IBD Flashcards
infliximab indications
UC and CD
may be preferred for UC induction or fulminant UC
adalimumab indications
UC and CD induction and mx
can use in pts with poor response to infliximab
TNF inhibitors ADRs
- increased risk of infection
- injection site rxns
- risk of malignancy
- risk of demyelinating disease
- CHF exacerbation
golimumab indications
UC ONLY - induction and mx
certolizumab indications
CD ONLY - induction and mx
ozanimod and estrasimod indications
UC ONLY - moderate-severe
varicella vaccine is recommended prior to starting which treatments?
ozanimod and estrasmiod
which drugs are metabolized by CYP3A and therefore need to be monitored with CYP3A inducers/inhibitors ?
tofacitinib
upadacitinib
In which patients would you consider use of Xeljanz or Rinvoq?
in patients who had an inadequate response or are intolerant to TNF blockers
Ozanimod is contraindicated with what?
MAOIs
vedolizumab and ustekinumab indications
UC and CD - induction and mx
CDAI 150-220
mild-moderate CD, ambulatory with minimal symptoms
CDAI 220-450
moderate-severe CD, patient who fail therapy for mild-moderate or with major symptoms
CDAI > 450
severe-fulminant CD, persistent symptoms despite steroid or biologic use, presence of cachexia, obstruction, or abscess
Fistulas are common in: CD or UC?
CD
The inflammation is deeper in: CD or UC?
CD
What is the most common affected site in CD?
terminal ileum
What is the active and inactive component of sulfasalazine?
inactive = sulfapyridine (associated with ADRs)
active = 5-ASA (mesalamine)
What dosage forms is mesalamine typically in? Which dosage form is usually most effective?
-topical (enema)
-suppository
-oral DR/CR tablet
topical is generally more effective than oral
ASA agents - ADRs
N/V, headache, anorexia, rash
How to avoid ADRs with ASA agents
initiate at low dose and increase slowly over 1-2 weeks
ASA agents drug interactions
-antiplatelets/anticoagulants
-NSAIDs
-> may increase bleeding risk
-agents affecting gastric pH (PPIs, H2RAs, antacids) - could affect release of drug
Which ASA agent has the highest incidence of diarrhea?
Olsalazine
Which routes are corticosteroids used for IBD?
oral, rectal, parenteral
*rectal hydrocortisone common
What supplements should be given while on steroids?
calcium and vitamin D
Azathioprine and 6-MP indications
-long-term tx of UC and CD - maintenance
-maintain remission, steroid-sparing
-reserved for pts who fail 5-ASA tx or pts dependent on steroids
Azathioprine and 6-MP ADRs
N/V/D, anorexia
bone marrow suppression
hepatotoxicity
fever, rash
Methotrexate indications
CD - assist in inducing remission, steroid-sparing effects
Methotrexate ADRs
bone marrow suppression, mucositis, cirrhosis, pneumonitis, rash, alopecia, teratogenic
TNF-a antagonists
- infliximab
- adalimumab
- golimumab
- certolizumab
Infliximab has an increased risk of which malignancy?
hepatosplenic T-cell lymphoma
Which biologics require an infusion?
-infliximab
-natalizumab
-vedolizumab
Corticosteroids short-term adverse effects
- hyperglycemia
- gastritis
- mood changes
- elevated BP
Corticosteroids long-term adverse effects
- aseptic necrosis
- cataracts
- obesity
- growth failure
- osteoporosis
Methotrexate contraindications
- pregnancy
- immunodeficiency
- blood dyscrasias
- chronic liver disease
- pleural effusions
- leukopenia/thrombocytopenia
- CrCl < 40
ozanimod and estrasimod ADRs
- increased risk of infection
- bradycardia/AV conduction delays
- potential risk of PML
- increased BP
- increased LFTs/liver injury
- macular edema
- respiratory effects
- reversible posterior leukoencephalopathy syndrome
T/F: 5-ASA therapy may be used for severe UC
FALSE - used for moderate disease
