Exam III: IBD Drugs

Question 1

Which drug class is known as “aspirin for the gut”

Answer 1

5-ASA Derivatives (Mesalamine,Sulfasalazine, Olasalazine, Balsalazide)

Question 2

Mesalamine Drug Class

Answer 2

5-ASA

Question 3

Sulfasalazine Drug Class

Answer 3

5-ASA

Question 4

Balsalazide Drug Class

Answer 4

5-ASA

Question 5

Canasa Generic Name

Answer 5

Mesalamine —> delivered to rectum only.

Question 6

Rowasa Formulation (generic name)

Answer 6

Mesalamine—> delivered to rectum and distal colon.

Question 7

Which formulation of mesalamine would be used for ulcerative colitis?

Answer 7

Rowasa (delivered to rectum and distal colon.)

Question 8

What are the immunomodulators listed in class?

Answer 8

1. Thiopurines (Azathioprine and 6-mercapto purine)
2. Methotrexate (chron’s disease only)
3. Cyclosporine (not really used)

Question 9

How long does it take thiopurines to work?

Answer 9

~ 3 months.

Question 10

What do we typically use thiopurines with?

Answer 10

Steroids or biologics –> help with the transition to something which can be used chronically.T

Question 11

Thiopurine Black Box Warning

Answer 11

Malignancy (especially with TNF-alpha inhibitors)

Question 12

Which corticosteroid is used for IBD due to poor oral absorption?

Answer 12

Budesonide

Question 13

Which formulation of budesonide is used for Chron’s Disease

Answer 13

Entocort–> release in the terminal ileum

Question 14

Which formulation of budesonide is used for ulcerative colitis

Answer 14

Uceris.

Question 15

______is 15X more potent than prednisone.

Answer 15

Budesonide.

Question 16

How long is budesonide used for IBD?

Answer 16

8 weeks. But may be repeated to treat relapses.

Question 17

When are antibiotics used for IBD?

Answer 17

Reserved for patients wtih fistulas or fissures which must be surgically closed.

Question 18

What antibiotics are commonly used for patients with fistulas or fissures which require surgical intervention?

Answer 18

Metronidazole, Ciprofloxacin, 3rd Gen Cephalosporins.

Question 19

Remicade (generic,class)

Answer 19

Infliximab
Anti-TNF-alpha

Question 20

Humira (generic,class)

Answer 20

Adalimumab
Anti-TNF-Alpha

Question 21

Cimzia (generic, class)

Answer 21

Certolizumab
Anti-TNF-Alpha

Question 22

Simponi (generic, class)

Answer 22

Golimumab (simponi)
Anti-TNF-alpha

Question 23

Anti-TNF-alpha Black Box Warning

Answer 23

1. Increased Infection risk (all patients must get PPD, CXR, HBV, HCV, CMV, EBC prior to treatment.
2. Increased Malignancy Risk (especially if administered with azathioprine)

Question 24

Tysabri (generic, class, mechanism)

Answer 24

Natalizumab –> IV only
Selective Adhesion Inhibitor
Alpha-4 inhibition

Question 25

Tysabri [Natalizumab] BBW

Answer 25

PML-CNS REMS program

Question 26

Entyvio (generic, class, mechanism)

Answer 26

Vedolizumab
Selective Adhesion Molecule Inhibitor
Alpha-4-beta-7 inhibitor

Question 27

Stelara (generic, class)

Answer 27

Ustekinumab –> IV then SQ
IL 12 + 23 inhibitor

Question 28

Skyrizi (generic, class)

Answer 28

Risankizumab –> IV then SQ
IL-23 Inhibitors

Question 29

Omvoh (generic, class)

Answer 29

Mirkizumab (Omvoh) —> IV then SQ
IL-23 inhibitor.

Question 30

How are JAK inhibitors administered?

Answer 30

By mouth

Question 31

Xeljanz (generic, class)

Answer 31

Tofacitinib
JAKi

Question 32

Rinvoq (generic, class)

Answer 32

Upadacitinib
JAKi

Question 33

JAK inhibitor BBW

Answer 33

1. All-cause mortality
2. Cancer
3. MACE
4. Embolism
5. Infections

Question 34

Zeposia (generic, class)

Answer 34

Ozanimod
Spingosine-1-phosphate receptor modulator

Question 35

Velsipity

Answer 35

Estrasimod
Sphingosine-1-phosphate-receptor modulator.

Question 36

Spingosine-1-Phosphate Receptor Modulator Contraindications

Answer 36

MI, Stroke, Decompensated HF, MAO-I

Side Effects: CV, Hepatotoxicity, Lymphocytopenia, Macular Edema, PML, Reversible Posterior leukoencephalopathy.

Question 37

How can we reduce the risk of infusion reactions with Biologics?

Answer 37

1. Slow down the infusion rate.
2. Premedicate (APAP + Diphenhydramine +/- IV hydrocortisone)

Question 38

What are the risks of using biologics?

Answer 38

1. Infusion reactions
2. Delayed reactions
3. Injection site reactions
4. Infection risk
5. malignancy Risk