IBD Pharma

Question 1

what is the order of medicine for IBD in terms of what you give from mild to severe IBD?

Answer 1

aminosalicylates to thiopurines to biologics for most severe

Question 2

what class of drugs can you only give as short term bridge or induction therapy?

Answer 2

steroids

Question 3

why do you need to taper off steroids?

Answer 3

to avoid adrenal insufficiency

Question 4

what is the oral steroid for IBD?

Answer 4

prednisone

Question 5

what is the gut targeted steroid for IBD?

Answer 5

budesonide

Question 6

what are the topical steroid options for IBD?

Answer 6

suppository
rectal form
enema

Question 7

when should you give topical steroids over other steroid types?

Answer 7

if disease located only in rectum

Question 8

what are the two side effects of steroids for IBD?

Answer 8

osteoporosis and lots of infections

Question 9

what is the structure of aminosalicylate similar to?

Answer 9

aspirin

Question 10

is aminosalicylate used for UC or crohns or both?

Answer 10

used in UC

Question 11

how do aminosalicylates usually work in the GI tract?

Answer 11

anti inflamm agents…mechanism unknown but gues sof inhib prostaglandins and leukotrienes

Question 12

what are the two ways to give aminosalicylate ?

Answer 12

oral or rectal topical form

Question 13

are thiopurines used for UC crohns or both?

Answer 13

both

Question 14

are thiopurines used for maintenance induction or both?

Answer 14

maintenance only…takes a long time to get working

Question 15

are aminosalicylate used for maintenance induction or both?

Answer 15

both

Question 16

name the two thiopurines to know

Answer 16

azathioprine and 6mercaptopurine

Question 17

what is the MoA of thiopurines?

Answer 17

block purine synthesis and inhibit proliferation of B and T cells in the immune system

Question 18

name the four toxicities associated with thiopurines? which two need to be checked consistently

Answer 18

hepatotxicity (check)
bone marrow suppression (check)
pancreatitis
cancer

Question 19

what is a drug that is similar to thiopurines but not used as often? why is it not used as much?

Answer 19

methotrexate…teratogenic

Question 20

what is the mechanism of methotrexate?

Answer 20

blocks purine synthesis…

Question 21

do you use methotrexate with Crohns UC or both?

Answer 21

can use for both..better for Crohns

Question 22

what can happen with biologics that renders them ineffective/

Answer 22

immunogenecity…means the body makes an antibody against the antibody in the biologic

Question 23

name the three anti TNF drugs used for IBD

Answer 23

infliximab
adalimumab
certolizumab

Question 24

is infliximab used for crohns UC or both?

Answer 24

both

Question 25

is adalimumab used for crohns UC or both?

Answer 25

UC only

Question 26

is certolizumab used for crohns UC or both?

Answer 26

crohns only

Question 27

how do the anti TNF biologics work?

Answer 27

they likely inhibit activation of T cells in the gut

Question 28

do you use TNF bios for induction maintenance or both?

Answer 28

both

Question 29

when do you give TNF bios, for crohns of UC? what stage?

Answer 29

Both...moderate to severe

Question 30

name the four common toxicities of TNF bios

Answer 30

infection reactivation of TB or hep B malignancy exacerbation of heart failure

Question 31

what is the MoA of vedolizumab?

Answer 31

it is an inhibitor of integrins so the leukcytes cannot bund the selectins in the gut and migrate into the tissue

Question 32

name the drug that is an integrin inhibitor biologic

Answer 32

vedolizumab

Question 33

when do you give vedolizumab, maintenance induction or both? crohns UC or both?

Answer 33

both and both

Question 34

what are the toxicities of vedolizumab?

Answer 34

minimal because gut targeted...so gut infections

Question 35

name the drug that inhibits the p40 receptor?

Answer 35

Ustekinumab

Question 36

the p40 receptor that ustekinumab inhibits, leads to inhibition of what? what are these molecules important for?

Answer 36

IL-12 and 23..important for the JAK STAT pathway

Question 37

ustekinumab is used for crohns, UC or both? maintenanc induction or both?

Answer 37

just crohns...both

Question 38

what is the toxicity of ustekinumab?

Answer 38

just systemic immune supression

Question 39

what drug is a small molecule (not antibody) that inhibits the JAK STAT pathway?

Answer 39

tofacitinib

Question 40

what do you use tofacitinib for? UC crohns or both? maintenanc induction or both?

Answer 40

just UC...both

Question 41

what are the four toxicities of tofacitinib?

Answer 41

elevated cholesterol lymphpenia elevated LFTs systemic immune suppression