IBD Drugs

Question 1

prototypical IBD anti-inflammatory:

not absorbed –> active in gut (including small intestine)

Answer 1

Mesalamine (5-ASA)

Question 2

Balsalazide

Answer 2

ASA based

anti-inflammatory

must be activated by gut bacteria – local action in colon

Question 3

Olsalazine

Answer 3

ASA based

anti-inflammatory

activated by gut bacteria – local action in colon

Question 4

Sulfasalazine

side fx:

Answer 4

ASA based

anti-inflammatory

activated by gut bacteria – local action in colon

Side fx:
-hypersensitivity (sulfa)

• GI upset
• nausea/HA
• bone marrow suppression
• decreased folate

Question 5

Corticosteroid with low bioavailability –> good for Crohn’s

Answer 5

budesonide

Question 6

Indications for ASA’s:

Answer 6

mild to moderate ulcerate colitis

**not good for Crohn’s dt disease severity and lack of dose amount at site

Question 7

Anti-TNF-a

activates complement

Answer 7

Infliximab

Question 8

Immune sys response problematic with Infliximab tx:

Answer 8

can develop Ab’s to drug

Question 9

Side Fx’s of Infliximab:

Answer 9

increased risk of infx

infusion rxn

hepatotoxic

increased lymphoma risk

TB reactivation

Question 10

Second line IBD

anti-metabolites (3):

Answer 10

azathioprine

6-MP

MTX

Question 11

Last line against refractory IBD before surgery:

Answer 11

Infliximab

Question 12

4 treatment strategies for IBD from mild - severe disease:

Answer 12

mild:
topical corticosteroids

abx

5-ASA

moderate:
MTX

6-MP

AZAthioprine

oral corticosteroids

Severe:
anti-TNF-a

cyclosporine

IV-corticosteroids

Refractory to med managment:

surgery