Drugs for IBD

Question 1

Name 4 types of drugs which might be considered for use in IBD.

Answer 1

1) Aminosalicylates
2) Azathioprine
3) Corticosteroids
4) Cytokine modulators

Question 2

Give examples of P drugs for the following classes:

1) Aminosalicylates
2) Corticosteroids
3) Cytokine modulators

Answer 2

1) Melsalazine and Sulfasalazine
2) Budesonide, hydrocortisone, prednisolone
3) Adalimumab and infliximab

Question 3

Give the 2 common clinical indications for use of aminosalicylates.

Answer 3

1) Melsalazine is the first line treatment for use in mild to moderate UC. Sulfasalazine is an alternate but has largely been replaced by mesalazine for this indication.
2) Sulfasalazine is one of several options for use for management of rheumatoid arthritis. Here it is used as. a DMARD and as part of combination therapy.

Question 4

1) In UC, how to melsalazine and sulphasalazine exert their effects?
2) What are the 2 effects of 5-ASA?
3) Simply, how do aminosalicylates act on the gut?

Answer 4

1) By releasing 5- aminosalicylic acid (5-ASA)
2) anti-inflammatory and immunosuppressive.
3) appears to act topically on the gut rather than systemically.

Question 5

1) How is it ensured that melsalazine is released in the more distal gut?
2) Why has melsalazine replaced sulphasalazine for a lot of indications?
3) Why is sulphasalazine used in RA?

Answer 5

1) The oral form comprises a tablet that resists gastric breakdown.
2) sulphasalazine is combined with a molecule of sulphapyridine. In the colon, bacterial enzymes break the bond and release the 2 molecules. Sulphapyridine has no therapeutic effect in UC, but causes side effects .
3) Because Sulphapyridine is thought to be active in rheumatoid arthritis. Also, melsalazine has no role in arthritis.

Question 6

1) Which aminosalicylate causes fewer side effects?
2) Give 2 common side effects of aminosalicylates.
3) Give 3 more serious side effects that aminosalicylates can cause.
4) Give a specific side effect of aminosalicylates in men,
5) Aminosalicylates can cause a serious hypersensitivity reaction comprising of what?

Answer 6

1) Melsalazine
2) Headaches and GI disturbance (nausea and dyspepsia)
3) Leucopenia, thrombocytopenia and renal failure
4) Oligospermia (reversible reduction in sperm count).
5) Fever, rash and liver abnormalities.

Question 7

Give a contraindication for the use aminosalicylates and explain why this is the case.

Answer 7

Patients with aspirin hypersensitivity. This is because aminosalicylates are salicylates like aspirin.

Question 8

Describe an important interaction of melsalazine.

Answer 8

Melsalazine has a pH sensitive coating so may interact with other drugs that alter pH in the gut.

PPIs increase gastric pH so may cause the coating to be broken down prematurely. Lactulose lowers stool pH and may prevent 5-ASA release into the colon.

Question 9

Which symptoms should be reported to a doctor by a patient because they might indicate blood count abnormalities when taking aminosalicylates?

Answer 9

Bleeding, bruising or infective symptoms.

Question 10

1) What should be monitored for people taking Melsalazine?

2) What should be monitored for people taking sulphasalazine?

Answer 10

1) Renal function should be checked in people taking oral melsalazine.
2) FBC and liver profile should be monitored in people taking sulphasalazine.