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PHRM 864: Therapeutics IV > IBD > Flashcards

IBD Flashcards

1
Q

What is Inflammatory Bowel Disease?

A
  • Chronic or recurring immune response and inflammation of the gastrointestinal tract
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2
Q

What are the two types of of IBD?

A
  • Ulcerative Colitis [UC]
  • Crohn’s Disease [CD]
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3
Q

What is Ulcerative Colitis?

A
  • Inflammation limited to the rectum and colon [only in large intestines]
  • Smoking protects it??
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4
Q

What is Crohn’s Disease?

A
  • Inflammation of the GI tract that can affect any part from the mouth to the anus [has fistulas]
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5
Q

What is the treatment overview for IBD?

A
  • induce and maintain remission
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6
Q

What are some of the non-pharmacoloic therapies of IBD?

A
  • Nutrition Support: EN, PN [last line], Vitamins
  • Surgery: Proctocolectomy cures UC [removing colon = removed disease]
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7
Q

What are some of the classes that are used in the treatment of IBD?

A
  • ASAs
  • Corticosteroids
  • Immunomodulators
  • Biologics
  • Antimircrobials
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8
Q

What is are the ASA agents that are used in IBD?

A
  • Sulfasalazine = Sulfpyridine + 5-ASA [mesalamine]
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9
Q

What is the MOA for Sulfasalzine in IBD?

Which is ACTIVE or INACTIVE?

A
  • Cleaved by colon bacteria to release the sulfpyridine [absorbed] & 5-ASA [stays in lumen]
  • Sulfpyridine is INACTIVE
  • 5-ASA is ACTIVE [causing inflammation]
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10
Q

What is important to know about giving Mesalamine alone in IBD?

Indication? Dosage Forms?

A
  • Rapidly and completely absorbed in intestine BUT not in colon
  • Topical [enema: left-sided disease], Suppository [Proctitis], Oral
  • Topical > Oral; can combo
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11
Q

What are some of the Adverse Drug Reactions for ASA agents?

A
  • Sulfasalazine: N/V, Headache, rash, Hypersensitivity [SULFA]
  • Mesalamine: N/V, Headache, increased bleeding [no antiplatelet/coags/NSAIDS], pH affects [PPIs/H2RAs/Antacids]
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12
Q

What are Cortcosteroids good for in IBD?

MOA? Main Use?

A
  • MOA: anti-inflammatory
  • Used for induction NOT maintenance
  • Suppositories [Proctitis] & Enema [Left-sided disease]
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13
Q

What is the corticosteroid that is used?

A
  • Budesonide
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14
Q

What is important to know about Budsonide for IBD?

A
  • First pass metabolism [CYP3A inhibitor: ketoconazole, grapefruit = INCREASE exposure]
  • PO and Foam
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15
Q

What are the Systemic Cortiosteroids that are used in IBD?

A
  • Oral Prednisone & Prednisolone [IV methylprednisolone too]
  • TAPER
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16
Q

What are some of the Adverse Drug Reaction for Systemic Corticosteroids in IBD?

Short Term or Long Term?

A
  • Short Term: Hyperglycemia, Gastrits, Mood Swings, Increased BP
  • Long Term: Cataracts, Obesity, Growth Failure, Osteoporosis
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17
Q

What are the Immunosuppresive agents that are used in IBD?

A
  • Azathioprine [AZA]
  • Mercaptopurine [6-MP]
  • Cyclosporine
  • Methotrexate
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18
Q

What are Azathioprine & Mercaptopurine good for in IBD?

Place in treatment? Other Info?

A
  • Long Term treatment of UC & CD [for those that have faild 5-ASA & steriods] - good for Maintanence
  • AZA becomes 6-MP [Prodrug]
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19
Q

What are some of the Adverse Drug Reactions for Azathioprine & Mercaptopurine in IBD?

A
  • N/D/V, Bone Marrow Suppression, Hepatotoxicity, Fever, Rash
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20
Q

What are some Monitoring to know for Azathiopurine & Mercaptopurine in IBD?

A
  • TMPT, CBC, LFTs
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21
Q

What is important to know about Cyclosporine in IBD?

Indication? Dosage Forms?

A
  • NOT CD but good at Inducing remission in UC [not long term]
  • NOT for those that fail AZA & 6-MP
  • IV or PO
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22
Q

What are the Adverse Drug Reactions for Cyclosporine in IBD?

A
  • Nephrotoxity, Neurotoxicity, HTN, GI upset
  • Drug interactions: CYP3A & PGP
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23
Q

What are some of the Monitoring to do for Cyclosporine in IBD?

A
  • BP [bc of HTN], BUN/Scr, LFTs
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24
Q

What is important to know about Methotrexate in IBD?

Indication? Dosage Forms?

A
  • Used in CD for induction
  • SubQ or IM
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25
Q

What are the Adverse Drug Reactions for Methotrexate in IBD?

Just like in RA?

A
  • Bone Marrow Suppression [add folic acid], N/V/D, cirrhosis, rash, TERATOGENIC
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26
Q

What are some Monitoring to do for Methotrexate in IBD?

Just like in RA?

A
  • CXR [chest xray], CBC, SCr, LFTs
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27
Q

What are the biologics that are used in IBD?

Three Categories?

A
  • TNF-a Antagonist [Infliximab, Adalimumab, Golimumab, Cartolizumab]
  • Others [Natalizumab, Vedolizumab, Ustkinumab, Risankizumab, Mirikizumab]
  • Small Molecules [Tofacitnib, Upadacitinib, Ozanmiod, Estrasimod]
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28
Q

What are some of the general Adverse Drug Reactions for the TNF-a Inhibitors in IBD?

Just like in RA?

A
  • Increased risk of infection [PPD, CXR, Hep B/C; Up to date vaccines, NO live vaccines]
  • SubQ or IV
  • Risk of Lymphoma, CHF
29
Q

What are some of the general Monitoring for TNF-a Inhibitors in IBD?

Monitoring for basically ALL Biologics!
Just like in RA?

A
  • CXR, PPD, Infections, UA, CBC, SCr, LFT
    Hep B & C
30
Q

What is important to know about Infliximab [Remicade] in IBD?

MOA? Indication? Place in Treatment?

A
  • UC & CD for induction and maintenance
  • IV
  • Forming Antibodies [decrease response, D/C]

TNF a- Antagonist

31
Q

What is some extra Monitoring for Infliximab in IBD?

A
  • Infections, Vitals, Infusion Reactions, TDM
32
Q

What is Adalimumab [Humira] good for in IBD?

Types of IBD? Dosage?

A
  • UC & CD for inducation and maintenance of Mod-Severe UC/CD
  • Those that Failed Inflixumab
  • SubQ
  • Forming Antibodies

TNF-a Antagonist

33
Q

What is important to know about Golimumab [Simponi] in IBD?

A
  • ONLY in UC for induction and maintenance
  • SubQ
  • Forming Antibodies
34
Q

What is important to know about Certolizumab [Cimzia] in IBD?

A
  • ONLY in CD for induction and maintenance
  • SubQ
  • Forming Antibodies
35
Q

What is Natalizumab [Tysabri] good for in IBD?

MOA? Type of IBD? Dosing?

A
  • MOA: Anti-a-subunit [decrease inflammation]
  • ONLY in CD for induction and maintaining remission, those that fail TNF
  • IV
36
Q

What are the Adverse Drug Reactions for Natalizumab in IBD?

One MAIN one

A
  • PML [test for JC virus]
  • Similar to other biologics
37
Q

What is Vedolizumab [Entyvio] good for in IBD?

MOA? Type of IBD? Dosage?

A
  • Anti-a4b7 antinbody
  • UC & CD for induction and maintanence
  • IV
  • ADRs like biologics

“Other” Biologics

38
Q

What is important to know about Ustekinumab [Stelara] in IBD?

MOA? Indication? Place in treatment?

A
  • IL-12 and IL-23 antagonist [IL is important for inflammation]
  • UC & CD for inducation [IV] and maintenance [SubQ]
39
Q

What is important to know about Risankizumab-rzaa [Skyrizi] in IBD?

MOA? Indication? Dosage Forms?

A
  • IL-23 antagonist
  • CD those that failed biologics including Ustekizumab for Induction [IV] and maintenance [SubQ]
40
Q

What are the Adverse Drug Reactions for Risankizumab in IBD?

A
  • Headache, Nasopharyngitis, Abdominal Pain, Anemia, Nausea
  • Forming Antibodies [PPD, Vaccines?, avoid live vaccines]
41
Q

What is some of the monitoring for Risankizumab in IBD?

Typical ones?

A
  • CXR, PPD, Hep B/C, Lipids, LFTs
42
Q

What is important to know about Mirilizumab-mrkz [Omvoh] in IBD?

MOA? Indication? Dosage Forms?

A
  • IL-23p19 antagonist
  • UC for those that failed biologics or JAK; induction [IV] and maintenance [SubQ]
43
Q

What are the Adverse Drug Reactions for Miriklizumab in IBD?

A
  • Headache, Rash, injection site reactions
  • Forming Antibodies [PPD, Vaccine?, Avoid live vaccine]
44
Q

What are some monitoring to do for Mirikizumab in IBD?

A
  • CXR, PPD, Hep B/C, Lipids, LFTs
45
Q

What is the TDM of Biologics?

Think Table?

A
  • Sub-therapeutic & Detect: Change drug same class
  • Sub-theraputic & Undetect: increase dose
  • Therapeutic & Detect: Change drug out of class
  • Theraputic & undetect: Change drug out of class
46
Q

What is important to know abourt Tofacitinib [Xeljanz] in IBD?

MOA? Indication? Dosage Forms?

A
  • ORAL JAK inhibitor [enzymes involved in immune signaling]
  • ONLY of UC for those that failed TNF and Biologics
  • NOT used with Immunosuppressants or biologics [combo]
47
Q

What are the Adverse Drug Reactions of Tofacitinib in IBD?

A
  • Diarrhea, increased cholesterol, headahce, herpes, rash, increased infection [PPD, CXR, Hep B/C, Vaccine?, Avoid Live Vaccines]
  • BLACK BOX WARNING: Cardiovascular issues
48
Q

What are some monitoring for Tofacitnib for in IBD?

A
  • CXR, PPD, Hep B/C, ANC, CBC, Lipids, LFTs, Infections
49
Q

What is Upadacitinib [Rinvoq] good for in IBD?

MOA? Type of IBD? Dosage?

A
  • ORAL JAK1 inhibitor [JAK is good for immune signaling]
  • UC [8w] & CD [12w] for those that have fail TNF
50
Q

What are the Adverse Drug reactions for Upadacitinib in IBD?

Basically the same as Tofacitinib, Black Box Warning?

A
  • URT infection, Ance, Increased Cholesterol, Headache, Shingles
  • BLACK BOX WARNING: Cardiovascular
  • Increased infections risk [PPD, CXR, Hep B/C, Vaccine?, Avoid Live Vaccines]

Only changeD for Tofactinib & URT/Ance Infections for Upadacitinib

51
Q

What are some of the Monitoring to do for Upadacitinib in IBD?

A
  • CXR, PPD, Hep B/C, ANC/ALC, CBC, Lipids, LFTs Infections

Has ANC?? what other one does too?

52
Q

What is Ozanimod [Zeposia] good for in IBD?

MOA? Type of IBD? Place in Treatment

A
  • Oral S1P modulator that prevents lymphocyte mobilization in inflammatory sites
  • ONLY for UC
  • Induction and maintenance

New Small Molecules

53
Q

What are some contraindications for Ozanimod in IBD?

A
  • Cardio issues
  • Sleep Apnea
  • Taking MAO inhibitors
54
Q

What are the Adverse Drug Reactions for Ozanimod in IBD?

A
  • Increased Infection risk,PML [really with the other drugs in this class so maybe with this one too], Increased BP, Edema, Bradycardia
  • Drug Interactions: MAO, CYP2C8 inhibitors and inducers
55
Q

What are some of the monitoring for Ozanimod in IBD?

A
  • CXR, PPD, Hep B/C, CBC, LFTs, Infections, BP, ECG

-imods have BP

56
Q

What is important to know about Estrasimod [Velsipity] in IBD?

MOA? Indiction? Place in Treatment?

A
  • Oral S1P modulator: prevents lymphocyte mobilization in inflammatory sites
  • ONLY for UC for induction and maintenance [10/2023]

Same as Ozanimod

57
Q

What are some Adverse Drug Reactions for Estrasimod in IBD?

Like Ozanimod?

A
  • Increased infection risk, PML [with other drugs within the same class], Increased BP, Bradycardia, Edema
  • Sleep Apnea?

Sleep Apnea is a contraindication?

58
Q

What are some monitoring for Estrasimod in IBD?

A
  • CXR, PPD, Hep B/C, CBC, LFTs, Infections, BP, ECG

-imods have BP

59
Q

What are some Antimicrobials that are in IBD?

A
  • Ciprofloxacin, metronidazole, Rifamycin
  • Maybe used in CD with fistulas
  • C. Diff
60
Q

What dosage form to use for what UC issue in Mild-Moderate Active UC?

A
  • left-sided = enema
  • proctits = supp.
  • extensive = systemic
61
Q

What is some Oral and/or Topical medications to use for Mild-Moderate Active UC?

A
  • ASA [Mesalamine > sulfasalazine]
  • Extensive –> oral 5-ASA
  • Left-sided –> Enema
  • proctits –> Supp.
  • Combo oral/topical is better
62
Q

What should you do if 5-ASA is unresponsive in Mild-Moderate Active UC?

A
  • Changing Formulation [increase dose, do Combo, change product]
63
Q

What steroids might be used in Mild-Moderate Active UC?

A
  • CR Budesonide [or pred] in oral or topical 5-ASA fails
  • PO corticosteroid
  • NOT for maintenance, only for remission
64
Q

What is important to know about Moderate-Severe Active UC?

A
  • 4-6 stools per day, +/- bloody stools
  • NO methotrexate for induction or maintenance
  • COMBO TNF, Vedolizumab, or Ustekinumab with Thiopurine or MTX [decrease antibodies
65
Q

What are some treatment options for Moderate-Severe Active UC?

A
  • 5-ASA for moderate NOT severe
  • Systemic Corticosteroids [moderate use PO Budesonide]
  • Consider TNF [those that failed ASA & Steroids]
66
Q

What are some medication class that are used in Moderate-Severe Active UC?

A
  • TNF Inhibitor, Anti-Integrin, IL12/IL23 inhibitors, JAK inhibitors, S1P inhibitor
67
Q

What is important to know about Severe-Fulminant Active UC?

A
  • 6-10 Bowel Movements, NPO?
  • Parenteral Corticosteroids [Methylprednisolone or Hydrocortisone x3-7d]
  • TNF [Infliximab] or Cyclosporine if failed IV steroids
68
Q

What should you used for Maintenance of Remission in UC?

A
  • Basically used what got you into remission [ASA, TNF, Azathioprine, or 6-MP]
  • Failed ASA or Steroids = Azathioprine or 6-MP
69
Q

What is important to knwo about 5-ASA and Sulfasalazine in Mild-Moderate Active CD?

A
  • Sulfasalamine = slight effect
  • 5-ASA = no effect

PHRM 864: Therapeutics IV (28 decks)

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