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GI 2 Final > IBD And IBS Pharmacology > Flashcards

IBD And IBS Pharmacology Flashcards

1
Q

What agents are used for UC only?

A

5-ASA

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2
Q

What are the 5-ASA drugs used in UC?

A
  • Sulfasalazine
  • Mesalamine
  • Olsalazine
  • Balsalazide
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3
Q

What agents are used for CD only?

A

IL-12/23 inhibitors

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4
Q

What is the name of the IL-12/23 inhibitor used in CD?

A

Ustekinumab

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5
Q

What is the name of the alpha-4 integrin inhibitor used in UC?

A

Vedolizumab

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6
Q

What are the names of the alpha-4 integrin inhibitor used in CD?

A
  • Natalizumab

- Vedolizumab

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7
Q

What TNF-alpha inhibitor is used specifically in UC?

A

-Golimumab

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8
Q

What TNF-alpha inhibitor is used specifically in CD?

A

-Certolizumab

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9
Q

What is the MOA for the 5-ASA medications?

A

Inhibition of PG and LT production by inhibiting COX and LIPOX in the arachidonic acid pathway

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10
Q

What are the contraindications with the use of 5-ASA drugs?

A

All 5-ASA medications are contraindicated in ASA-allergic patients and Sulfasalazine is contraindicated in patients with Sulfa allergies.

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11
Q

What are the indications for use of 5-ASA medications in patients with UC?

A

Used in mild-to-moderate active UC and maintenance of remission of UC.

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12
Q

What is olsalazine used for?

A

Only for maintenance therapy of UC

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13
Q

What is Balsalazide used for?

A

Only for the treatment of active UC disease.

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14
Q

What are the side effects of TNF-alpha inhibitors?

A

-Infections->TB testing pre-therapy must be done prior to use of medication

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15
Q

What two TNF-alpha inhibitors can be used for both UC and CD?

A
  • Adalimumab
  • Infliximab

“All Inclusive”

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16
Q

What level of disease are the TNF-alpha inhibitors used in?

A

Moderate-to-severe

17
Q

Which TNF-alpha inhibitor is given via IV?

A
  • Infliximab

* all others are SQ

18
Q

What are the side effects assocaited with use of alpha-4 Integrin Inhibitors?

A

-PML

19
Q

What are the 3 risk factors for PML?

A
  • Treatment more than 2 years
  • Prior immunosuppression
  • Anti-JC virus antibodies
20
Q

What are the indications for use of Natalizumab?

A

Moderate-to-severe treatment resistant CD and maintance therapy to prevent relapse.

21
Q

What are the indications for use of Vedolizumab?

A

Moderate-to-Severe treatment-resistant CD and UC as well as maintenenace therapy to prevent relapse.

22
Q

What is the MOA of the IL-12/23 inhibitors?

A

Inhibit Th1 and Th17 response

23
Q

What are the side effects of the IL-12/23 inhibitors?

A

Infections-> must test for TB prior to administration of medication

24
Q

What are the indications of use of the IL-12/23 inhibitors?

A

Moderate-to-severe treatment-resistant CD. Treats both active disease and maintenance.

25
Q

When are steroids indicated in the use of UC and CD?

A

-Acute and/or severe UC and CD uncontrolled by other medications.

26
Q

What is the key principle with the use of steroids?

A

always use the lowest dose for shortest duration possible.

27
Q

What are the class of agents used for abdominal pain in IBS?

A

Antimuscarinic agents

28
Q

Name the antimuscaric agents used in treatment of abdominal pain for IBS?

A
  • Hyoscyamine
  • Dicyclomine
  • Clidinium/ chlordiazepoxide
29
Q

What are the three classes of drugs that can be used for the treatment of diarrhea in IBS?

A
  • Anti-diarrheal
  • Opioid agonists/antagonists
  • Serotonin (5HT3 antagonists)
30
Q

What are the two anti-diarrheal medications and what are their MOA?

A

1) Loperamide (Imodium)- interferes with peristalisis

2) Diphenoxylate (lomotil)- inhibit GI motility and slows excess GO propulsion.

31
Q

What is the name and MOA of the 5HT3 antagonist that is used in the treatment of diarrhea in IBS?

A

Alosetron- blocks GI-based 5HT3 receptors.

32
Q

What is potential serious side effect with the use of alosetron?

A
  • Ischemic colitis is a major concern.

- Constipation

33
Q

What is the indication for use of Alosetron?

A

Women with chronic, severe IBS-D not responsive to other conventional therapies.

34
Q

What is the name of the opioid agonist/ antagonist?

A

-Eluxadoline-> agonist at mu and kappa and antagonist at delta opioid receptor.

35
Q

What are the two medications used for constipation in IBS?

A
  • guanylate cyclase-C agonists

- selective chloride channel actiovators

36
Q

What is the name and MOA of the guanylate cyclase-C agonists?

A

-Linaclotide-> binds and inhibits guanylate cyclase on luminal side of three intestinal epithelium-> stimulate cGMP-> stimulates seceration of Cl and HCO3 via CFTR into lumen

37
Q

What are the side effects and indications of linaclotide?

A

Diarrhea abdominal pain

Indicated in chronic idiopathic constipation, not supported in <17 y/o.

38
Q

What is the name and MOA of the the Cl channel activators used in the treatment of IBS constipation ?

A

Lubiprostone-> activates specific CIC-2 chloride channels in the luminal cells.

39
Q

What are the indications for use of Lubiprostone in IBS constipation treatment?

A
  • IBS-C in women, efficacy not established in men.

- Chronic Idopathic Constipation (adults)

GI 2 Final (9 decks)

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