IBD THERAPY Flashcards
MANAGEMENT of IBD (2)
medical approach for patients with IBD is symptomatic care (ie, relief of symptoms) and mucosal healing
step-up or stepwise approach number of steps
5
Step I
Aminosalicylates (oral, enema, suppository formulations): For treating flares (acute attack) and maintaining remission; more effective in UC than in CD
Step IA
Antibiotics: most commonly used for perianal disease (abcesses), fistulas, intra-abdominal inflammatory masses.
Step II
Corticosteroids (intravenous, oral, topical, rectal): For acute disease flares only
•Step III
Immunomodulators: used in refractory disease; primary treatment for fistulas and maintenance of remission in patients intolerant of or not responsive to aminosalicylates
Step IV
Clinical trial agents: Tend to be disease-specific (i.e., an agent works for CD but not for UC, or vice versa)
THE FOLLOWING MEDICATIONS MAY BE USED IN PATIENTS WITH IBD: (5)
•5-Aminosalicylic acid derivatives •Immunosuppressant agents •Tumor necrosis factor inhibitors Antibiotics •Corticosteroid agents
•Therapy for Crohn disease is generally less effective than that for ulcerative colitis
No answer here
5-AMINOSALICYLIC ACID DERIVATIVES used for
for treating flares of mild to moderate ulcerative colitis and occasionally Crohn colitis and for maintaining remission.
5-AMINOSALICYLIC ACID DERIVATIVES include(2)
Mesalamine
Sulfasalazine
Sulfasalazine used for
This agent is used for acute disease and for maintenance of remission
considered as first-line therapy for Crohn disease
Sulfasalazine is a prodrug that is metabolized to its active components
sulfapyridine and 5-aminosalicylic acid (5-ASA; mesalamine)
Sulfasalazine mechanism
inhibits leukotriene synthesis and lipoxygenase
Sulfasalazine ADVERSE EFFECTS >10% : (6)
- Anorexia
- Headache
- Nausea
- Vomiting
- Gastric distress
- Apparently reversible oligospermia
Sulfasalazine ADVERSE EFFECTS <1% (7)
- Skin rash
- Pruritus
- Urticaria
- Fever
- Heinz body anemia
- Hemolytic anemia •Cyanosis
•Mesalamine is
is a 5-ASA that acts systemically and also has activity as a topical anti-inflammatory.
IMMUNOSUPPRESSANTS useful as
steroid-sparing agents, in healing fistulas, and in patients with serious contraindications to surgery.
IMMUNOSUPPRESSANTS used for
patients who are refractory to or unable to tolerate steroids and in patients in whom remission is difficult to maintain with the aminosalicylates alone.
Azathioprine useful in
Crohn disease complicated by recurrent rectal fistulas or perianal disease
AZATHIOPRINE mechanism
inhibits mitosis and cellular metabolism by antagonizing purine metabolism and inhibiting synthesis of DNA, RNA, and proteins; these effects may decrease proliferation of immune cells and result in lower autoimmune activity.
AZATHIOPRINE Adverse Effects >10% (2)
- Leukopenia (28-50%)
* Infection (20%)
AZATHIOPRINE Adverse Effects <1% (8)
•Lymphoma (Frequency Not Defined) •Abdominal pain – Alopecia -Arthralgia -Diarrhea –Fever - malaise •Bacterial, fungal, protozoal, viral infections •Bone marrow suppression •Hepatotoxicity •Skin cancer •Macrocytic anemia . •others
TNF INHIBITORS include
Infliximab
Adalimumab
Infliximab mechanism
neutralizes cytokine TNF-alpha and inhibits its binding to the TNF-alpha receptor
Adalimumab adverse effects
Development of antinuclear antibodies (50%))
