GI: IBD Pharm Flashcards
Which drugs are specific to UC?
5-ASA
-all have -sala- in the name
JAK Kinase Inhibitor
-Tofacitinib
TNF-a inhibitor
-Golimumab,
What base root word is in all the 5-ASA drugs?
-sala-
- Sulfasalazine
- Mesalamine
- Olsalazine
- Balsalazide
What drug is a JAK Inhibitor?
Tofacitinib
What drug is an IL23/12 inhibitor?
Ustekinumab
What drugs are TNF-a inhibitors?
Adalimumab
Golimumab (UC)
Infliximab
Certolizumab (CD)
What drugs are an a-4 integrin inhibitor?
Vedolizumab (both)
Natalizumab (cd)
Which are all Sulfasalazine, Olsalazine, and Balsalazide prodrugs of?
Mesalamine
Which TNF inhibitors can be used to treat both forms of IBD?
TNF-a inhibitors
-adalimumab, Infliximab
What drugs are specific to treating CD?
TNF-a inhibitor
-certolizumab
a-4 integrin inhibitors
-natalizumab
What a-4 inhibitors can be used for both forms of IBD?
a-4 intigrin inhibitors
-vendolizumab
5-ASA MOA?
Inhibit Aracadonic acid pathway, so no prostaglandins or Leukotrienes
- Less COX/LIPOX=less PMN and Mo chemotaxis
- -Less inflammation!
May also inhibit NFkB
If UC is limited to the Rectum, which formulation of 5-ASA choice would be best?
Rectal suppositories
If IBD affects up to the splenic flexure, what formulation of 5-ASA would be best?
Rectal Enema
-doesnt concentrate rectum
If IBD is bad enough and extends beyond just splenic flexure, what formulation of 5-ASA would be best?
Oral
-released throughout the GI
What are the two big contraindications to someone taking 5-ASA?
- ASA-allergy
2. Sulfasalazine = Sulfa allergy
What are 5-ASA drugs recommended for?
Active and Maintenance of mild to moderate UC
-besides olsalazine and balsalazine
Which 5-ASA drug would you prescribe only for maintenance of remission?
Olsalazine
Which 5-ASA drug would you proscribe only for ACTIVE disease?
Balsalazide
What is the MOA of TNF-a inhibitors?
binds and neutralizes membrane-associated and soluble human TNF-a mediated inflammation, to reduce leukocyte migration
Which of the TNF-a inhibitors is given IV?
Infliximab
Side effects of TNF-a inhibitors?
Infections
- reactivation of TB
- -Test before starting
Liver toxicity
What should you test for before starting TNF-a inhibitors?
Test for TB
-TNF-a inhibition can cause reactivation
What TNF-a inhibitors are used for Active and maintenance Moderate to severe UC?
Adalimumab
Golimumab
What TNF-a inhibitors are used for Active and maintenance Moderate to Severe CD?
Infliximab
Certolizumab
Adalimumab
What TNF-a inhibitor is used for Active and maintenance Severe UC?
Infliximab
What TNF-a Inhibitor maintenance dosing is SubQ every 2 weeks?
Adalimumab
What TNF-a Inhibitor maintenance dosing is SubQ every 4 weeks?
Golimumab (UC)
Certiluzumab (CD)
What TNF-a Inhibitor maintenance dosing is IV every 8 weeks?
Infliximab
a-4 integrin inhibitor MOA?
Limit integrin associated cell adhesion and diapedesis of leukocytes
Side effects of Natalizumab (a-4 inhibitor)?
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
Indications for Natalizumab?
Active and maintenance of Moderate to severe CD
-after TNF-a therapy fails!
Indications for Vedolizumab
Active and maintenance of Moderate to severe CD and UC
-after TNF-a therapy fails!
What is the maintainence dosing for Natalizumab?
IV infusion every 4 weeks
What is the maintainence dosing for Vedolizumab?
IV infusion every 8 weeks
Ustekinumab MOA
IL-12/23 inhibitor
Binds to P40 subunit of IL-12 and 23, which blocks activation of Tcells and NFkB
-reduces inflammation
Side effects of Ustekinumab?
Infections
-Test for TB!
Infusion rxn
Indications for Ustekinumab?
Active and maintenance Moderate-to-severe UC and CD
-only after TNF-a therapy fails!
what is the maintenance dose of Ustekinumab?
SQ every 8 weeks
-after single IV infusion for induction
MOA of JAK Inhibitors?
Bind and inhibit free floating and bound JAK-1 and JAK-3
-blocks gene transcription via blocking phosphorylation of JAK
—less proinflammatory mediators
Side effects of Tofacitinib?
JAK Inhibitor
Lymphopenia/Lymphocytosis
Neutropenia/Anemia
Increases in LDL and HDL
Indications for JAK Inhiitors?
Active and maintenance of Moderate to severe UC
Would you use biologics or immunosuppressants with JAK inhibitors?
Nope!
Dosing of Tofacitinib?
PO BID
Why would you use steroids for UC/CD?
Acute and/or severe UC and CD uncontrolled by others conventional meds
Would you use steroid agents for maintanence of remission?
Not unless absolutely required
-steroid-dependent
How would you dose Steroids for IBD?
Lowest dose for shortest duration possible
