IBD And IBS Pharmacology

Question 1

What agents are used for UC only?

Answer 1

5-ASA

Question 2

What are the 5-ASA drugs used in UC?

Answer 2

• Sulfasalazine
• Mesalamine
• Olsalazine
• Balsalazide

Question 3

What agents are used for CD only?

Answer 3

IL-12/23 inhibitors

Question 4

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

Answer 4

Ustekinumab

Question 5

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

Answer 5

Vedolizumab

Question 6

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

Answer 6

• Natalizumab

- Vedolizumab

Question 7

What TNF-alpha inhibitor is used specifically in UC?

Answer 7

-Golimumab

Question 8

What TNF-alpha inhibitor is used specifically in CD?

Answer 8

-Certolizumab

Question 9

What is the MOA for the 5-ASA medications?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

What is olsalazine used for?

Answer 12

Only for maintenance therapy of UC

Question 13

What is Balsalazide used for?

Answer 13

Only for the treatment of active UC disease.

Question 14

What are the side effects of TNF-alpha inhibitors?

Answer 14

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

Question 15

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

Answer 15

• Adalimumab
• Infliximab

“All Inclusive”

Question 16

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

Answer 16

Moderate-to-severe

Question 17

Which TNF-alpha inhibitor is given via IV?

Answer 17

• Infliximab

* all others are SQ

Question 18

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

Answer 18

-PML

Question 19

What are the 3 risk factors for PML?

Answer 19

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

Question 20

What are the indications for use of Natalizumab?

Answer 20

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

Question 21

What are the indications for use of Vedolizumab?

Answer 21

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

Question 22

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

Answer 22

Inhibit Th1 and Th17 response

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

What is the key principle with the use of steroids?

Answer 26

always use the lowest dose for shortest duration possible.

Question 27

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

Answer 27

Antimuscarinic agents

Question 28

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

Answer 28

- Hyoscyamine - Dicyclomine - Clidinium/ chlordiazepoxide

Question 29

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

Answer 29

- Anti-diarrheal - Opioid agonists/antagonists - Serotonin (5HT3 antagonists)

Question 30

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

Answer 30

1) Loperamide (Imodium)- interferes with peristalisis | 2) Diphenoxylate (lomotil)- inhibit GI motility and slows excess GO propulsion.

Question 31

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

Answer 31

Alosetron- blocks GI-based 5HT3 receptors.

Question 32

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

Answer 32

- Ischemic colitis is a major concern. | - Constipation

Question 33

What is the indication for use of Alosetron?

Answer 33

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

Question 34

What is the name of the opioid agonist/ antagonist?

Answer 34

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

Question 35

What are the two medications used for constipation in IBS?

Answer 35

- guanylate cyclase-C agonists | - selective chloride channel actiovators

Question 36

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

Answer 36

-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

Question 37

What are the side effects and indications of linaclotide?

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

- IBS-C in women, efficacy not established in men. | - Chronic Idopathic Constipation (adults)