IBD drugs Flashcards
What is the first line treatment for active UC?
Mesalazine (5-ASA) +/- corticosteroids.
What is the MOA of 5-ASAs?
Anti inflammatory.
Inhibit synthesis of inflammatory mediators (i.e. PGs).
Scavenge oxygen radicals.
What are the side effects of Mesalazine?
Diarrhoea. Headache. Rash. Nausea. Renal impairment - rare.
What was the first 5-ASA available? Name some side effects.
Sulfasalazine. Allergic reactions: > Rash. > Fever. > Leukopaenia. > Agranulocytosis.
Male infertility.
Orange secretions.
What would you combine with Mesalazine for the first line treatment of UC?
Corticosteroids.
What is the MOA of corticosteroids?
Inactivates pro-inflammatory transcription factors (i.e. NF-kB).
Prevents stimulation of inflammatory mediators (i.e. cytokines).
Give some examples of oral corticosteroids?
Prednisolone - first line steroid.
Budesonide - CD.
Beclometasone - UC.
Give an example of a corticosteroid that would be used IV?
Hydrocortisone.
What are the side effects of corticosteroids?
Cushing-like side effects: > Obesity. > Moon face. > Buffalo hump. > Hypertension.
Osteoporosis.
Immunosuppression.
What treatment should be given alongside corticosteroids to protect against side effects?
Bisphosphonates.
Calcium & vitamin D.
Give two examples of Thiopurines? What type of drug are they?
Immunosuppressants.
Examples:
> Azathioprine.
> 6-mercaptopurine.
What are the side effects of Azathioprine?
Allergic reactions. Bone marrow suppression - esp in patients with TPMT deficiency. Leukopaenia. Hepatotoxicity. Cytotoxic - avoid in pregnancy.
What does TPMT do?
Metabolises azathioprine & 6-mercaptopurine.
When would you use thiopurines?
For maintenance of remission in CD & UC or as 2nd line treatment for active CD.
When would you use ciclosporin?
As 2nd line treatment for patients with active severe UC who have failed to respond to IV steroids.
What is the MOA of ciclosporin?
Calcineurin inhibitor - prevents expansion of T-cells.
What are the side effects of ciclosporin?
Hypertension. Infection. Renal impairment. Increased risk of seizure in patients with: > Hypocholesterolaemia. > Hypomagnesaemia. Gum hypertrophy & hirsuitism.
What drug interactions does ciclosporin have?
It inhibits the metabolism of drugs that use P450 enzymes.
When would you use methotrexate?
As a 2nd line treatment for the maintenance of remission in CD.
What are the MOA of methotrexate?
Inhibits cytokine & eicosanoid synthesis.
What drug should only be prescribed for one week at a time?
Methotrexate?
What are the side effects of methotrexate?
GI symptoms.
Hepatotoxicity.
Blood disorders.
What should be given to reduce the GI side effects of methotrexate?
Folic acid.
What two monoclonal antibodies are used in the treatment of IBD?
Infliximab.
Adalimumab.
