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Pharmacology > GI: IBD Pharm > Flashcards

GI: IBD Pharm Flashcards

1
Q

Which drugs are specific to UC?

A

5-ASA
-all have -sala- in the name

JAK Kinase Inhibitor
-Tofacitinib

TNF-a inhibitor
-Golimumab,

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2
Q

What base root word is in all the 5-ASA drugs?

A

-sala-

  • Sulfasalazine
  • Mesalamine
  • Olsalazine
  • Balsalazide
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3
Q

What drug is a JAK Inhibitor?

A

Tofacitinib

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4
Q

What drug is an IL23/12 inhibitor?

A

Ustekinumab

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5
Q

What drugs are TNF-a inhibitors?

A

Adalimumab
Golimumab (UC)
Infliximab
Certolizumab (CD)

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6
Q

What drugs are an a-4 integrin inhibitor?

A

Vedolizumab (both)

Natalizumab (cd)

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7
Q

Which are all Sulfasalazine, Olsalazine, and Balsalazide prodrugs of?

A

Mesalamine

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8
Q

Which TNF inhibitors can be used to treat both forms of IBD?

A

TNF-a inhibitors

-adalimumab, Infliximab

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9
Q

What drugs are specific to treating CD?

A

TNF-a inhibitor
-certolizumab

a-4 integrin inhibitors
-natalizumab

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10
Q

What a-4 inhibitors can be used for both forms of IBD?

A

a-4 intigrin inhibitors

-vendolizumab

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11
Q

5-ASA MOA?

A

Inhibit Aracadonic acid pathway, so no prostaglandins or Leukotrienes

  • Less COX/LIPOX=less PMN and Mo chemotaxis
  • -Less inflammation!

May also inhibit NFkB

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12
Q

If UC is limited to the Rectum, which formulation of 5-ASA choice would be best?

A

Rectal suppositories

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13
Q

If IBD affects up to the splenic flexure, what formulation of 5-ASA would be best?

A

Rectal Enema

-doesnt concentrate rectum

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14
Q

If IBD is bad enough and extends beyond just splenic flexure, what formulation of 5-ASA would be best?

A

Oral

-released throughout the GI

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15
Q

What are the two big contraindications to someone taking 5-ASA?

A
  1. ASA-allergy

2. Sulfasalazine = Sulfa allergy

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16
Q

What are 5-ASA drugs recommended for?

A

Active and Maintenance of mild to moderate UC

-besides olsalazine and balsalazine

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17
Q

Which 5-ASA drug would you prescribe only for maintenance of remission?

A

Olsalazine

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18
Q

Which 5-ASA drug would you proscribe only for ACTIVE disease?

A

Balsalazide

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19
Q

What is the MOA of TNF-a inhibitors?

A

binds and neutralizes membrane-associated and soluble human TNF-a mediated inflammation, to reduce leukocyte migration

20
Q

Which of the TNF-a inhibitors is given IV?

A

Infliximab

21
Q

Side effects of TNF-a inhibitors?

A

Infections

  • reactivation of TB
  • -Test before starting

Liver toxicity

22
Q

What should you test for before starting TNF-a inhibitors?

A

Test for TB

-TNF-a inhibition can cause reactivation

23
Q

What TNF-a inhibitors are used for Active and maintenance Moderate to severe UC?

A

Adalimumab

Golimumab

24
Q

What TNF-a inhibitors are used for Active and maintenance Moderate to Severe CD?

A

Infliximab
Certolizumab
Adalimumab

25
Q

What TNF-a inhibitor is used for Active and maintenance Severe UC?

A

Infliximab

26
Q

What TNF-a Inhibitor maintenance dosing is SubQ every 2 weeks?

A

Adalimumab

27
Q

What TNF-a Inhibitor maintenance dosing is SubQ every 4 weeks?

A

Golimumab (UC)

Certiluzumab (CD)

28
Q

What TNF-a Inhibitor maintenance dosing is IV every 8 weeks?

A

Infliximab

29
Q

a-4 integrin inhibitor MOA?

A

Limit integrin associated cell adhesion and diapedesis of leukocytes

30
Q

Side effects of Natalizumab (a-4 inhibitor)?

A

Progressive Multifocal Luekoencephalopathy (if pt has JC Virus)–Brutus Sketchy

risk factors for PML: treatment over 2 years, with prior immunosuppressant therapy, and anti-JCV abs

31
Q

Indications for Natalizumab?

A

Active and maintenance of Moderate to severe CD

-after TNF-a therapy fails!

32
Q

Indications for Vedolizumab

A

Active and maintenance of Moderate to severe CD and UC

-after TNF-a therapy fails!

33
Q

What is the maintainence dosing for Natalizumab?

A

IV infusion every 4 weeks

34
Q

What is the maintainence dosing for Vedolizumab?

A

IV infusion every 8 weeks

35
Q

Ustekinumab MOA

A

IL-12/23 inhibitor

Binds to P40 subunit of IL-12 and 23, which blocks activation of Tcells and NFkB
-reduces inflammation

36
Q

Side effects of Ustekinumab?

A

Infections
-Test for TB!

Infusion rxn

37
Q

Indications for Ustekinumab?

A

Active and maintenance Moderate-to-severe UC and CD

-only after TNF-a therapy fails!

38
Q

what is the maintenance dose of Ustekinumab?

A

SQ every 8 weeks

-after single IV infusion for induction

39
Q

MOA of JAK Inhibitors?

A

Bind and inhibit free floating and bound JAK-1 and JAK-3
-blocks gene transcription via blocking phosphorylation of JAK
—less proinflammatory mediators

40
Q

Side effects of Tofacitinib?

A

JAK Inhibitor

Lymphopenia/Lymphocytosis
Neutropenia/Anemia
Increases in LDL and HDL

41
Q

Indications for JAK Inhiitors?

A

Active and maintenance of Moderate to severe UC

42
Q

Would you use biologics or immunosuppressants with JAK inhibitors?

A

Nope!

43
Q

Dosing of Tofacitinib?

A

PO BID

44
Q

Why would you use steroids for UC/CD?

A

Acute and/or severe UC and CD uncontrolled by others conventional meds

45
Q

Would you use steroid agents for maintanence of remission?

A

Not unless absolutely required

-steroid-dependent

46
Q

How would you dose Steroids for IBD?

A

Lowest dose for shortest duration possible

Pharmacology (50 decks)

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