Crohn's Flashcards
Antibiotics
metronidazole if fistulas or perineal disease
cipro if fistulas or perineal disease (used if pts cant take metronidazole)
budesonide (entocort)
enteric coated matrix
high first pass metabolism (80-90%)
decreases systemic exposure to steroids
$$
systemic corticosteroids
treatment of moderate to severe crohn’s
not used as maintenance
cyclosporine iv
used for treatment in refractory, severe disease
not maintenance
tacrolimus (prograf)
alternative to cyclosporine
blocks IL2 production by Tcells
AE: nephrotoxicity, hypertension, hyperglycemia, tremor, HA
maintenance
azathioprine
6MP
methotrexate
mycophenolate (cellcept)
alternative to azathioprine or 6MP
metabolized by MPA and # the purine pathway of DNA synthesis
AE: neutropenia, thrombocytopenia, infections, NV, diarrhea
interactions: acyclovir and ganciclovir increase levels of MPA and MPA increases levels of them. Antacids and cholestyramine interfere with absorption
infliximab (remicade)
tx of moderate to severe disease that is refractory or intolerant to steroids
give 1 time if no fistulas
if fistulas, repeat in 2 weeks and 6 weeks
maintenance in crohns with fistulas- repeat every 8 weeks
adalimumab (humira)
tx of moderate to severe disease that is refractory or intolerant to conventional therapy
certolizumab pegol (cimizia)
used for tx of moderate to severe disease that is refractory or intolerant to conventional therapy
MAb against TNF
q4w after 3 loading doses over 1st 4 wks
SE: URT infections, tb, hepatitis, increased risk of malignancies, worsen heart failure, $$
natalzumab
induction and maintenance in moderate to severe crohns in pts with refractory or intolerant to traditional tx and TNF #
q4w
MAb against integrin receptors on WBC except neutrophils- prevents adhesion and recruitment of T lymphocytes
SE: PML due to JC virus infection- loss of coordination, clumsiness, aphasia, memory loss, vision problems, weak legs and arms
other SE: infections, hepatotoxicity, $$
