Exam 4 - IBD meds Flashcards
Where does Pentasa work?
Entire GI tract, from Duodenum to Rectum.
What class is Pentasa?
Aminosalicylates 5-ASA Mesalamine
What route is Pentasa? What not to do?
PO. Do not crush!
CI for Pentasa?
Salicylate allergy
Where does Budesonide work?
Right/ascending colon and ileum.
What is DOC for IBD of ascending/right colon or ileum?
Budesonide
Can Budenoside help induce remission in UC?
Yes
Where do all the “-salazines” work?
Colon and rectum. LI only.
Which is only IBD drug to work in the Jenunum and Duodenum?
Pentasa
Canasa is a suppository which only works where?
Rectum
Enemas work in which two locations?
Rectum and sigmoid colon
What happens to Sulfasalazine in the gut?
Bacteria cleave and becomes active Mesalamine
ADRs of Sulfasalazine?
- Skin/urine organge-yellow
- Folic acid malabsorption
- Hemolytic anemia in G6PD decifiency
CIs of Sulfasalazine?
Sulfa and Salicylate drugs.
MOA for AZA?
AZA -> 6-MP
What does AZA inhibit?
T-lymphocytes
What does 6-MP inhibit?
DNA synthesis
How long does AZA/6-MP take to work?
3 months to 1 year.
AZA/6-MP for induction or maintenance of remission?
Maintenance only! Takes 3 months to 1 year to work!
AZA and bone marrow suppression- how?
TMPT gene produces enzyme to convert AZA to 6-MP. Lack of enzyme causes increased AZA resulting in leukopenia.
Can AZA cause lymphoma?
Yes. Skin cancer from long-term use of AZA.
AZA causes which organ to become toxic?
Hepatotoxicity
MOA of MTX (immunomodulator)? (hint: 2)
Inhibit dihydrofolate reductase and DNA synthesis
MTX in CD or UC
CD only!!
MTX dosed how often? Route?
IM q week
What else to give with MTX?
Folic acid
3 ADRs of MTX?
Myelosuppression, hepatotoxic, nausea
MOA of Cyclosporine (immunomodulator)?
Calcineurin-inhibitor
Cyclosporine reserved for when in IBD?
Severe, refractory cases
Cyclosporine IV vs PO does what?
IV=induce remission
PO=w/AZA for maintenance
ADR of Cyclosporine?
Nephrotoxic
TNF inhibitors used for which IBD more than the other?
CD»_space; UC
TNF inhibitors end in what”
“-mab”
What stage of IBD to use TNF inhibitors?
Moderate to Severe is conventional therapy fails
Which TNF-inhib is IV only? Other route?
Remicade IV only. Rest are SC.
Simpuni is for which moderate-to-severe IBD?
UC
What can TNF inhibitors reactivate?
Latent TB and Hep B.
TNF Inhib caution with which condition?
III/IV HF
TNF Inhib can develop antibodies which which med?
AZA
What sort of reactions with TNF Inhib?
Hypersensitivity
What are the two classes of “biologics”?
- TNF-inhibitors
2. Anti-Alpha 4 Integrin
Entyvio (vedolizumab) MOA? Route?
Anti-alpha 4 integrin. IV.
Entyvio (vedolizumab) use?
Moderate to severe UC/CD if conventional therapy fails.
Entyvio (vedolizumab) and JC virus?
If positive for JC virus only use 9-12 months before using Tysabri.
PML and Entyvio (vedolizumab)?
Rare
Tysabri (natalizumab) MOA? Route?
Anti-alpha 4 Integrin. IV.
Tysabri (natalizumab) use?
Moderate to severe CD (only!) in PT w/o response to conventional tx or other anti-TNF.
PML and Tysabri (natalizumab)?
Big problem. Enroll in TOUCH program. Risk increases with # of infusions.
