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GI 2 > GI Pharm > Flashcards

GI Pharm Flashcards

1
Q

What are the 6 drug classes used for tx of IBD?

A
  • aminosalicylates
  • corticosteroids
  • Abx
  • immunosuppressive
  • IV cyclosporine
  • Immune modifies
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2
Q

Aminosalicylates:

  • 2 MC medications
  • uses
  • Routes of Adminitration
A

2MC medications: Sulfasalazine and Mesalamine

Use: 1st line
-induce and maintain remission in UC & Crohns

Routes of Administration: -PO

  • Enema
  • Suppository
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3
Q

Sulfasalazine:

  • pregnancy category?
  • unique characteristic
  • CI
  • frequency of administration
A

Pregnancy ca. B

Unique: converted to mesalamine in the proximal colon

Frequency: tablets administered 4x daily

CI in sulfa allergy

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4
Q

Mesalamine:

  • pregnancy category
  • routes of administration
  • unique features
A

Pregnancy: B

Routes:

  • PO tablet/capsule
  • enema
  • rectal suppositores

Unique: poorly absorbed through the GI tract so works primarily like a topical agents with limited systemic SE and drug interactions.

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5
Q

aminosalicylates:
- moa
- CI
- dosing

A

MOA:

  • unknown
  • blocks prostaglandin production, perhaps interfers with production of inflamm cytokines, may inhibit NK cells, lymphocytes, and mfs.

CI :

  • aspirin or salicylate allergy
  • G6PD
  • hx of sulfa allergy

Dosing:

  • must be used at max dose for max therapeutic effect
  • varies from once daily to 4x/day
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6
Q

Sulfasalazine:

  • SE
  • WHat labs must you monitor?
A
  • Worst side effect profile of all aminosalicylates
  • n/v
  • photosensitivity
  • oligospermia
  • skin discoloration
  • decreased folate levels (Must take folic acid supplement)
  • Severe: SJS, hepatitis, bone marrow suppression.

Labs:

  • CBC
  • LFT
  • renal
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7
Q

Mesalamine

  • SE
  • what labs must be monitored?
A

HA, malaise, abd pain, diarrhea

Labs:

  • renal function
  • CBC
  • LFT
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8
Q

Corticosteroids

  • when do you use these?
  • short and long term SE
  • medication names
A

Used for acute exacerbations, NOT used for maintaining remission

SE:
Short -psychosis, elevated blood sugar, HTN, upset stomach, insomnia

Long:osteoporosis, obesity (buffalo hump), cataracts, suppression of pituitary adrenal axis, hirsutism

Meds:
-Prednisone or Prednisolone: IV = hydrocortisone and methylprednisolone.

-Budesonide (poor bioavailability , good b/c stays in the gut.

Topical:
-cortenema, cortifoam, anusol-HC suppositories

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9
Q

Abx:

  • what medications?
  • use
A

Ciprofloxacin
Metronidazole
take at least 1mo to induce sx improvement

Use:
used when pt doesnt respond to 5-ASA (mesalamine) after 3-4wks or if pt is intolerant to 5-ASA
(add on or 2nd line therapy)

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10
Q

Immune Moddifiers

  • what are the medication names?
  • clinical use
  • time to sx reduction
  • MOA
A

Meds:

  • azathioprine*
  • 6-mercaptiopurine*
  • methotrexate
  • infliximab
  • cyclosporine

Use:
induction and maintenance of remission
-allows reduction of steroid therapy

Time to sx reduction: 17wks

MOA:
-inhibition of purine neucleotide metabolism and DNA synthesis and repair, resulting in inhibition of cell division and proliferation.
(*decrease proliferation of immune cells leading to lower autoimmune activity)

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11
Q

Azathioprine and 6-mercaptopurine

  • SE
  • CI
A

SE:

  • n/v/d
  • fever, rash
  • pancreatitis
  • bone marrow suppression*
  • hepatic toxicity
  • arthralgias, malaise
  • drug toxicity with concurrent use of allopurinol

CI:

  • CI in pregnancy or active liver dz
  • decrease dose for CrCl less than 50
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12
Q

Whenever using immune suppression drugs what 3 organs are we most concerned with?

A

Kidneys, Liver, BM

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13
Q

Methotrexate

  • use
  • routes of administration
  • MOA
  • Pregnancy category
  • SE
A

use: induction and maintenance

Routes: PO, SQ, IM

MOA:

  • inhibits metabolism of folic acid
  • interferes with inflamm actions
  • may stimulate apoptosis and death of activated T lymphos.
  • *Make sure on folic acid supplements**

Pregnancy cat X

SE:

  • alopecia
  • muscositis
  • BM suppression
  • megaloblastic anemia
  • cirrhosis and liver fibrosis
  • penumonitis
  • folic acid deficiency
  • rash
  • nause and diarrhea
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14
Q

Cyclosporine

  • use
  • time to sx relief
  • routes of admin
  • SE
A

Use: used for acute tx of severe, steroid refractory exacerbations

Sx relief in 2-3days

Routes of admin: IV

SE: nephrotoxicity, hypomagnesemia, HTN

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15
Q

anti- TNF inhibitors

  • use
  • medications
  • MOA
  • SE
  • BBW
A

Uses: severe dz, when not responding to steroids.
must get TB test prior to use of this drug

Meds:

  • infliximab (Remicade)
  • Adalimumab (Humira)
  • Certolizumab Pegol (Cimzia)

MOA: monoclonal abys dial down the immune system

SE:

  • fever chills, pruritis, urticaria, chest pain, hemodynamic instability = infusion rxns
  • delayed infusion rxns: myalgia, athralgia, rash, urticaria, facial, hand, and lip edema

BBW:
-reactivation of latent TB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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16
Q

Overview of medical therapy: describe the stepwise Rx order of IBD medications

A

5-ASA… if no response give Abx….if no response… oral steroids… if no response… immunosuppressive drugs.
*skip ABX step if treating UC.

5-ASA …complete response = maintenance.

17
Q

T/F, use of combo oral and rectal 5-ASA have better efficacy than either agent alone?

A

True.

18
Q

IBS

-therapy is based on what?

A

Symptomology, ie. constipation or diarrhea.

19
Q

Tx constipation

Tx Pain

Tx Diarrhea

A 
Constipation: 
Increase fluids and fiber 
TCA or SSRI 
Peppermint oil 
osmotic laxatives 
lubiprostone

Pain:

  • antispasmodics (anticholinergics)
  • TCAs
  • SSRI
  • Peppermint oil

Diarrhea;

  • fiber
  • loperamide
  • cholestyramine
  • TCA
  • lotronex
  • SSRI
20
Q

Antispasmodics:

  • medications
  • MOA
  • SE
  • CI
  • which med is 1st line?
  • dosage
A

Meds:
Anticholinergics: Hyoscyamine (levbid), dicyclomine (bentyl)

MOA:

  • block action of Ach at muscarinic cholinergic receptors.
  • reduce contraction of bowel**

SE:
anticholinergic

CI:

  • peptic ulcer
  • arrhythmia
  • CHF
  • Glaucoma

1st line is Bentyl

Dosage: PRN

21
Q

Anti-constipation agents:

-meds

A

MedS: Miralax/polyethylene glycol (osmotic)

Lubiprostone, linaclotide

22
Q

Chloride Channel Activator: LUBIPROSTONE

  • MOA
  • use
  • SE
A

MOA: locally acting calcium channel activator that increases intestinal fluid secretion.

uSe; approved for women with CONSTIPATION predominant IBS

SE:

  • n/d
  • abd pain
  • abd distention
23
Q

Chloride Channel Activator: Linaclotide (Linzess)

  • MOA
  • Admin route
A

MOA: binds to GC-C receptor on intestinal epithelium and increases intestinal fluid.

route: once daily in Am after eating

24
Q

Psychotrophic Agents used in IBS?

A

TCAS:

  • amitryptyline
  • desipramine
  • imipramine

SSRI:

  • escitalopram (lexapro)
  • citalopram (celexa)
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluoxetine (Prozac)
25
Q

TCA’s:

  • use
  • CI
A

slows transit time and helps with belly pain.

CI:

  • narrow angle glaucoma
  • recent MI
  • MAOI or Prozac in pts who took them in previous 2 wks
26
Q

SSRI’s

-use

A

Use: improvement in overall sense of well being but have little impact on abd pain or bowel sx.

27
Q

Alosetron (Lotronex)

  • drug class?
  • indications
  • CI
A

Drug class: 5-HT3 receptor inhibitor

Indicated in women with severe diarrhea who have IBS
cannot give to pts with constipation

CI:

  • Crohns and UC
  • diverticulitis
  • diverticulosis
28
Q

What are the nonabsorbable abx?

which probiotic is shown to have modest improvement of sx in IBS?

A

non-absorbable:

  • rifaximin (xifaxan)
  • not FDA approved

Bifodobacterium infantis has shown modest improvement in sx in small studies

GI 2 (9 decks)

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