IBD Pharm Flashcards
Drug Classes for UC
- 5-ASA**
- Corticosteroids
- TNF-alpha inhibitors
- alpha-4 integrin inhibitors
Drug Classes for CD
- IL-12/23 inhibitors**
- Corticosteroids
- TNF-alpha inhibitors
- alpha-4 integrin inhibitors
UC- 5-ASA- drugs
-SulfaSALAzine (sulfapyridine + 5-ASA)
-MeSALAmine (single 5-ASA)
-OlSALAzine (2 molecules of 5-ASA)
-BalSALAzide (inert carrier + 5-ASA)
(SMOB)
UC- TNF-alpha inhibitors- drugs
- AdalimuMAB
- GolimuMAB
- InflixiMAB
UC- alpha-4 integrin inhibitors- drugs
-VedolizuMAB
CD- IL-23 inhibitors- drug
-UstekinuMAB
CD- TNF-alpha inhibitors- drugs
(same as UC)
- AdalimuMAB
- GolimuMAB
- InflixiMAB
CD- alpha-4 integrin inhibitors- drugs
- NatalizuMAB
- VedolizuMAB (also in UC)
5-ASA- moa
-inhibition of PG and LT production via arachidonic acid pathway- COX and LIPOX
5-ASA- contraindications
- ALL contraindicated in ASA-allergic pts
- Sulfasalazine- contraindicated in sulfonamide-allergic pts!!!
5-ASA agents- indications
- mild to moderate Active UC
- maintenance (of remission) of UC
- except- Olsalazine- only maintenance
- except- Balsalazide- only for active
TNF-alpha inhibitors- moa
- neutralizes TNF-alpha-mediated pro-infl cell signaling
- inhibits expression of pro-infl genes
TNF-alpha inhibitors- SE
- infections!!!
- TB testing pre-therapy!!!
TNF-alpha inhibitors- indications
- all moderate to severe
- Adalimumab and Infliximab- UC and CD! (All and Inclusive)
- Golimumab- UC (doesnt start with C)
- Certolizumab- CD (starts with C)
TNF-alpha inhibitors- dosing
- Adalimumab- SQ- every other week
- Infliximab- IV (starts with I)- every 8 wks
- Golimumab- SQ- every 4 wks
- Certolizumab- SQ- every 4 wks
alpha integrins- role in what?
lymphocyte migration!!
-alpha4B7- esp migration into GI tract
alpha-4 integrin inhibitors- moa
-limits integrin’s-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue
alpha-4 integrin inhibitors- SE
-infections
-PML(progressive multifocal leukoencephalopathy)!!! (esp natalizumab)- opportunistic infection of brain- risk factors: tx > 2yrs, prior immunosuppressant tx, anti-JC virus ab’s
(doctor must be in TOUCH prescribing program)
alpha-4 integrin inhibitors- indications
- both moderate-to-severe and maintenance
- Natalizumab- CD
- Vedolizumab- CD and UD
alpha-4 integrin inhibitors- dosing
- Natalizumab- IV- 4 wks
- Vedolizumab- IV- 8 wks
Interleukin (IL-12/23) inhibitors- moa
-bind to IL-12/23 R- inhibit signal transduction activities and production of pro-infl Th1 and Th17 cells
Interleukin inhibitors- SE
- infections!!
- TB testing pre-therapy recommended
Interleukin inhibitors- indications
- moderate-to-severe treatment resistant CD! (active and maintenance)
- for pts intolerant or resistant to initial CD therapies, including TNF-alpha inhibitors
Interleukin inhibitors- dosing
- Ustekinumab
- IV (single infusion)- for induction
- SQ (every 8 wks)- for maintenance
Steroids- indications, dosing
- Acute and/or severe UC and CD uncontrolled by other conventional medications
- LOWEST dose for SHORTEST duration possible
IBS (irritable bowel syndrome)
- constipation
- diarrhea
- abd pain
Abdominal pain- use what drug class?
Antimuscarinic agents! -Hyoscyamine -Dicyclomine -Clidinium/Chlordiazepoxide (HDC)
Antimuscarinic agents- drugs
-Hyoscyamine
-Dicyclomine
-Clidinium/Chlordiazepoxide
(HDC)
Antimuscarinic agents- moa
- dec GI motility and spasms
* for Abd pain/spasms!
Antimuscarinics- SE
classic antimuscarinics
IBS- drug classes for diarrhea
- anti-diarrheals
- opioid agonists/antagonists
- serotonin (5HT3) antagonists
Anti-diarrheals- drugs
- Loperamide
- Diphenoxylate
Opioid Agonists/Antagonists- drug
-Eluxadoline
Serotonin antagonists drug
Alosetron
Loperamide- moa
-interferes with peristalsis- direct action of circular/longitudinal m’s of intestinal wall
Diphenoxylate- moa
- locally and centrally on GI smooth m cells
- inhibits GI motility and slows excess GI propulsion
- atropine added to discourage abuse
Alosetron- moa
-blocks GI-based 5HT3 R’s
Alosetron- SE
-ischemic colitis!!!
Alosetron- indication
- women with chronic, severe IBS-diarrhea, not responsive to other conventional therapies
- Dr’s must enroll in prescribing program
Eluxadoline- moa
- agonist at opioid mu and K R’s in GI tract (slows peristalsis/delays digestion)
- antagonist at delta opioid R’s in GI tract- secretionsdecreased
Drug classes for Constipation
- Guanylate Cyclase-C agonists
- Selective Chloride (C2) Channel Activators
Guanylate Cyclase-C agonists- drug
-Linaclotide
Selective Chloride (C2) Channel Activators- drug
-Lubiprostone
Linaclotide- moa, indications
Guanylate Cyclase-C agonist
-for IBS-Constipation!
Lubiprostone- moa, drug
- selective Chloride (C2) Channel Activator
- IBS-Constipation (women)
