreductase

34
Q

2 different actions of glucocorticoids that are used for IBD

A

anti-inflammatory
immunosuppressant—–genomic (block inflammatory gene expression)

35
Q

glucocorticoids used in CD and UC

A

BUDESONIDE
PREDNISONE
METHYLPRENISOLONE

36
Q

preferred glucocorticoid to use in IBD due to its metabolism by CYP34A so less SE’s

A

BUDESONIDE

37
Q

SE’s of this type of drug include:
neuropsychiatric (mood)
cosmetic (acne, hair loss)
metabolic (bone loss)
infectious

A

glucocorticoids

38
Q

chemoattractants for leukocytes to sites of infection/inflammation

A

IL-17
IL-22
IL-8
CXCL8

39
Q

cytokine produced from activated macrophages that induces acute-phase protein production by the liver (CRP)

A

IL-6

40
Q

2 anti-TNF drugs used to treat CD and UC

A

INFLIXIMAB
ADALIMUMAB

41
Q

anti-TNF drug used in CD that is safe in pregnancy

A

CERTOLIZUMAB pegot

42
Q

anti-TNF drug used only in UC

A

GOLIMUMAB

43
Q

adverse effects of immunosuppressant therapy

A

infection

44
Q

Why do you do a PPD test before starting anti-TNF type biologics?

A

reactivation of TB

45
Q

Why do patients need to obstain from alcohol during Rx with metronidazole?

A

inhibits aldehyde dehydrogenase (enzyme used by the liver to further break down alcohol) and causes flushing

46
Q

MoA of Metronidazole

A

produces free radicals that damage bacterial DNA

47
Q

inhibitors of purine de novo synthesis (used for both CD and UC)

A

6-MP
Azathioprine

48
Q

Activation of Ebstein-Barr Virus
Pancreatitis
Hepatitis
LEUKOPENIA

A

SE’s of 6-MP and AZA

49
Q

Co-administration of which drugs or mutation of which gene will cause leukopenia in a patient on 6-MP/AZA?

A

6-MP/AZA + Allopurinol/febuxostat
TPMT mutation

50
Q

_____ blocks xanthine oxidase (which makes 6-MP inactive); so if you use 6-MP + ____= toxicity

A

Allopurinol

51
Q

blocks phosphatase (removal of phosphate group from NFAT); calcineurin inhibitor

A

Cyclosporine (for UC)
Tacrolimus

52
Q

blocks mTOR pathway

A

Sirolimus

53
Q

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)

A

co-factor roles for copper

54
Q

ATP7A mutation

A

Menkes

55
Q

ATP7B mutation

A

Wilson’s

56
Q

Pathogenesis of acrodermatitis enteropathica in Zn deficiency

A

ZIP4 pathogenic variant (gene mutation)

57
Q

clinical features of this include:
alopecia
diarrhea
lethargy
Acute eczematous periorificial and acral dermatitis

A

acrodermatitis enteropathica in Zn deficiency

58
Q

antibiotics used for which IBD

A

CD

59
Q

probiotics used for which IBD

A

UC

60
Q

fecal microbiota transplantation used for what IBD

A

CD and UC

61
Q

this IBD has goblet cell preservation

A

CD

62
Q

this IBD has goblet cell depletion

A

UC

63
Q

Uveitis, episcleritis, arthropathy, pyoderma gangrenosum, erythema nodosum, nephrolithiasis, PSC, thromboembolism

A

extra-manifestations for CD and UC

64
Q

major side effect for Zn deficiency

A

diarrhea and dermatitis

65
Q

Deficiency of ___ affects rapidly proliferating tissues

A

zinc

66
Q
A

Infliximab

67
Q

3 rapid agents effective for severe active UC

A

Infliximab
cyclosporine
methylprenisolone IV

68
Q

effective for maintenance of remission for UC but NOT treatment of active disease

A

Azathioprine

69
Q

effective for mild to moderate UC, NOT severe UC

A

MESALAMINE

70
Q

what to check for in patient before starting them on 6-MP or AZA

A

TPMT mutation

71
Q

folate antagonist that blocks purine synthesis and used for CD only

A

Methotrexate

72
Q
A

continuous colonic inflammation

73
Q
A

A.

74
Q
A

B

75
Q
A

C

76
Q
A

C

77
Q
A

A

DIG: Biweekly 3 (12 decks)

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