Drugs-IBD

Question 1

Th1 and Th17 important in?

Answer 1

CD

Question 2

Th2 and NK cells important in?

Answer 2

UC

Question 3

this drug is used to maintain remission in UC, also reduces risk of colon cancer by 75%

Answer 3

5-ASA

Question 4

at high doses, this drug can induce remission in mild UC/CD

Answer 4

5-ASA

Question 5

this drug acts topically

Answer 5

5-ASA

Question 6

5-ASA also called?

Answer 6

mesalamine

Question 7

pentasa works by releasing mesalamine in?

Answer 7

microgranules; causes delayed release in small intestine and colon as water diffuses and pushes granules out

Question 8

asacol acts of the ileum and colon by?

Answer 8

combining mesalamine with eudragit-S, making it pH dependent

Question 9

Azo-combounds act only on the colon because?

Answer 9

they the diazo bond is broken down by bacteria in the colon

Question 10

this drug has very few side effects and puts 70% of people into remission

Answer 10

5-ASA

Question 11

this is used to INDUCE but not to maintain remission in moderate to severe ACTIVE IBD

Answer 11

corticosteroids

Question 12

this is supplied orally and rectally

Answer 12

corticosteroids

Question 13

numerous side effects limit the longterm use of this otherwise very effective drug

Answer 13

corticosteroids

Question 14

side effects of corticosteroids

Answer 14

osteoporosis, compression fractures, weight gain, cataracts, abdominal fat, moon facies, bruising and poor wound healing

Question 15

advantage of budesonide over other steroids

Answer 15

rapid first pass metabolism and ileal release = less systemic effects

Question 16

who gets budesonide?

Answer 16

mild to moderate ileal crohn’s dz

Question 17

what is still at risk using budesonide?

Answer 17

bones

Question 18

these drugs can be used for active dz and/or remission maintenance for both UC and CD, but are generally preserved for those with severe cases and/or consistent need for steroids

Answer 18

immunomodulators (azathioprine, methotrexate)

Question 19

azathioprine inhibits ______ and induces?

Answer 19

ribonucleotide synthesis; T cell apoptosis

Question 20

methotrexate inhibits ____ and should be co-administered with ____ to reduce myelosuppression and mucositis

Answer 20

DHFR; folate

Question 21

30% of pts on azathioprine fail due to intolerance or no response – what are the side effects/risks?

Answer 21

myelosuppression, pancreatitis, hepatotoxicity, nausea, myalgias; RISK of lymphoma, HPV, infection

Question 22

serious AE of methotrexate

Answer 22

hepatic and pulmonary toxicity, myelosuppression, birth defects (monitor LFTs, CBC)

Question 23

anti-TNF antibodies are administered _____ because?

Answer 23

shots/IV; stomach acid would denature protein

Question 24

give anti-TNF to?

Answer 24

active, severe Crohn’s pts (either top down or step up tx)

Question 25

anti-TNF works by?

Answer 25

blocking WBC recruitment

Question 26

side effects of monoclonal ab tx (anti-TNF)

Answer 26

decreased response over time; serum sickness

Question 27

surgery is a good option for?

Answer 27

UC

Question 28

5-ASAs are less effective for (UC/CD)

Answer 28

CD

Question 29

antibiotics can be used as a first line tx for (UC/CD)

Answer 29

CD

Question 30

in Crohn’s dz, these two therapies are given together

Answer 30

corticosteroids & immunomodulators

Question 31

new therapies for IBD are directed against?

Answer 31

leukocyte trafficking (alpha-4 integrins)