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PHM 604- GI Therapeutics > IBD Therapies > Flashcards

IBD Therapies Flashcards

1
Q

5-aminosalicylates MoA

A

Act topically to decrease GI tract inflammation

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2
Q

Frequency of 5-ASA dosing

A

Most require multiple daily dosages

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3
Q

5-ASA drugs

A

Sulfasalazine, mesalamine, olsalazine, balsalazide

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4
Q

Sulfasalazine is cleaved by gut bacteria into what molecules?

A

5-ASA and sulfapyridine

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5
Q

What is the carrier and what is the active component in sulfasalazine

A

Carrier: sulfapyridine

Active component: 5-ASA

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6
Q

What is responsible for the ADEs in sulfasalazine?

A

Sulfa moiety

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7
Q

ADEs of sulfasalazine

A

GI symptoms, rash, photosensitivity, blood dyscrasias

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8
Q

Sulfasalazine dosing

A

500-1500mg PO q6h

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9
Q

Where are 5-ASAs used in IBD treatment?

A

UC!

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10
Q

Mesalamine routes of administration

A

PO and PR

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11
Q

Mesalamine PR products

A

Rowasa is an enema

Canasa is a suppository

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12
Q

Where does Rowasa deliver drug to?

A

Rectum and distal colon

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13
Q

Where does Canasa deliver drug to?

A

Rectum only

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14
Q

PO formulation of mesalamine comes in what kind of duration?

A

Delayed/controlled release

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15
Q

Olsalazine (Dipentum) is cleaved by gut bacteria into what?

A

2 5-ASA molecules

2=Di, brand name is Dipentum!

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16
Q

Olsalazine/Dipentum dosing

A

500-1000mg PO BID

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17
Q

Olsalazine/Dipentum ADE

A

Diarrhea

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18
Q

Feature of balsalazide (Colazal)

A

It’s basically sulfasalazine without the sulfa

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19
Q

What is balsalazide cleaved into?

A

5-ASA and 4-aminobenzyol-beta-alanine

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20
Q

What are the active and carrier components of balsalazide?

A

Active: 5-ASA
Carrier: 4-aminobenzoyl-beta-alanine

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21
Q

Balsalazide (Colazal) dosing

A

3, 750mg capsules PO TID

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22
Q

What are immunomodulators used to do in IBD treatment?

A

Maintain treatment remission

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23
Q

Immunomodulators used in IBD treatment

A

Azathioprine, 6-MP, methotrexate, cyclosporine and tacrolimus have also been used

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24
Q

Azathioprine is a prodrug for what drug?

A

6-MP

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25
Q

Azathioprine dosing

A

2-2.5mg/kg/day

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26
Q

What can you use AZA in combo with?

A

Biologics (but can also use alone)

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27
Q

What disease states can you use AZA in?

A

Both Crohn’s and UC

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28
Q

6-MP dosing

A

1-1.5mg/kg/day

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29
Q

Methotrexate dosing

A

15-25mg/week IM or SQ, but can switch to PO after being on IM or SQ treatment for a long time

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30
Q

What disease state can you use methotrexate in?

A

Crohn’s

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31
Q

Immunomodulator monitoring

A

CBC at least q3 months
Check LFTs and pancreatic enzymes
Watch out for lymphomas

32
Q

ABX are used in what disease state?

A

Best for perianal Crohn’s

33
Q

ABX used in IBD

A

Metronidazole and ciprofloxacin

34
Q

Metronidazole dosing

A

500mg TID or 20mg/kg/day

35
Q

Ciprofloxacin dosing

A

400mg IV or 500mg PO BID

36
Q

What do corticosteroids do in IBD therapy?

A

Work quickly to reduce inflammation

37
Q

Corticosteroids used in IBD

A

Prednisone, methylprednisolone, hydrocortisone, budesonide

38
Q

Prednisone dosing

A

20-60mg PO QD

39
Q

Methylprednisolone formulation/route of administration

A

IV

40
Q

Hydrocortisone topical formulations

A

10mg enema, 25mg suppository, 10% foam

41
Q

Hydrocortisone also comes in what formulation?

A

IV

42
Q

Budesonide formulation

A

EC capsule

43
Q

Budesonide dosing to induce remission

A

9mg PO QD up to 8 weeks; recurring episodes can be treated with repeated courses

44
Q

Budesonide dosing to maintain remission in Crohn’s

A

After 8 weeks, can continue at 6mg PO QD with a down taper if needed

45
Q

Budesonide brand for Crohn’s

A

Entocort

46
Q

Where does Entocort release?

A

Terminal ileum

47
Q

Budesonide brand for UC

A

Uceris

48
Q

Where does Uceris release?

A

Throughout the colon

49
Q

Role of biologics in IBD

A

Induce and maintain remission

50
Q

Anti-TNFs for IBD

A

Infliximab (Remicade)
Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)

51
Q

Selective adhesion molecules inhibitors for IBD

A

Natalizumab (Tysabri)

Vedolizumab (Entyvia)

52
Q

IL-12, IL-23 inhibitor for IBD

A

Ustekinumab (Stelara)

53
Q

JAK inhibitors for IBD

A

Tofacitinib (Xeljanz)

Upadacitinib (Rinvoq)

54
Q

Biologics used in BOTH Crohn’s and UC

A

Infliximab (Remicade)
Adalimumab (Humira)
Vedolizumab (Entyvia)
Ustekinumab (Stelara)

55
Q

Biologics used in Crohn’s only

A

Natalizumab (Tysabri)

Certolizumab (Cimzia)

56
Q

Biologics used in UC only

A

Golimumab (Simponi)
Tofacitinib (Xeljanz)
Upadacitinib (Rinvoq)

57
Q

Biologics with IV route of administration

A

Infliximab (Remicade)
Natalizumab (Tysabri)
Vedolizumab (Entyvia)
Ustekinumab (Stelara) when used as induction Tx

58
Q

Biologics with SQ route of administration

A

Adalimumab (Humira)
Certolizumab (Cimzia)
Golimumab (Simponi)
Ustekinumab (Stelara) when used as maintenance Tx

59
Q

Biologics with PO route of administration

A

Tofacitinib (Xeljanz)

Upadacitinib (Rinvoq)

60
Q

ADRs of biologics: acute infusion-related reactions

A

Headache, dizziness, nausea, flushing, fever, chest pain, cough, dyspnea, pruritus

61
Q

How to control acute infusion-related reactions

A

Decrease infusion rate, pre-medicate with 1000mg APAP, 50mg IV/PO diphenhydramine +/- 50mg IV hydrocortisone

62
Q

ADRs of biologics: delayed infusion-related reactions

A

Myalgias, arthralgias, fever, rash, pruritis, urticaria, headaches

63
Q

How long does it take for delayed infusion-related reactions to take place?

A

3-14 days

64
Q

How to manage delayed infusion-related reactions

A

Can go away on its own or require a short course of steroids

65
Q

ADRs of biologics: injection site reactions

A

Pain and redness at the site of injection

66
Q

BBWs on TNFis and JAKis

A

Infections, malignancy

67
Q

Kinds of infections that are possible while on TNFis and JAKis

A

Active TB, invasive fungal infections, bacterial, viral, or other opportunistic infections

68
Q

How to monitor for infections while on TNFis and JAKis

A

Monitor for signs/symptoms of infection

D/C when there’s a serious infection or sepsis

69
Q

What should patients be tested for before starting TNFis or JAKis therapy?

A

TB skin test, chest x-ray, must be vaccinated or treated for HBV

70
Q

What vaccines can you not get while on a TNFi or JAKi?

A

Live attenuated vaccines

71
Q

ADE of natalizumab

A

Progressive multifocal leukoencephalopathy

BBW on natalizumab, cautionary for vedolizumab

72
Q

What causes progressive multifocal leukoencephalopathy?

A

Reactivation of the JC polyomavirus which can lead to CNS infection and death

73
Q

Due to its ADE/BBW, how must natalizumab be administered?

A

As monotherapy

74
Q

How do you get natalizumab?

A

Patients and prescribers must enroll in the TOUCH program

75
Q

The safety review for JAKis found that there was an increased risk of what?

A

Cancer, CV-related events, thrombosis, and death

76
Q

The increased risks of cancer, CV-related events, thrombosis, and death while taking JAKis are more likely to happen to what kinds of patients?

A

> 50 years old with at least 1 CV risk factor (smoking, HTN, HLD, etc.)

77
Q

The FDA has limited the use of JAKis to what?

A

Patients who haven’t responded or can’t tolerate 1 or more TNFIs

PHM 604- GI Therapeutics (10 decks)

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