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P2 E3 Shea > IBD 2 > Flashcards

IBD 2 Flashcards

1
Q

What are the 4 Immunosuppressives?

A
  • azathioprine
  • mercaptopurine
  • cyclosporine
  • methotrexate
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2
Q

What are the 2 Purine Analogs?

(Immunosuppressives)

A
  • Azathioprine
  • 6-Mercaptopurine
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3
Q

6-MP (purine analog/immunosuppresive) is transformed by what 2 things?

A
  • xanthine oxidase
  • thiopurine
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4
Q

Azathioprine (purine analog/immunosuppressive) is rapidly converted –> to what?

A

6-MP

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5
Q

Which drug prolongs the half life of purine analogs (Azath & 6-MP) days, to delay of 17 weeks, BEFORE the onset of therapeutic benefit of the oral azath/6-MP?

A

6-thioguanine nucleotides

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6
Q

Which drug?

  • Induction and maintenance of remission of Ulcerative colitis and Crohn’s disease
  • helps eliminate/reduce steroid use,
  • remission within 3-6 months
A

Purine Analogs:

Azathioprine & 6-Mercaptopurine

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7
Q

ADE’s of which drug?

  • ↓ depress bone marrow à leukopenia, macrocytosis, anemia, thrombocytopenia
  • ↑ inc. risk of lymphoma,
  • Hepatoxicity (MUST get CBC & LFTs to monitor)
  • hypersensitivity rxn = pancreatitis/hepatitis
  • Crosses placenta, but pregnancies successful/low risk of teratogenicity
A

Purine Analogs: (immunosuppressives)

Azathioprine & 6-Mercaptopurine

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8
Q
  • What drug has a bad interaction w/ Purine Analogs/Immunosuppressive?
  • What are the 3 results?
A

Allopurinol

  • inhibits Xanthine oxidase from breaking down purine analogs
  • ↑ increasing active 6-thioguanine nucleotides
  • Severe leukopenia
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9
Q

Which drug?

  • Inhibits dihydrofolate reductase enzyme (important in production of thymidine & purines)
  • May interfere w/ inflammatory actions of interleukin
A

Methotrexate

(immunosuppressive)

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10
Q

Which drug?

  • May stimulate increased release of adenosine (endogenous anti-inflammatory autacoid)
  • May stimulate apoptosis & DEATH of activated T-lymphocytes
A

Methotrexate

(Immunosuppressive)

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11
Q

Which drug is used in maintenance of Crohn’s?

A

Methotrexate

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12
Q

ADEs of which drug?

  • depress bone marrow
  • megaloblastic anemia***
  • alopecia**
  • mucositis
  • mouth sores (stomatitis)***
  • PERMANANT peripheral neuropathy (if prolonged use)***
  • liver damage if +psoriasis, renal insufficiency inc. risk of liver toxicity
A

Methotrexate

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13
Q

Name the 5 Biologic Anti-TNFs

A
  • Infliximab
  • Adalimumab
  • Natalizumab
  • Golizumab
  • Certolizumab

“I CAN Go”

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14
Q

Which drug?

  • inhibits inflammatory cytokine release
  • impairs T-cells
  • PREVENT cytokine from binding to its receptors
  • REVERSE signaling à suppress cytokine release
A

Anti-TNF / Biologics (mab)

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15
Q

Which drug?

  • acute/chronic Mod-Severe Crohn’s
  • 1/3 lose response bc/ antibodies are made…
  • Antibody development is less common if combo tx w/ _____, BUT this increases risk of lymphoma
A

Anti-TNFs (Biologics, mab)

  • purine analogs (metho or 6-MP)
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16
Q

Monoclonal antibodies to human TNF are approved in these conditions.

Which drug?

  • Crohn’s, Plaque psoriasis, Psoriatic arthritis, RA, UC
A
  • Infliximab
  • Adalimumab
17
Q

Monoclonal antibodies to human TNF are approved in these conditions.

Which drug?

  • MS
A

Natalizumab

18
Q

Monoclonal antibodies to human TNF are approved in these conditions.

Which drug?

  • Plaque psoriasis, Psoriatic arthritis, RA, UC
  • NOT CROHN’s
A

Golimumab

19
Q

Which drug?

  • Bind to membrane bound TNF
  • Fc portion of human IgG region promotes antibody-mediated apoptosis
  • Complement activation
  • Cellular cytotoxicity of activated T-lymphocytes & macrophages
A

GIA

  • Infliximab
  • Adalimumab
  • Golimumab
20
Q

Which drug?

  • lacks Fc portion
A

Certolizumab

(also lacks properties of GIA)

21
Q

ADE’s of which drug?

  • reactivate latent TB
  • Listeriosis
  • Sinusitis, bronchitis, PNA, cellulitis
  • delayed serum sickness like rxn (1-2 wks after starting med)
  • myalgia, jaw tight, urticaria, edema
  • Lupus-like syndrome (rare/reversible)
  • SERIOUS INFECTIONS increased w/ corticosteroid use
  • Antibodies to Antibody (ATA)
  • New/Worsened CHF
A

Anti-TNF (biologics) mab

22
Q

What are the 2 “anti-integrins”

A
  • Natalizumab
  • Vedolizumab
23
Q

Which drug?

  • Humanized IgG4 monoclonal antibody targeted against alpha-4 subunit
  • Blocks SEVERAL integrins on circulating inflammatory cells
  • Prevents binding to adhesion molecules, prevents migration into tissues
A

Anti-integrin (Nat/Vedo)

24
Q

ADE’s of which drug?

  • Acute infusion rxn
  • Small risk of opportunistic infections
A

Natalizumab

25
Q

3 things to monitor when giving Natalizumab?

A
  • MRI of brain
  • Mental status
  • PMI (Progressive Multifocal Leukoencephalopathy)
26
Q

Which drug?

  • Selectively blocking gut, NOT brain
  • “lymphocyte trafficking”
  • Selectivity may prevent JC virus reactivation (PMI=progressive multifocal leukoencephalopathy)
A

Vedolizumab (anti-integrin)

27
Q

Which drug?

  • Use for refractory Crohn’s every 8 – 12 weeks
  • Adult pts w/ Mod-Severe active Crohn’s who have failed standard therapy (glucocorticoids, immunosupp, Anti-TNF)
A

Anti-IL 12/23 antibody (Ustekinumab)

28
Q

MOA of Anti-IL 12/23 antibody (Ustekinumab)

  • Human IgG monoclonal antibody
  • Blocks biologic activity of IL-12 & IL-23 by inhibiting receptors for these cytokines on what 3 cells?
A
  • T-cells
  • Natual killer cells
  • Antigen presenting cells
29
Q

3 ADE’s of Anti-IL 12/23 antibody (Ustekinumab)

A
  • Nasopharyngitis
  • SCC
  • Neurotoxicity (RPLS = reversible posterior leukoencephalopathy syndrome)

P2 E3 Shea (9 decks)

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