IBD popcorn

Question 1

1st line tx for mild - moderate

UC & Crohn’s

Answer 1

5-ASA

• Sulfasalazine
• Olsalazine
• Balsalazide
• Mesalamine

Question 2

Maintenance treatment

UC & Crohn’s

Answer 2

6-thioguanine nucleotides

(Purine Analogs)

• Azathioprine
• 6-Mercaptopurine

Question 3

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

Answer 3

Budesonide

Question 4

Treatment to induce/maintain remission of Crohn’s?

Answer 4

Methotrexate

(Immunosuppressive)

• once weekly sub-q injection

Question 5

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

Answer 5

Anti-TNF

• Infliximab
• Adalimumab
• Natalizumab
• Golimumab
• Certolizumab

Question 6

2 “last resort” tx for Crohn’s?

Answer 6

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

Question 7

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

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

(AOMA)

Answer 7

Moderate disease

Question 8

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

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

(TABA)

Answer 8

Mild disease

Responsive to therapy

Question 9

Disease Severity: Mild, Mod, or Severe?

Responsive or Refractory?

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

Answer 9

Severe disease

Refractory to therapy

Question 10

Which drug?

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

Answer 10

5-ASA

• Sulfasalazine
• Olsalazine
• Balsalazide
• Mesalamine

Question 11

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

Answer 11

5-ASA

• Sulfasalazine
• Olsalazine
• Balsalazide
• Mesalamine

Question 12

Folate should be taken with which 2 drugs?

Answer 12

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

Question 13

ADE of which drug?

• “slow acetylator” –> worse SE

Answer 13

Sulfasalazine (sulfapyridine)

(5-ASA)

Question 14

ADE of which drug?

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

Answer 14

Sulfasalazine (5-ASA)

Question 15

ADE of which drug?

• Secretory diarrhea

Answer 15

Olsalazine

(5-ASA)

Question 16

ADE of which drug?

• High dose –> interstitial nephritis

Answer 16

Mesalamine

(5-ASA)

Question 17

What are the 3 AZO compounds?

Answer 17

5-ASA

• Sulfasalazine
• Olsalazine
• Balsalazide

“Suck Old Balls”

Question 18

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

Answer 18

Azo Compounds

• Sulfasalazine
• Olsalazine
• Balsalazide

“Suck Old Balls”

Question 19

Name the 5 Mesalamine compounds

Answer 19

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

“PAL to Row a Canoe”

Question 20

Which Mesalamine compound?

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

Answer 20

Pentasa

Question 21

Which Mesalamine compound?

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

Answer 21

Rowasa

Question 22

Which Mesalamine compound?

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

Answer 22

Asacol / Apriso

Question 23

Which Mesalamine compound?

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

Answer 23

Canasa

Question 24

Which Mesalamine compound?

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

Answer 24

Lialda

Question 25

Name the 3 corticosteroids

Answer 25

* Prednisole / Prednisolone * Budesonide * Hydrocortisone

Question 26

**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

Answer 26

Corticosteroids

Question 27

What are the 3 mechanisms of corticosteroids?

Answer 27

* _inhibit production_ of inflammatory cytokines_,_ * _reduces expression_ of inflammatory cell adhesion molecules, * _inhibits transcription_ of Nitric Oxide synthase

Question 28

**ADE's of which drug?** * Hyperglycemia, dyslipidemia * Osteoporosis, HTN, acne * Edema, infection, myopathy * psychosis

Answer 28

Corticosteroids

Question 29

* MC oral glucocorticosteroid * Systemic * Used once daily * Better than Budesonide (Less SE)

Answer 29

Prednisone / Prednisolone

Question 30

**Which drug?** * NOT USEFUL in maintaining remission (use ASA or immunosuppressives-azathrioprine) * RAPID 1^st pass hepatic metabolism (low oral bioavailability)

Answer 30

Budesonide

Question 31

**Which drug?** * controlled-release oral formulation of Budesonide à releases drug in distal/terminal ileum & ascending colon. pH & time dependent. * _pH = 5.5_

Answer 31

**Entocort** | (Type of Budesonide - Corticosteroid)

Question 32

**Which drug?** * pH dependent. à _Terminal ileum & ascending colon._ * **pH = 6.4**

Answer 32

**Budenofalk** | (Type of Budesonide - Corticosteroid)

Question 33

**Which drug?** * multi-matrix w/ gastric acid resistant coating à ascending, transverse, descending colon. * **pH = 7.0**

Answer 33

Uceris / Cortiment

Question 34

**Which drug?** * Topical tx in rectum & sigmoid * (enemas, suppositories, foam) * ↓absorption w/ rectal route

Answer 34

Hydrocortisone

Question 35

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

Answer 35

**Antimicrobials** * Metronidazole * Ciprofloxacin

Question 36

Antimicrobrials for Crohn's have what 6 mechanisms?

Answer 36

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