IBD

Question 1

What are the two forms of IBD?

Answer 1

Crohn’s and Ulcerative Colitis

Question 2

What are the symptoms of IBD?

Answer 2

Severe diarrhea (+blood, mucus), abd pain, weight loss, fever, malaise, fistulas, strictures, ulcers, skin, eye, joint inflammation

Question 3

What are the uses for sulfasalazine?

Answer 3

• Aminosalicylate
• Used to treat mild or moderate UC and Chrohn Disease and to maintain remission after symptoms have subsided
• RA

Question 4

What is the MOA of Sulfasalazine?

Answer 4

• Metabolized by intestinal bacteria into 5-aminosalicylic acid (5-ASA) and sulfapyridine –> reduce inflammation

Question 5

What supplement needs to be taken with Sulfasalazine?

Answer 5

Folate

Question 6

What are the side effects of sulfasalazine?

Answer 6

• HA, nausea, fever, rash, fatigue, arthralgia, hematologic disorders may also occur
• May impair male fertility

Question 7

What are the uses of Mesalamine?

Answer 7

• Aminosalicylate made of single 5-ASA molecules enclosed within an enteric coat
• Mild to moderate UC (flares, maintenance)

Question 8

What is the MOA of Mesalamine?

Answer 8

Anti-inflam and immunosupp properties d/t inhibit of cytokine, leukotrine, and prostaglandin synth, scavenging of free radicals

Question 9

What is the PK of Mesalamine?

Answer 9

• Oral or rectal admin
• Absorption increased with more severe disease and decreased with decreasing pH

Question 10

What are the side effects of Mesalamine?

Answer 10

• Nausea, HA, diarrhea, abd pain, nephrotoxicity, intersitial nephritis
• Caution in severe renal and hepatic impairment

Question 11

What steroids can be used for moderate-severe Crohn’s and UC flares?

Answer 11

Prednisone
Budesonide
Methylpred
Hydrocortisone

Question 12

What is the MOA of steroids in the treatment of IBD flares?

Answer 12

Inhibits production of inflammatory cytokines

Question 13

How should hydrocortisone be administered in treating IBD flares?

Answer 13

Rectally

Question 14

What are the side effects of corticosteroids?

Answer 14

Hyperglycemia, adrenal supp, peptic ulcers, immunosupp, anxiety, fluid retention

Question 15

What are the Immune System Suppressors for IBD?

Answer 15

Aian
Methotrexate
Adalimumab/Infliximab

Question 16

What are the uses of Aian?

Answer 16

• Induce and maintain remission in both UC and Crohn disease
• Cannot be used for acute tx
• Can help reduce steroid use

Question 17

What is the PK of Aian?

Answer 17

• Oral admin
• Prodrug that undergoes conversion to mercaptopurine
• Onset of effects may be delayed for 6 months

Question 18

What are the side effects of Aian?

Answer 18

N/V, pancreatitis, neutropenia, liver toxicity

*Monitor CBC and LFT’s

Question 19

What are the indications for Methotrexate in IBD?

Answer 19

• Induce and maintain remission in Crohn’s disease
• Less common in UC

Question 20

What is the MOA of methotrexate?

Answer 20

Folic acid antagonist that inhibits cytokine production and purine nucleotide biosynthesis –> immunosuppressant, and anti-inflammatory effects

Question 21

What is the PK of methotrexate?

Answer 21

Oral admin

Question 22

What are the side effects of methotrexate?

Answer 22

• Cytotoxic at high doses
• Diarrhea, N/V, alopecia, bone marrow suppression, mucositis

*Contra in pregnancy

Question 23

Is adalimumab better at treating Crohn’s or UC?

Answer 23

Crohn’s

Question 24

Is infliximab better at treating Crohn’s or UC?

Answer 24

UC

Question 25

What is the MOA of biologics in treating IBD?

Answer 25

TNF-alpha inhibitors –> help mitigate overactive immune response

Question 26

Biologics should be used with caution in what conditions?

Answer 26

Heart and liver disease