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P2 E3 Shea > IBD popcorn > Flashcards

IBD popcorn Flashcards

1
Q

1st line tx for mild - moderate

UC & Crohn’s

A

5-ASA

  • Sulfasalazine
  • Olsalazine
  • Balsalazide
  • Mesalamine
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2
Q

Maintenance treatment

UC & Crohn’s

A

6-thioguanine nucleotides

(Purine Analogs)

  • Azathioprine
  • 6-Mercaptopurine
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3
Q

1st line for inducing remission in LOW RISK/Mild Crohn’s

A

Budesonide

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4
Q

Treatment to induce/maintain remission of Crohn’s?

A

Methotrexate

(Immunosuppressive)

  • once weekly sub-q injection
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5
Q

Treatment for Acute/Chronic/Moderate-Severe Crohn’s ?

A

Anti-TNF

  • Infliximab
  • Adalimumab
  • Natalizumab
  • Golimumab
  • Certolizumab
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6
Q

2 “last resort” tx for Crohn’s?

A
  • Natalizumab (Anti-TNF/Anti-Integrin)
  • Ustekinumab (Anti-IL12/23 antibody)
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7
Q

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

  • Anti-TNF
  • Oral corticosteroids
  • Methotrexate
  • Azathioprine / 6-MP

(AOMA)

A

Moderate disease

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8
Q

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

  • Budesonide
  • Topical corticosteroids (proctitis)
  • Abx
  • 5-ASA

(TABA)

A

Mild disease

Responsive to therapy

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9
Q

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

  • Surgery
  • Natalizumab
  • Cyclosporine
  • Anti-TNF
  • IV corticosteroids
A

Severe disease

Refractory to therapy

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10
Q

Which drug?

  • Absorption in colon is extremely low
  • Undergoes N-acetylation in gut epithelium & liver –> metabolite –> excreted in kidneys
  • Has no anti-inflammatory activity
A

5-ASA

  • Sulfasalazine
  • Olsalazine
  • Balsalazide
  • Mesalamine
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11
Q

Which drug?

  • Modulates inflammatory mediators derived from cyclooxygenase & lipoxygenase pathways
  • Interferes w/ production of inflammatory cytokines (inhibits nuclear factor k-b)
  • Inhibit cellular functions of natural killer cells, lymphocytes, & macrophages. Scavenge reactive oxygen metabolites
A

5-ASA

  • Sulfasalazine
  • Olsalazine
  • Balsalazide
  • Mesalamine
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12
Q

Folate should be taken with which 2 drugs?

A
  • 5-ASA (Sulfasalazine)
  • Methotrexate (immunosuppressives) – reduces ADEs
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13
Q

ADE of which drug?

  • “slow acetylator” –> worse SE
A

Sulfasalazine (sulfapyridine)

(5-ASA)

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14
Q

ADE of which drug?

  • Rash
  • anemia
  • pneumonitis
  • hepatotoxicity
  • thrombocytopenia
  • lymphoma
  • OLIGOSPERMIA (reversible)
A

Sulfasalazine (5-ASA)

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15
Q

ADE of which drug?

  • Secretory diarrhea
A

Olsalazine

(5-ASA)

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16
Q

ADE of which drug?

  • High dose –> interstitial nephritis
A

Mesalamine

(5-ASA)

17
Q

What are the 3 AZO compounds?

A

5-ASA

  • Sulfasalazine
  • Olsalazine
  • Balsalazide

“Suck Old Balls”

18
Q

Which drug?

  • Reduces absorption of parent drug (5-ASA) from the small intestine
  • Resident bacteria cleave the azo w/ an azoreductase enzyme à releasing 5-ASA
  • High concentrations of active drug are made available in the TERMINAL ILEUM or COLON
A

Azo Compounds

  • Sulfasalazine
  • Olsalazine
  • Balsalazide

“Suck Old Balls”

19
Q

Name the 5 Mesalamine compounds

A
  • Pentasa
  • Asacol/Apriso
  • Lialda
  • Rowasa
  • Canasa

“PAL to Row a Canoe”

20
Q

Which Mesalamine compound?

  • timed-release microgranules, release 5-ASA into SMALL INTESTINE
A

Pentasa

21
Q

Which Mesalamine compound?

  • enemas, RECTUM & SIGMOID (used for Proctitis / Proctosigmoiditis)
A

Rowasa

22
Q

Which Mesalamine compound?

  • pH sensitive resin, dissolves at pH of 6-7, pH of DISTAL ILEUM & PROXIMAL COLON
A

Asacol / Apriso

23
Q

Which Mesalamine compound?

  • suppositories, RECTUM & SIGMOID (used for Proctitis / Proctosigmoiditis)
A

Canasa

24
Q

Which Mesalamine compound?

  • pH dependent resin in colon, water penetrates à slow release of mesalamine throughout COLON
A

Lialda

25
Q

Name the 3 corticosteroids

A
  • Prednisole / Prednisolone
  • Budesonide
  • Hydrocortisone
26
Q

Which drug?

  • Uses: moderate – severe ACTIVE IBD.
  • Higher dose DOES NOT have more efficacy = more SEs
  • Response within 1 – 2 weeks, à then taper
  • Severely ill: route is via IV
  • Dz of rectum/colon: route is rectal
A

Corticosteroids

27
Q

What are the 3 mechanisms of corticosteroids?

A
  • inhibit production of inflammatory cytokines_,_
  • reduces expression of inflammatory cell adhesion molecules,
  • inhibits transcription of Nitric Oxide synthase
28
Q

ADE’s of which drug?

  • Hyperglycemia, dyslipidemia
  • Osteoporosis, HTN, acne
  • Edema, infection, myopathy
  • psychosis
A

Corticosteroids

29
Q
  • MC oral glucocorticosteroid
  • Systemic
  • Used once daily
  • Better than Budesonide (Less SE)
A

Prednisone / Prednisolone

30
Q

Which drug?

  • NOT USEFUL in maintaining remission (use ASA or immunosuppressives-azathrioprine)
  • RAPID 1st pass hepatic metabolism (low oral bioavailability)
A

Budesonide

31
Q

Which drug?

  • controlled-release oral formulation of Budesonide à releases drug in distal/terminal ileum & ascending colon. pH & time dependent.
  • pH = 5.5
A

Entocort

(Type of Budesonide - Corticosteroid)

32
Q

Which drug?

  • pH dependent. à Terminal ileum & ascending colon.
  • pH = 6.4
A

Budenofalk

(Type of Budesonide - Corticosteroid)

33
Q

Which drug?

  • multi-matrix w/ gastric acid resistant coating à ascending, transverse, descending colon.
  • pH = 7.0
A

Uceris / Cortiment

34
Q

Which drug?

  • Topical tx in rectum & sigmoid
  • (enemas, suppositories, foam)
  • ↓absorption w/ rectal route
A

Hydrocortisone

35
Q

What is used in ACTIVE Crohn’s to induce remission?

A

Antimicrobials

  • Metronidazole
  • Ciprofloxacin
36
Q

Antimicrobrials for Crohn’s have what 6 mechanisms?

A
  • ↓ concentrations of bacteria/fungi in lumens of gut
  • Alter flora to favor beneficial bacteria
  • ↓ bacterial invasion
  • tx micro-abscesses
  • ↓ bacterial translocation
  • ↓systemic dissemination

P2 E3 Shea (9 decks)

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