IBD Pharm (Quiz 4) Flashcards
Aminosalicytes are used for what severity and condition
- mild ulcerative colitis
thiopurines are used for what severity
- moderate disease
biologics are used for what severity
- severe disease
we use steroids for what kind of therapy
duration and dose?
- short term bridge therapy
- short duration and lowest dose
we use surgery for what in IBD
- medically refractory disease
- complications
- cancer/dysplasia of bowel
what is induction therapy
- treating the flare
what is maintenance therapy
- long term treatment
do we use corticosteroids for induction or maintenance
do we use it for Chrons or ulcerative colitis
- induction only
- both
for corticosteroids need to _______ to prevent renal insufficiency
- taper off
MOA for corticosteroids
- enter cell nucleus and influence DNA gene expression
- anti-inflammatory effects
- immune suppression
how do you take prednisone
- orally
Budesonide is what kind of medication
- steroid
Budesonide enteric capsules have _______ release
- ileal
Budesonide multimatrix has _______ release
- colonic
importance of Budesonide with enterohepatic circulation
- has rapid first pass metabolism
- less systemic effects
side effects of corticosteroids
- osteoporosis
- immune suppression/infection
- weight gain
do we use aminosalicytes for induction or maintenance therapy
for what condition
- both
- ulcerative colitis
medications that are aminosalicylates
- 5-aminosalicylic acid
- sulfasalazine
- balsalazine
- olsalazine
MOA of aminosalicylates
- topical anti-inflammatory agent in GI tract
rare side effects of aminosalicylates
- pancreatitis
- interstitial nephritis
we use oral delayed release capsules of aminosalicylates for what location
- entire colon
we use rectal enema of aminosalicylates for what location
- up through sigmoid colon
we use rectal foam of aminosalicylates for what location
- entire rectum
we use rectal suppository of aminosalicylates for what location
- anus
what drugs are the thiopurines
- azathioprine
- 6-mercaptopurine
- methotrexate
speed of azathioprine,6-MP
- slow
do we use azathioprine,6-MP for induction or maintenance?
- maintenance
if we need to use azathioprine,6-MP for induction, what do we need to do first
- steroid bridge
MOA of azathioprine,6-MP
- inhibits nucleotide synthesis
- prevent proliferation of B and T lymphocytes
measure ______ levels to guide dosing/therapy of azathioprine,6-MP
- 6-TGN
side effects of azathioprine,6-MP
- bone marrow suppression
- cancer risk
what kind of cancer can azathioprine,6-MP cause
- lymphoma
- nonmelanoma skin cancer
methotrexate MOA
- interferes with purine DNA synthesis
big side effect of methotrexate
- teratogenic in pregnancy
how do we administer monoclonal antibodies
- IV infusion
- subcutaneous injection
problem with monoclonal antibodies and patient immune system
- immune system can make Ab against drug and neutralize it
Anti-TNF monoclonal antibodies
- infliximab
- adalimumab
- certolizumab
- golimumab
gold standard therapy for moderate to severe IBD
- anti-TNF meds
which Anti-TNF alpha med is used for UC only
- Adamlimumab
which anti-TNF alpha med is used for Chrons only
- certolizumab pegol
MOA of anti-TNF biologics
- inhibits T cell activation
do we use anti-TNF meds for induction or maintenance
- both
risks of anti-TNF meds
- infection
- lymphoma/melanoma
- exacerbation of heart failure
what is the first gut targeted medication for IBD
- vedolizumab
MOA of vedolizumab
- gut selective integrin inhibitor
- white cell can’t migrate into gut tissue
do we use vedolizumab for induction or maintenance therapy
- both
vedolizumab risks
- very little immunosuppression risk
Ustekinumab used for UC or Crohns
induction or maintenance
- Crohns only
- both
MOA of Ustekinumab
- inhibits p40 of IL12 and IL23
- inhibits downstream JAK/STAT
Ustekinumab risks
- systemic immune suppression/infection
Tofacinitib used for UC/Crohns
induction or maintenance
- UC only
- both
is Tofacinitib an antibody
MOA
- no
- inhibits JAK/STAT signaling pathway
in what form do we give Tofacinitib
- tablet
risks of Tofacinitib
- systemic immune suppression/infection
- elevated cholesterol and LFTs
