IBD tx Flashcards
5-aminosalicylic acid preperations
melsalamine, sulfasalazine - 5-ASA
MOA: uncertain - thought to mudulate inflamm. mediators derived from prostaglandins and leukotrienes
Formulations: 5-ASA is too toxic on its own - formulated with mesalamine compounds
Use: first line tx for mild/moderate UC
efficacy on crohn’s disease unproven
* but used in CD as well
ADR’s: ** high in sulfasalazine
dose related nausea, GI upset, h/a, arthralgias, myalgias
* nephrotoxicity can occur *
* rare cases of lupus-like syndrome, pancreatitis, hepatotoxicity
prednisone
corticosteroid
MOA: inhibits production of inflammatory cytokines/chemokines
Use: tx of moderate to severe IBD
daily oral dosing
ADRs: not likely seen in short term use <2 weeks. may have insomnia, behavioral changes, acute peptic ulcers. fluid/electrolyte abnormalities, osteoposris, increased risk of infections ,behavioral problems
budesonide
corticosteroid
Use: tx of moderate to severe IBD
formulated as delayed release
ADRs: not likely seen in short term use <2 weeks. may have insomnia, behavioral changes, acute peptic ulcers fluid/electrolyte abnormalities, osteoposris, increased risk of infections ,behavioral problems
infliximab
anti-TNFalpha antibody
TNF is a key pro-inflamm. cytokine and mediator of intestinal inflammation that is increased in IBD - prevents receptor binding and cytokine release
MOA: bind soluble TNFalpha - preventing it from binding receptors
USE: moderate to severe CD
ADRs:
serious infections: sepsis, TB, opportunistic infections
- all pts. must be tested for TB prior
development of Abs to the antibody (ATA) - due to chimeric human-mouse IgG
delayed serum sickness
rare acute hepatic failure, SLE like syndrome, demyelinating disorders, hematologic reactions
azathioprine
immunosuppressant - purine analog
MOA: inhibits purine nucleotide syntheis
USE: maintenance of remission of UC/CD
ADRs: naseau, vomiting, bone marrow depression, hepatic toxicity, hypersensitivity
mercaptopurine
immunosuppressant - purine analog
MOA: inhibits purine nucleotide syntheis
- takes a long time to work
USE: maintenance of remission of UC/CD
ADRs: naseau, vomiting, bone marrow depression, hepatic toxicity, hypersensitivity
methotrexate
immunosuppressant
MOA: inhibits dihydrofolate reductase affecting lymphocyte and macrophage function - may stimulate apoptosis and death of activated T lymphocytes
use: induction in maintenance of remission in pts. w/ CD
cyclosporine
immunosuppressant
MOA: inhibits IL-2 production from T helper cells
Use: tx severe UC that is unresponsive to IV glucocorticoids - may save pt. from colectomy
melsalamine
5-ASA
first line tx for mild/moderate UC?
5-ASA
sulfasalazine, melsalamine
tx of moderate/severe UC?
corticosteroids - prednisone, budesonide: tx flare ups
tx for maintenenace of remission of UC/CD?
purine analogs - azthioprine, 6-mercaptopurine
for CD: methotrexate
tx severe UC that is unresponsive to IV glucocorticoids - may save pt. from colectomy
cyclosporine
tx for moderate/severe CD?
infliximab
tx of women w/ severe constipation IBS?
5-Ht4 agonist - tegaserod
* induces peristalsis
Cl- channel activator: lupiprostone
