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PHPY 305 > IBD And IBS > Flashcards

IBD And IBS Flashcards

1
Q

Inflammatory Bowel Disease

A

Severe inflammatory disorder affecting the lower GI tract

  • inflammation is destructive and painful
  • perforation can occur, which can be fatal
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2
Q

Two types of IBD

A

Crohn’s Disease

Ulcerative colitis

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3
Q

IBD treatment addresses

A

Inflammation and immune response

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4
Q

Drug classes for IBD (4)

A

Aminosalicylates
TNF inhibitors
Corticosteroids
Immunosuppressants

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5
Q

Aminosalicylates example

A

5-Aminosalicylic Acid (5-ASA)
- also known as mesalamine
Extended Release Microspheres (5-ASA ER)

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6
Q

Aminosalicylates mechanism

A
  • Inhibit inflammatory mediators

- may also inhibit cyclooxygenase

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7
Q

Aminosalicylates pharmacokinetics

A
  • act locally (target colon)
  • strategies: Prodrug cleaved in colon, enteric coating dissolved in colon, microspheres release drug slowly, rectal administration.
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8
Q

Aminosalicylates Prodrug

A

Sulfasalazine

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9
Q

Sulfasalazine mechanism

A

5-ASA + sulfapyridine

  • two molecules separated in colon by bacteria
  • efficacy largely due to 5-ASA
  • adverse effects due to sulfapyridine
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10
Q

Extended Release Microspheres mechanism

A

Release 5-ASA throughout the small intestine to rectum

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11
Q

Rectal Suppositories

A

Suppositories effects may extend to the upper rectum (10-15cm)

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12
Q

Rectal (Enema)

A

Enemas reach further than suppositories, up to the distal colon

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13
Q

Aminosalicylates Side Effects

A

Gastrointestinal (worse with sulfasalazine)
Headache
Other rare ones but serious harms

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14
Q

TNF alpha inhibitors

A

TNF alpha is a key mediator of inflammation

Appears to be particularly important in IBD

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15
Q

TNF alpha inhibitor example

A

Monoclonal antibodies

Infliximab

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16
Q

TNF alpha inhibitors mechanism

A

MAbs bind to TNF and prevent it from interacting with its receptor

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17
Q

TNF alpha inhibitors side effects

A

Opportunistic infections

  • Immunosuppressive effects may increase the risk (réactivation of tuberculosis)
  • Hypersensitivity reactions: acute or delayed, infliximab is chimeric (animal/human)
  • malignancies: due to reduced immune surveillance, TNF lyses tumor cells
18
Q

Corticosteroids mechanisms

A

Anti-inflammatory effects
Immunosuppressive
Prednisone and Budesonide

19
Q

Corticosteroids routes

A

Oral, rectal, parenteral

20
Q

Corticosteroids side effects

A
  • Numerous serious side effects with systemic agents like Prednisone
  • Fewer with Budesonide
21
Q

Immunosuppressants example

A

Antimetabolites

- Azathioprine

22
Q

Azathioprine mechanism

A
  • converted to a structural analogue of guanine
  • “false nucleotide” halts DNA/RNA synthesis
  • Immune cells (lymphocytes) rely on de novo purine synthesis: therefore more susceptible to actions of metabolites
23
Q

Immunosuppressants side effects

A

Infection
Cancer
Bone marrow suppression
Gastrointestinal

24
Q

Cyclosporine mechanism

A

Inhibits T-cell activation by inhibiting IL-2

25
Q

Cyclosporine is difficult to use because..

A

Narrow margin for safety
Many drug interactions
Significant adverse effects

26
Q

Other Immunosuppressants

A

Methotrexate
Folate antagonist
- significant adverse effects

27
Q

Irritable Bowel Syndrome

A

Very common, challenging to treat

  • Constipation, diarrhea or mixed
  • abdominal pain
  • psychological, dietary components
28
Q

Antispasmodics

A
  • anticholinergics

- calcium antagonists

29
Q

Anticholinergics example

30
Q

Anticholinergics mechanism

A

Muscarinic receptors stimulate peristalsis in the GI tract

- blocking M receptors inhibits contractions of the colon

31
Q

Anticholinergic side effects

A
  • Dry mouth
  • urinary retention
  • constipation
32
Q

Calcium antagonist example

A

Pinaverium

33
Q

Calcium antagonists mechanism

A

Blocks entry of Calcium into smooth muscle cells of the GI tract
- calcium plays a role in smooth muscle contraction

34
Q

Calcium Antagonists side effects

A
  • constipation
  • Abdonminal distension
    Serious: esophageal irritation - patients should take with a full glass of water/small snack to make sure drug clears the esophagus
35
Q

IBS managing pain and constipation (drug name)

A

Linaclotide - cGMP agonist: increases intestinal secretions and reduces transmission of pain signals

36
Q

Anti-depressants used in treatment of IBS

A
  • tricyclic antidepressants

- serotonin selective reuptake inhibitors

37
Q

Tricyclics antidepressant used in IBS

A

Amitriptyline

38
Q

Tricyclics antidepressant side effects

A
  • exhibit side effects similar to anticholinergic (dry mouth, constipation, and urinary retention)
  • Better for use in IBS-D than SSRI’s
39
Q

SSRI example

A

Citalopram

40
Q

SSRI use in IBS

A

Typically used to treat IBS-C but the effects on the GI are not as reliable as TCA

PHPY 305 (14 decks)

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