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IBD > IBD drugs > Flashcards

IBD drugs Flashcards

1
Q

What is the first line treatment for active UC?

A

Mesalazine (5-ASA) +/- corticosteroids.

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2
Q

What is the MOA of 5-ASAs?

A

Anti inflammatory.
Inhibit synthesis of inflammatory mediators (i.e. PGs).
Scavenge oxygen radicals.

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3
Q

What are the side effects of Mesalazine?

A 
Diarrhoea.
Headache.
Rash.
Nausea.
Renal impairment - rare.
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4
Q

What was the first 5-ASA available? Name some side effects.

A 
Sulfasalazine.
Allergic reactions:
> Rash.
> Fever.
> Leukopaenia.
> Agranulocytosis.

Male infertility.
Orange secretions.

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5
Q

What would you combine with Mesalazine for the first line treatment of UC?

A

Corticosteroids.

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6
Q

What is the MOA of corticosteroids?

A

Inactivates pro-inflammatory transcription factors (i.e. NF-kB).
Prevents stimulation of inflammatory mediators (i.e. cytokines).

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7
Q

Give some examples of oral corticosteroids?

A

Prednisolone - first line steroid.
Budesonide - CD.
Beclometasone - UC.

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8
Q

Give an example of a corticosteroid that would be used IV?

A

Hydrocortisone.

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9
Q

What are the side effects of corticosteroids?

A 
Cushing-like side effects:
> Obesity.
> Moon face.
> Buffalo hump.
> Hypertension.

Osteoporosis.
Immunosuppression.

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10
Q

What treatment should be given alongside corticosteroids to protect against side effects?

A

Bisphosphonates.

Calcium & vitamin D.

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11
Q

Give two examples of Thiopurines? What type of drug are they?

A

Immunosuppressants.
Examples:
> Azathioprine.
> 6-mercaptopurine.

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12
Q

What are the side effects of Azathioprine?

A 
Allergic reactions.
Bone marrow suppression - esp in patients with TPMT deficiency.
Leukopaenia.
Hepatotoxicity.
Cytotoxic - avoid in pregnancy.
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13
Q

What does TPMT do?

A

Metabolises azathioprine & 6-mercaptopurine.

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14
Q

When would you use thiopurines?

A

For maintenance of remission in CD & UC or as 2nd line treatment for active CD.

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15
Q

When would you use ciclosporin?

A

As 2nd line treatment for patients with active severe UC who have failed to respond to IV steroids.

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16
Q

What is the MOA of ciclosporin?

A

Calcineurin inhibitor - prevents expansion of T-cells.

17
Q

What are the side effects of ciclosporin?

A 
Hypertension.
Infection.
Renal impairment.
Increased risk of seizure in patients with:
> Hypocholesterolaemia.
> Hypomagnesaemia.
Gum hypertrophy & hirsuitism.
18
Q

What drug interactions does ciclosporin have?

A

It inhibits the metabolism of drugs that use P450 enzymes.

19
Q

When would you use methotrexate?

A

As a 2nd line treatment for the maintenance of remission in CD.

20
Q

What are the MOA of methotrexate?

A

Inhibits cytokine & eicosanoid synthesis.

21
Q

What drug should only be prescribed for one week at a time?

A

Methotrexate?

22
Q

What are the side effects of methotrexate?

A

GI symptoms.
Hepatotoxicity.
Blood disorders.

23
Q

What should be given to reduce the GI side effects of methotrexate?

A

Folic acid.

24
Q

What two monoclonal antibodies are used in the treatment of IBD?

A

Infliximab.

Adalimumab.

25
Q

What is the MOA of the monoclonal antibodies?

A

Inhibits free TNF-a.

Binds to membrane bound TNF-a > lysis of immune cells.

26
Q

What monoclonal antibody is used for severe active CD only?

A

Adalimumab.

27
Q

What cautions must be taken when prescribing infliximab?

A

TB screen - can activate latent Tb.

Delayed hypersensitivty reactions.

28
Q

When should infliximab not be prescribed?

A

If patients have a severe infection as it is an immunosuppressant.

29
Q

Outline the treatment for active UC?

A

1st line:
> Mesalazine +/- corticosteroids.

2nd line:
> Ciclosporin or infliximab (if ciclosporin is contra-indicated).

3rd line:
> Colectomy.

30
Q

Outline the treatment for remission maintenance in UC?

A

Mesalazine +/- azathioprine.

31
Q

Outline the treatment for active CD?

A

1st line:
> Corticosteroids.

2nd line:
> Azathioprine or monoclonal antibodies.

32
Q

Outline the treatment for remission maintenance in CD?

A

1st line:
> Azathioprine.

2nd line:
> Methotrexate or monoclonal antibodies.

IBD (1 decks)

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