IBD pharmacology Flashcards
Faecal calprotectin
Protein that is calcium and zinc binding and is neutrophil specific
Reflects the number of participating neutrophils in inflammation
Not specific to UC or Crohn’s, indicates inflammation in the bowel
5-ASA mechanism of action
Act locally on colonic mucosa
Reduces inflammation through a variety of anti-inflammatory processes
5-ASA contra-indications
blood clotting abnormalities in peads
Salicyclate hypersensitivity
5-ASA side effects
Athralgia
Cough
Diarrhoea
Dizziness
Fever
GI discomfort
Headache
Leucopenia
N&V
Steroid prescribing in IBD
Start at 40mg
Reduce by 5mg per week to zero
Co-prescribe Vit D/ calcium
Consider PPI
Thiopurines
Immunomodulators/ immunosuppressants
Azothioprine and 6MP
Thiopurine mechanism of action
Intracellular purine analogue and alkylation
Decrease nucleic acid synthesis
DNA damage
Thiopurine contra-indications
Hypersensitivity
Active infections
BM impairment
Live vaccines
Thiopurine interactions
Allopurinol
Immunosuppressants
Warfarin (decrease warfarin effect)
ACEi, co trmoxazole, cimetidine = increase myelosuppression
Thiopurine side effects
Dizziness
Flu-like
N&V
Myelosuppression
Pancreatitis
Sun toxicity
Challenges of immunosuppression
ADRs
Infection risk
Cancer risk
Family planning
Monitoring
Cancer risk
2-5 years interval dep on recurrence risk
Stopping thiopurines reduced the risk of NMSC to pre-exposure levels irrespective of the prior exposure duration
Infection risk
Screening
- HCV, HBV, HIV, CMV, TB
- VZG
- EBV
3 immunosuppressants = co-trmoxazole prophylaxis
Crohn’s biologics
1st line: infliximab, adalimumab
2nd/3rd line: vedolizumab, ustekinumab
UC biologics
1st line: infliximab, adalimumab, golimumab
2nd/3rd line: tofacitinib
4th: vedolizumab
