IBD/IBS/CIC Pharm

Question 1

What disease are 5-ASA products used for and what is the suffix?

Answer 1

Ulcerative colitis

-azine

Question 2

What 5-ASA drugs are used only for maintenance and treatment of active disease, respectively?

Answer 2

Olsalazine–> only for UC maintenance/remission
Balsalazine–> only for UC active disease tx
Both indicated for mild-to-moderate UC

Question 3

What 5-ASA drugs are contraindicated for people with drug allergies?

Answer 3

Sulfasalazine–> C/I for people with sulfa allergy **

All 5-ASA drugs C/I in people with aspirin allergies

Question 4

Most TNF-a inhibitors are used for both UC and CD. Which ones can only be used for one or the other?

Answer 4

Certolizumab–> moderate-to-severe CD only

Golimumab-> moderate-to-severe UC only

Question 5

What is the black box warning for TNF-a inhibitors?

Answer 5

Infections are high-risk and a major concern **

Question 6

What are the TNF-alpha inhibitors?

Answer 6

All Monoclonal AntiBodies (-mab)

Adalimumab, Infliximab, Golimumab(UC), Certolizumab (CD)

Question 7

What are the Alpha-4 Integrin inhibitors and their indications?

Answer 7

Natalizumab: moderate-to-severe treatment-resistant CD
Vedolizumab: moderate-to-severe treatment-resistant CD and UC

Question 8

What are the adverse effects of the Alpha-4 Integrin inhibitors?

Answer 8

Infections **

Black box warning: Progressive Multifocal Leukoencephalopathy (PML)

Question 9

What GI problem would you use antimuscarinics for?

Answer 9

IBS spasms and abdominal pain

Question 10

What is the use of Loperamide?

Answer 10

Anti-diarrheal

Slows intestinal motility (chemically related to opioids but NO opioid action)

Question 11

What drug could you use for diarrhea that does not have anti-cholinergic side effects?

Answer 11

Alosetron (5HT3 antagonist)

Question 12

What is a serious complication of Alosetron?

Answer 12

Ischemic colitis: Black Box warning **

Question 13

What drug used for IBS-C and CIC has the same MOA as the ETEC heat-stable toxin?

Answer 13

Linaclotide

Both increase cGMP–> secretion of Cl/HCO3 into lumen–> increased intestinal fluid

Question 14

What Cl-channel activator is indicated for opioid induced constipation?

Answer 14

Lubiprostone

Question 15

When should you take bulk-forming agents?

Answer 15

It doesn’t matter, just don’t take them within 1-2 hours of other drugs because they have LOTS of interactions

Question 16

If stimulants are causing abdominal cramping, what drug class could you use that causes less abdominal cramping?

Answer 16

Stool softeners

Dolcusate salts and Mineral oil

Question 17

Which osmotic agent is used for severe liver disease? How does it help?

Answer 17

Lactulose (for hyperammonemia) **

Changes pH and traps ammonia in GI tract

Question 18

What drugs are indicated for pre-colonoscopy only?

Answer 18

Prepopik (Na Picosulfate), and large doses of PEG-3350 **