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IBD drugs Flashcards

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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
toxicity monitoring for thiopurines
6-MMP and 6-TG
26
counseling for thiopurines
take after meals and divide daily doses (nausea), wear sunscreen, report s/s of infection
27
what is not recommended with thiopurines
switching from AZA to 6-MP in treatment failure (unless mild GI upset), taking allopurinol
28
thiopurines take ___ for onset
weeks to months
29
methotrexate mechanism
dihydrofolate reductase inhibitor: inhibits DNA synthesis and cell division leading to immunosuppression
30
methotrexate dosage forms
sc and im (po not recommended for IBD)
31
methotrexate adverse affects
bone marrow suppression (leukopenia), hepatotoxicity, malignancy (lymphoma)
32
methotrexate black box warning
potentially fatal toxicities and fetal risk
33
methotrexate contraindications
pregnancy and breastfeeding category X, alcoholism, liver disease, immunodeficiency syndromes, blood dyscrasias
34
how to reduce risk and severity of toxicity with methotrexate
folic acid supplementation 1 mg/day
35
methotrexate monitoring
pregnancy test, hepatitis, HIV risk before initiation
36
methotrexate counseling
avoid alcohol and NSAIDs/salicylates/PPIs due to increased toxicity risk, 2 forms of birth control, report s/s of infxn
37
cyclosporine mechanism
calcineurin inhibitor: inhibits production and release of IL-2, immunosuppressive
38
cyclosporine dosage forms
po, iv
39
cyclosporine monitoring
drug levels
40
cyclosporine is used as ___ therapy
rescue therapy for severe, steroid-refractory ulcerative colitis
41
cyclosporine adverse effects
seizure, pneumocystis carinii pneumonia, permanent nephrotoxicity, neurotoxicity
42
tacrolimus mechanism
calcineurin inhibitor, thus reducing t-lymphocyte signaling and IL-2 transcription, resulting in immunosuppression
43
tacrolimus dosage forms
po, iv, topical
44
tacrolimus monitoring
thorough monitoring of trough levels
45
TNFa inhibitor mechanism
mAbs that bind to and inhibit TNFa, a cytokine involved in pro-inflammatory cell signalling
46
TNFa inhibitor dosage forms
IV infliximab, SC others
47
TNFa adverse effects
well tolerated, new onset/worsening CHF, BBW for risk of infection and lymphoma
48
TNFa contraindications
current infection. do not administer live vaccines while on TNFa therapy
49
do not use infliximab in a dose >5 mg/kg in which patients
NYHA Class III/IV HF
50
malignancy risk for TNFa inhibitors is higher with __
concomitant AZA or 6-MP, young adult males
51
TNFa monitoring
TB and hepatitis at baseline, s/s of HF (consider ECG if high risk)
52
counseling for TNFa
report s/s of infection, malignancy, rashes, or arthralgias, rotate infection site, some SQ products contain a latex needle cover (allergy)
53
a4 integrin antagonist moa
mAbs that bind to integrin, receptor proteins that mediate attachments of lymphocytes to endothelial cells and promote their migration into inflamed tissue
54
a4 integrin antagonist dosage forms
IV
55
which a4 integrin has a REMS program
natalizumab: REMS for PML, a debilitating fatal demyelinating brain disease
56
a4 integrin adverse
arthralgias, headache, pharyngitis, depression, low risk during pregnancy
57
a4 integrin monitoring
TB and viral hepatitis, anti-JCV antibodies (natalizumab)
58
a4 integrin counseling
report s/s of infection, meningitis, encephalitis, PML (natalizumab)
59
IL-12/23 inhibitor moa
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
IL-12/23 inhibitor dosage forms
IV first dose, subsequent doses are SQ
61
clinical pearl for IL-12/23 inhibitor
no increased risk for serious infections or malignancy in RCTs
62
IL-12/23 adverse effects
nasopharyngitis, injection site reaction, headache, low risk during pregnancy
63
IL-12/23 monitoring
TB and viral hepatitis screening prior to initiation
64
with biologics, ____ of response may occur
loss of response due to immunogenicity
65
which IBD drugs are biologics
TNFa inhibitors, a4 integrin antagonists, IL-12/23
66
which IBD drug is a small molecule
JAK inhibitor- tofacitinab
67
tofacitinab mechanism
preferentially inhibits JAK1 and JAK3
68
what are the JAK enzymes involved in
signaling pathways important for cell growth, development, survival, and differentiation
69
tofacitinab dosage form
po
70
tofacitinab black box warning
increased risk of infection and malignancy, major adverse CV events, and THROMBOSIS
71
tofacitinab use during pregnancy?
avoid
72
tofacitinab adverse
dyslipidemia, headache, nasopharyngitis
73
tofacitinab monitoring
TB and viral hepatitis, lipid panel
74
tofacitinab patient counseling
report s/s of DVT/PE, infection, malignancy, female patients avoid pregnancy while on therapy and 4 weeks after

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