IBD

Question 1

What are some of the things that treatment choice of IBD is based on?

Answer 1

actual dz (UC vs CD), location, severity, behavior, compliance

Question 2

MOA of 5-ASA agents?

Answer 2

block cyclooxyrgenase and lipoxygenase-> inhibit prostaglandin

Question 3

5-ASA (mesalamine and sulfasalazine) is used for ____

Answer 3

mild to moderate UC

Question 4

Corticosteroids are effective only for _____ in UC and CD

Answer 4

induction, not used for maintenance

Question 5

Budesonide is a low bioavailability ____ and used for _____ in CD and UC

Answer 5

steroid (good for side effect profile to be low bioavailable)
induction

Question 6

Budesonide has two formulations: _______ in ileocecal CD and _______ in UC

Answer 6

ileal release formulation

colonic release formulation

Question 7

Methotrexate MOA

Answer 7

interferes with purine synthesis (folate antagonist)

Question 8

Methotrexate can be used for _____ in CD but is contraindicated in ____

Answer 8

induction and maintenance (steroid sparing)

pregnancy becasue it is a teratogen

Question 9

Thiopurines (AZA, 6MP) work at 3 enzymatic pathways. They are:

Answer 9

xanthine oxidase
thiopurine methyltransferase (TPMT)
hypoxanthine phosphoribosyl transferase (HPRT) (towards the active metabolite)

Question 10

_____ was the first approved anti-TNF agent used for UC and CD. Other ones used now are:

Answer 10

infliximab

Adalimumab, certolizumab, golimumab

Question 11

Anti-TNF agents have a ___ response and can close ___ in CD. They induce ____ _____

Answer 11

rapid, fistulas, mucosal healing

Question 12

Ustekinumab (IV then SC) MOA is ____ and can be used in ___

Answer 12

IL-12/23 mAb

CD and UC

Question 13

Vedolizumab MOA is ____, which is good because it is _____

Answer 13

α4β7 integrin mAb, gut specific

Question 14

Tofacitinib is an oral medication that is a ___ (MOA) and is used in __

Answer 14

JAK inhibitor, induction and maintenance of UC

Question 15

Ozanimod is a ________ (MOA) and used in __

Answer 15

Sphingosine-1-phosphate receptor agonist

UC

Question 16

Thiopurines (AZA,6MP) are purine ____

Answer 16

antagonists -> interfere with protein and nucleic acid synthesis

Question 17

What is the benefit/danger with taking Allopurinol with thiopurines

Answer 17

blocks off one of the enzyme pathways

Question 18

What determines TPMT activity and why is that relevant to Thiopurines as a treatment for IBD

Answer 18

genetics-> get genetic polymorphisms before someone takes it

it metabolizes 6MP to 6MMP which is liver toxicity

Question 19

What is the desired metabolite from Thiopurines? what could it be toxic to?

Answer 19

6-TGN. if too much it is toxic to bone marrow