Exam 1 Pharm: Agents for IBD Flashcards
Drug classes used for ulcerative colitis
5-ASA JAK inhibitors IL-12/23 Inhibitors TNF-a inhibitors a-4 Integrin inhibitors
Drug classes used for Crohn Disease
IL-12/23 Inhibitors
TNF-a inhibitors
a-4 Integrin inhibitors
Nomenclature for 5-ASA agents
-sala-
Sulfasalazine
Mesalamine
Olsalazine
Balsalazide
Tx for UC
5-ASA Agents MOA
ASA = salisylic acid = COX and LIPOX inhibition (arachadonic acid breakdown pathway)
5-ASA inhibits cyclooxygenase and lipoxygenase, decreasing the production of prostaglandins and leukotrienes (decreased PMN and macrophage chemotaxis)
*5-ASA agents contraindications
All 5-ASA contraindicated in ASA allergies
Sulfasalazine contraindicated in sulfa allergies
5-ASA agent indications
-sala- drugs
Mild to moderate UC
Active and Maintenance
Mesalamine and Sulfasalazine
[Olsalazine only for maintenance]
[Balsalazide only for active]
TNF-a Inhibitors for UC
*Adalimumab
Golimumab (starts with G for “g”olitis)
*Infliximab
*=both UC and CD
TNF-a Inhibitors for CD
*Adalimumab
Certolizumab (starts with C for CD)
*Infliximab
*=both UC and CD
TNF-a Inhibitors MOA
monoclonal abs bind TNF-a, blocking leukocyte migration to site of inflammation
Administration routes for TNF-a inhibitors
All subcutaneous injection (adalimumab, golimumab, certolizumab)
Except Inflixumab is given IV (starts with I for IV)
*Which drug classes for UC/CD treatment need TB testing pre-therapy?
TNF-a inhibitors
IL-12/23 inhibitors (Ustekinumab)
Adalimumab drug class and indication
UC and CD
TNF-a inhibitor
Infliximab class and indication
CD and UC
TNF-a inhibitor
Golimumab class and indication
UC
TNF-a inhibitor
Certolizumab class and indication
CD
TNF-a inhibitor
*When should TNF-a inhibitors be used?
After conventional immunosuppressant therapy has failed (moderate to severe UC or CD)
a-4 Integrin inhibitor for UC
Vedolizumab (used for both UC and CD)
a-4 Integrin inhibitors used for CD
Vedolizumab (used for both UC and CD)
Natalizumab (CD only)
a-4 Integrin inhibitor MOA
binds integrin-associated cell adhesion molecules (i.e. VCAM), limiting trans-endothelial migration of leukocytes
*Critical potential side effect of natalizumab (a-4 integrin inhibitor)
Progressive multifocal leukoencaphalopathy associated with JCV (john cunningham virus)
*When should a-4 integrin inhibitors be used?
After conventional immunosuppressant therapy has failed (moderate to severe UC or CD)
IL-12/23 inhibitor used for UC and CD
Ustekinumab
IL-12/23 inhibitor MOA
Binds P40 subunit of I-12 and IL-23, blocking activation of T-cells and NK cells
IL-12/23 inhibitor indication
After conventional immunosuppressant therapy has failed (moderate to severe UC or CD)
______ is a 5-ASA agent that can ONLY be used for maintenance of UC
Olsalazine
only for maintenance of UC
______ is a 5-ASA agent that can ONLY be used for active of UC
Balsalazide
only for active UC
JAK inhibitor MOA
blocks JAKs, preventing transmission of signals arising from pro-inflammatory cytokines, therefore preventing pro-inflammatory gene transcription and expression
Tofacitinib drug class
JAK inhibitor
T in Tofacitinib for Tyrosine kinase (JAK)
JAK inhibitor (tofacitinib) indication
Moderate to severe UC
Active and maintenance
*JAK inhibitor (tofacitinib) contraindication
Do not use tofacitinib with other monoclonal abs or immunosuppressants
Glucocorticosteroid indication in UC and CD
Acute and/or severe UC or CD uncontrolled by other conventional methods
*not for maintenance unless absolutely necessary
Drug class of choice for mild-moderate UC
5-ASA
-sala-
