GI: IBD Pharm

Question 1

Which drugs are specific to UC?

Answer 1

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

JAK Kinase Inhibitor
-Tofacitinib

TNF-a inhibitor
-Golimumab,

Question 2

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

Answer 2

-sala-

• Sulfasalazine
• Mesalamine
• Olsalazine
• Balsalazide

Question 3

What drug is a JAK Inhibitor?

Answer 3

Tofacitinib

Question 4

What drug is an IL23/12 inhibitor?

Answer 4

Ustekinumab

Question 5

What drugs are TNF-a inhibitors?

Answer 5

Adalimumab
Golimumab (UC)
Infliximab
Certolizumab (CD)

Question 6

What drugs are an a-4 integrin inhibitor?

Answer 6

Vedolizumab (both)

Natalizumab (cd)

Question 7

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

Answer 7

Mesalamine

Question 8

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

Answer 8

TNF-a inhibitors

-adalimumab, Infliximab

Question 9

What drugs are specific to treating CD?

Answer 9

TNF-a inhibitor
-certolizumab

a-4 integrin inhibitors
-natalizumab

Question 10

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

Answer 10

a-4 intigrin inhibitors

-vendolizumab

Question 11

5-ASA MOA?

Answer 11

Inhibit Aracadonic acid pathway, so no prostaglandins or Leukotrienes

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

May also inhibit NFkB

Question 12

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

Answer 12

Rectal suppositories

Question 13

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

Answer 13

Rectal Enema

-doesnt concentrate rectum

Question 14

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

Answer 14

Oral

-released throughout the GI

Question 15

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

Answer 15

1. ASA-allergy

2. Sulfasalazine = Sulfa allergy

Question 16

What are 5-ASA drugs recommended for?

Answer 16

Active and Maintenance of mild to moderate UC

-besides olsalazine and balsalazine

Question 17

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

Answer 17

Olsalazine

Question 18

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

Answer 18

Balsalazide

Question 19

What is the MOA of TNF-a inhibitors?

Answer 19

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

Question 20

Which of the TNF-a inhibitors is given IV?

Answer 20

Infliximab

Question 21

Side effects of TNF-a inhibitors?

Answer 21

Infections

• reactivation of TB
• -Test before starting

Liver toxicity

Question 22

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

Answer 22

Test for TB

-TNF-a inhibition can cause reactivation

Question 23

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

Answer 23

Adalimumab

Golimumab

Question 24

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

Answer 24

Infliximab
Certolizumab
Adalimumab

Question 25

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

Answer 25

Infliximab

Question 26

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

Answer 26

Adalimumab

Question 27

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

Answer 27

Golimumab (UC) | Certiluzumab (CD)

Question 28

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

Answer 28

Infliximab

Question 29

a-4 integrin inhibitor MOA?

Answer 29

Limit integrin associated cell adhesion and diapedesis of leukocytes

Question 30

Side effects of Natalizumab (a-4 inhibitor)?

Answer 30

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

Question 31

Indications for Natalizumab?

Answer 31

Active and maintenance of Moderate to severe CD | -after TNF-a therapy fails!

Question 32

Indications for Vedolizumab

Answer 32

Active and maintenance of Moderate to severe CD and UC | -after TNF-a therapy fails!

Question 33

What is the maintainence dosing for Natalizumab?

Answer 33

IV infusion every 4 weeks

Question 34

What is the maintainence dosing for Vedolizumab?

Answer 34

IV infusion every 8 weeks

Question 35

Ustekinumab MOA

Answer 35

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

Question 36

Side effects of Ustekinumab?

Answer 36

Infections -Test for TB! Infusion rxn

Question 37

Indications for Ustekinumab?

Answer 37

Active and maintenance Moderate-to-severe UC and CD | -only after TNF-a therapy fails!

Question 38

what is the maintenance dose of Ustekinumab?

Answer 38

SQ every 8 weeks | -after single IV infusion for induction

Question 39

MOA of JAK Inhibitors?

Answer 39

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

Question 40

Side effects of Tofacitinib?

Answer 40

JAK Inhibitor Lymphopenia/Lymphocytosis Neutropenia/Anemia Increases in LDL and HDL

Question 41

Indications for JAK Inhiitors?

Answer 41

Active and maintenance of Moderate to severe UC

Question 42

Would you use biologics or immunosuppressants with JAK inhibitors?

Answer 42

Nope!

Question 43

Dosing of Tofacitinib?

Answer 43

PO BID

Question 44

Why would you use steroids for UC/CD?

Answer 44

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

Question 45

Would you use steroid agents for maintanence of remission?

Answer 45

Not unless absolutely required | -steroid-dependent

Question 46

How would you dose Steroids for IBD?

Answer 46

Lowest dose for shortest duration possible