IBD drugs Flashcards

1
Q

what are the 5-ASA drugs and suffix to look for? and what disease are they used for

A

Sulfasalazine*
Mesalamine
Olsalazine*
Balsalazide*

“sala”

Ulcerative Colitis

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2
Q

What is the Janus Kinase Inhibitor and what disease is it used for

A

Tofacitinib

Ulcerative Colitis

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3
Q

What are the 3 TNF-a Inhibitors and what disease is it used for

A

Adalimumab
Golimumab
Infliximab

Ulcerative Colitis

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4
Q

What is the one a-4 Integrin inhibitors and what disease are they used for

A

Vedolizumab

used for Ulcerative Colitis

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5
Q

What are first line therapy drugs that are not covered in this lecture that are used for both Ulcerative Colitis and Crohns disease

A

Steroids, Immune Modulators, and even antibiotics also utilized as first-line therapy but not officially indicated, and covered elsewhere in the Curriculum

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6
Q

What are the IL-12/23 inhibitors and what disease are they used for

A

Ustekinumab

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7
Q

what TNF-a Inhibitors are used for Crohns disease

A

Adalimumab
Certolizumab
Infliximab

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8
Q

what are the 2 a-4 integrin inhibitors used in Crohns disease

A

Natalizumab

Vedolizumab

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9
Q

What are the 5-ASA agents mechanism of action

A

Inhibition of Prostoglandin and Leukotriene production via the arachidonic acid pathway

inhibits both Cyclooxygenase and Lipoxygenase

Reduction in PMN & macrophage chemotaxis
May also inhibit the activation of NFκB(nuclear factor kappa-light-chain-enhancer of activated B cells)
–Regulates transcription of genes for pro-inflammatory proteins

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10
Q

when are all 5-ASA compounds contraindicated and when is Sulfasalazine contraindicated

A

All 5-ASA compounds contraindicated in ASA-allergic patients

•Sulfasalazine contraindicated in sulfonamide-allergic patients

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11
Q

how does administration of 5-ASA effect the extent of the disease

A

Oral:Varies by agent; may be released in the distal/terminal ileum, colon, or throughout GI tract

Rectal Enemas:
May reach the splenic flexure
Do not frequently concentrate in the rectum

Rectal Suppositories:
Reach the upper rectum (15-20 cm beyond the anal verge)

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12
Q

what are 5-ASA agents indications and what are the two exceptions

A

Indications (Active & Maintenance):
•Mild-to-Moderate U.C.

Except Olsalazine (only for maintenance of remission)

Except Balsalazide (only for active disease)

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13
Q

Mechanism of action of TNF-a Inhibitors?

A

Binds to an neutralizes membrane-associated and soluble human TNF-α-mediated pro-inflammatory cell signaling, ultimately blocking leukocyte migration to site of inflammation:

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14
Q

what is the only TNF-a inhibitor that can be given IV for IBD

A

Infliximab

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15
Q

what are side effects of TNF-a inhibitors?

A

Infections make sure to test for TB pre therapy since can activate from latent phase especially Adalimumab

can cause Liver toxicity

can cause Dermatologic-related (EM, SJS, TEN)
Malignancies (various)

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16
Q

when are TNF-a inhibitors used and what are their indications

A

Used after inadequate response to conventional or immunosuppressant therapy

used for active and maintenance

17
Q

Mechanism of action of a-4 integrin inhibitors

A

Limits Integrin’s-associated cell adhesion and subsequent trans-endothelial migration of leukocytes to cite of inflammation

18
Q

Side effects of a-4 Integrin inhibitors and how is this monitored

A
Infections
PML (assoc. w/ John Cunningham Virus (JCV)) –3 Risk Factors for PML:
–treatment >2 years
–prior immunosuppressant treatment
–anti-JC virus (JCV) antibodies

only has been seen in natalizumab

MRI and CSF analysis

19
Q

what are the Indications of A-4 integrin inhibitors and when is the recommended use

A

All α-4 Integrininhibitors recommended for use after inadequate response to conventional or TNF-α therapy

Natalizumab
Moderate-to-Severe C.D.
not recommended in combination with immunosuppressant’s; including TNF-α agents

•Vedolizumab
Moderate-to-Severe C.D. & U.C.

20
Q

how are a-4 integrin inhibitors dosed?

A

IV every 4 or 8 hours

21
Q

Mechanism of action for IL-12/23 inhibitors

A

Bind to P40-subunit of IL-12 & IL-23 blocking activation and differentiation of naïve T cells and activation of NK cells

thereby inhibiting production of pro-inflammatory cytokines; INFg(Th1), TNF-α, IL-17 (Th17) & IL-21, among others…

22
Q

what are side effects of IL-12/23 inhibitors

A

Infections therefore must do a TB test pre therapy

23
Q

what are the indications of IL-12/23 inhibitors and when should they be used

A

Indications (Active & Maintenance):

Moderate-to-Severe U.C. & C.D

used for For patients intolerant or inadequate response (resistant) to conventional, immune modulators, steroids or TNF-α therapy

24
Q

what is the dosing of Ustekinumab

A

SQ every 8 weeks (after single IV infusion for induction)

25
Q

Mechanism of action of JAK inhibitors

A

Bind to and inhibit free-floating and bound JAK-1 & JAK-3 (lesser extent to JAK-2)

thereby ultimately inhibiting gene transcription & more cytokine release

26
Q

what are the side effects of JAK inhibitors

A

Lymphopenia/Lymphocytosis
Neutropenia/Anemia
Increases in LDL & HDL (minimal ratio change)

Rare:
Increased risk of malignancies/serious infections
–from R.A. indication-data

27
Q

Indications and dosing of Tofacitinib?

A

Indications (Active & Maintenance):
Moderate-to-Severe U.C.

•Dosing
Tofacitinib(Xeljanz)
Administered PO BID

28
Q

what is the recommendation of use of Biologic therapies and potent immunosuppressants with JAK inhibitors

A

Not recommended

29
Q

What are the indications and dosing for steroid agents

A

Indications:
Acute and/or Severe U.C. & C.D. uncontrolled by other conventional medications

Not for maintenance of remission unless absolutely required (steroid-dependent)

•Dosing:
Use the lowest dose for shortest duration possible