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IBD drugs Flashcards

1
Q

indications for 5-ASA

A

induction and maintenance of remission ulcerative colitis, limited role in crohn’s

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2
Q

indications for corticosteroids

A

induction of remission in ulcerative colitis and crohn’s, not for maintenance

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3
Q

indications for thiopurines

A

maintenance of remission in ulcerative colitis and crohn’s, not appropriate for induction

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4
Q

indications for methotrexate

A

maintenance for crohn’s only, no benefit for ulcerative colitis

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5
Q

indications for cyclosporine

A

induction of remission in ulcerative colitis

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6
Q

indications for tacrolimus

A

induction of remission in ulcerative colitis and fistulizing crohn’s

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7
Q

indications for infliximab and adalimumab

A

induction and maintenance of remission in ulcerative colitis and crohn’s

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8
Q

indications for certolizumab

A

induction and maintenance of remission in crohn’s

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9
Q

indications for golimumab

A

induction and maintenance of remission in ulcerative colitis

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10
Q

indications for natalizumab

A

induction and maintenance of remission in crohn’s

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11
Q

indications for vedolizumab

A

induction and maintenance of remission in crohn’s and ulcerative colitis

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12
Q

indications for ustekinumab

A

induction and maintenance of remission in crohn’s and ulcerative colitis

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13
Q

indications for tofacitinab

A

induction and maintenance of remission in ulcerative colitis

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14
Q

5-ASA mechanism

A

anti-inflammatory: inhibit IL-1, TNFa, lipoxygenase, NFkB, scavenging of free radicals and oxidants

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15
Q

5-ASA adverse

A

sulfa allergic reaction, male infertility (reversible), inhibits folic acid synthesis (anemia, supplement), nephrotoxicity rare

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16
Q

5-ASA dosing

A

4x daily dosing, higher dose for induction

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17
Q

counseling points for 5-ASA

A

take with food, urine discoloration, avoid acid-suppressing medications if taking the pH sensitive tablets

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18
Q

corticosteroids mechanism

A

anti-inflammatory, immunosuppressive, glucocorticoid receptor binding

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19
Q

which corticosteroid minimizes systemic exposure

A

budesonide; high first pass metabolism

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20
Q

clinical pearls for corticosteroids

A

gradual tapering required, adrenal crisis, interferes with vaccines at high doses, take with food, hyperglycemia

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21
Q

thiopurines mechanism

A

metabolized into purine analogs that inhibit DNA synthesis: immunomodulators

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22
Q

black box warning for thiopurines

A

malignancy–> non-melanoma skin cancer & lymphomas

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23
Q

adverse for thiopurines

A

bone marrow suppression (leukopenia), hepatotoxicity, pancreatitis

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24
Q

monitoring for thiopurines

A

BEFORE initiating: TPMT genotype, viral hepatitis, TB

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25
Q

toxicity monitoring for thiopurines

A

6-MMP and 6-TG

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26
Q

counseling for thiopurines

A

take after meals and divide daily doses (nausea), wear sunscreen, report s/s of infection

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27
Q

what is not recommended with thiopurines

A

switching from AZA to 6-MP in treatment failure (unless mild GI upset), taking allopurinol

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28
Q

thiopurines take ___ for onset

A

weeks to months

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29
Q

methotrexate mechanism

A

dihydrofolate reductase inhibitor: inhibits DNA synthesis and cell division leading to immunosuppression

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30
Q

methotrexate dosage forms

A

sc and im (po not recommended for IBD)

31
Q

methotrexate adverse affects

A

bone marrow suppression (leukopenia), hepatotoxicity, malignancy (lymphoma)

32
Q

methotrexate black box warning

A

potentially fatal toxicities and fetal risk

33
Q

methotrexate contraindications

A

pregnancy and breastfeeding category X, alcoholism, liver disease, immunodeficiency syndromes, blood dyscrasias

34
Q

how to reduce risk and severity of toxicity with methotrexate

A

folic acid supplementation 1 mg/day

35
Q

methotrexate monitoring

A

pregnancy test, hepatitis, HIV risk before initiation

36
Q

methotrexate counseling

A

avoid alcohol and NSAIDs/salicylates/PPIs due to increased toxicity risk, 2 forms of birth control, report s/s of infxn

37
Q

cyclosporine mechanism

A

calcineurin inhibitor: inhibits production and release of IL-2, immunosuppressive

38
Q

cyclosporine dosage forms

A

po, iv

39
Q

cyclosporine monitoring

A

drug levels

40
Q

cyclosporine is used as ___ therapy

A

rescue therapy for severe, steroid-refractory ulcerative colitis

41
Q

cyclosporine adverse effects

A

seizure, pneumocystis carinii pneumonia, permanent nephrotoxicity, neurotoxicity

42
Q

tacrolimus mechanism

A

calcineurin inhibitor, thus reducing t-lymphocyte signaling and IL-2 transcription, resulting in immunosuppression

43
Q

tacrolimus dosage forms

A

po, iv, topical

44
Q

tacrolimus monitoring

A

thorough monitoring of trough levels

45
Q

TNFa inhibitor mechanism

A

mAbs that bind to and inhibit TNFa, a cytokine involved in pro-inflammatory cell signalling

46
Q

TNFa inhibitor dosage forms

A

IV infliximab, SC others

47
Q

TNFa adverse effects

A

well tolerated, new onset/worsening CHF, BBW for risk of infection and lymphoma

48
Q

TNFa contraindications

A

current infection. do not administer live vaccines while on TNFa therapy

49
Q

do not use infliximab in a dose >5 mg/kg in which patients

A

NYHA Class III/IV HF

50
Q

malignancy risk for TNFa inhibitors is higher with __

A

concomitant AZA or 6-MP, young adult males

51
Q

TNFa monitoring

A

TB and hepatitis at baseline, s/s of HF (consider ECG if high risk)

52
Q

counseling for TNFa

A

report s/s of infection, malignancy, rashes, or arthralgias, rotate infection site, some SQ products contain a latex needle cover (allergy)

53
Q

a4 integrin antagonist moa

A

mAbs that bind to integrin, receptor proteins that mediate attachments of lymphocytes to endothelial cells and promote their migration into inflamed tissue

54
Q

a4 integrin antagonist dosage forms

A

IV

55
Q

which a4 integrin has a REMS program

A

natalizumab: REMS for PML, a debilitating fatal demyelinating brain disease

56
Q

a4 integrin adverse

A

arthralgias, headache, pharyngitis, depression, low risk during pregnancy

57
Q

a4 integrin monitoring

A

TB and viral hepatitis, anti-JCV antibodies (natalizumab)

58
Q

a4 integrin counseling

A

report s/s of infection, meningitis, encephalitis, PML (natalizumab)

59
Q

IL-12/23 inhibitor moa

A

mAb that binds p40 subunit of IL-12/23, preventing their binding to NK and T cell receptors & downregulating immune cell signaling, activation and cytokine production

60
Q

IL-12/23 inhibitor dosage forms

A

IV first dose, subsequent doses are SQ

61
Q

clinical pearl for IL-12/23 inhibitor

A

no increased risk for serious infections or malignancy in RCTs

62
Q

IL-12/23 adverse effects

A

nasopharyngitis, injection site reaction, headache, low risk during pregnancy

63
Q

IL-12/23 monitoring

A

TB and viral hepatitis screening prior to initiation

64
Q

with biologics, ____ of response may occur

A

loss of response due to immunogenicity

65
Q

which IBD drugs are biologics

A

TNFa inhibitors, a4 integrin antagonists, IL-12/23

66
Q

which IBD drug is a small molecule

A

JAK inhibitor- tofacitinab

67
Q

tofacitinab mechanism

A

preferentially inhibits JAK1 and JAK3

68
Q

what are the JAK enzymes involved in

A

signaling pathways important for cell growth, development, survival, and differentiation

69
Q

tofacitinab dosage form

A

po

70
Q

tofacitinab black box warning

A

increased risk of infection and malignancy, major adverse CV events, and THROMBOSIS

71
Q

tofacitinab use during pregnancy?

A

avoid

72
Q

tofacitinab adverse

A

dyslipidemia, headache, nasopharyngitis

73
Q

tofacitinab monitoring

A

TB and viral hepatitis, lipid panel

74
Q

tofacitinab patient counseling

A

report s/s of DVT/PE, infection, malignancy, female patients avoid pregnancy while on therapy and 4 weeks after

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