IBD popcorn Flashcards
1st line tx for mild - moderate
UC & Crohn’s
5-ASA
- Sulfasalazine
- Olsalazine
- Balsalazide
- Mesalamine
Maintenance treatment
UC & Crohn’s
6-thioguanine nucleotides
(Purine Analogs)
- Azathioprine
- 6-Mercaptopurine
1st line for inducing remission in LOW RISK/Mild Crohn’s
Budesonide
Treatment to induce/maintain remission of Crohn’s?
Methotrexate
(Immunosuppressive)
- once weekly sub-q injection
Treatment for Acute/Chronic/Moderate-Severe Crohn’s ?
Anti-TNF
- Infliximab
- Adalimumab
- Natalizumab
- Golimumab
- Certolizumab
2 “last resort” tx for Crohn’s?
- Natalizumab (Anti-TNF/Anti-Integrin)
- Ustekinumab (Anti-IL12/23 antibody)
Disease Severity: Mild, Mod, or Severe?
Responsive or Refractory?
- Anti-TNF
- Oral corticosteroids
- Methotrexate
- Azathioprine / 6-MP
(AOMA)
Moderate disease
Disease Severity: Mild, Mod, or Severe?
Responsive or Refractory?
- Budesonide
- Topical corticosteroids (proctitis)
- Abx
- 5-ASA
(TABA)
Mild disease
Responsive to therapy
Disease Severity: Mild, Mod, or Severe?
Responsive or Refractory?
- Surgery
- Natalizumab
- Cyclosporine
- Anti-TNF
- IV corticosteroids
Severe disease
Refractory to therapy
Which drug?
- Absorption in colon is extremely low
- Undergoes N-acetylation in gut epithelium & liver –> metabolite –> excreted in kidneys
- Has no anti-inflammatory activity
5-ASA
- Sulfasalazine
- Olsalazine
- Balsalazide
- Mesalamine
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
5-ASA
- Sulfasalazine
- Olsalazine
- Balsalazide
- Mesalamine
Folate should be taken with which 2 drugs?
- 5-ASA (Sulfasalazine)
- Methotrexate (immunosuppressives) – reduces ADEs
ADE of which drug?
- “slow acetylator” –> worse SE
Sulfasalazine (sulfapyridine)
(5-ASA)
ADE of which drug?
- Rash
- anemia
- pneumonitis
- hepatotoxicity
- thrombocytopenia
- lymphoma
- OLIGOSPERMIA (reversible)
Sulfasalazine (5-ASA)
ADE of which drug?
- Secretory diarrhea
Olsalazine
(5-ASA)
ADE of which drug?
- High dose –> interstitial nephritis
Mesalamine
(5-ASA)
What are the 3 AZO compounds?
5-ASA
- Sulfasalazine
- Olsalazine
- Balsalazide
“Suck Old Balls”
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
Azo Compounds
- Sulfasalazine
- Olsalazine
- Balsalazide
“Suck Old Balls”
Name the 5 Mesalamine compounds
- Pentasa
- Asacol/Apriso
- Lialda
- Rowasa
- Canasa
“PAL to Row a Canoe”
Which Mesalamine compound?
- timed-release microgranules, release 5-ASA into SMALL INTESTINE
Pentasa
Which Mesalamine compound?
- enemas, RECTUM & SIGMOID (used for Proctitis / Proctosigmoiditis)
Rowasa
Which Mesalamine compound?
- pH sensitive resin, dissolves at pH of 6-7, pH of DISTAL ILEUM & PROXIMAL COLON
Asacol / Apriso
Which Mesalamine compound?
- suppositories, RECTUM & SIGMOID (used for Proctitis / Proctosigmoiditis)
Canasa
Which Mesalamine compound?
- pH dependent resin in colon, water penetrates à slow release of mesalamine throughout COLON
Lialda
Name the 3 corticosteroids
- Prednisole / Prednisolone
- Budesonide
- Hydrocortisone
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
Corticosteroids
What are the 3 mechanisms of corticosteroids?
- inhibit production of inflammatory cytokines_,_
- reduces expression of inflammatory cell adhesion molecules,
- inhibits transcription of Nitric Oxide synthase
ADE’s of which drug?
- Hyperglycemia, dyslipidemia
- Osteoporosis, HTN, acne
- Edema, infection, myopathy
- psychosis
Corticosteroids
- MC oral glucocorticosteroid
- Systemic
- Used once daily
- Better than Budesonide (Less SE)
Prednisone / Prednisolone
Which drug?
- NOT USEFUL in maintaining remission (use ASA or immunosuppressives-azathrioprine)
- RAPID 1st pass hepatic metabolism (low oral bioavailability)
Budesonide
Which drug?
- controlled-release oral formulation of Budesonide à releases drug in distal/terminal ileum & ascending colon. pH & time dependent.
- pH = 5.5
Entocort
(Type of Budesonide - Corticosteroid)
Which drug?
- pH dependent. à Terminal ileum & ascending colon.
- pH = 6.4
Budenofalk
(Type of Budesonide - Corticosteroid)
Which drug?
- multi-matrix w/ gastric acid resistant coating à ascending, transverse, descending colon.
- pH = 7.0
Uceris / Cortiment
Which drug?
- Topical tx in rectum & sigmoid
- (enemas, suppositories, foam)
- ↓absorption w/ rectal route
Hydrocortisone
What is used in ACTIVE Crohn’s to induce remission?
Antimicrobials
- Metronidazole
- Ciprofloxacin
Antimicrobrials for Crohn’s have what 6 mechanisms?
- ↓ concentrations of bacteria/fungi in lumens of gut
- Alter flora to favor beneficial bacteria
- ↓ bacterial invasion
- tx micro-abscesses
- ↓ bacterial translocation
- ↓systemic dissemination
