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
tx. for women w/ diarrhea predominant IBS?
5-HT3 antagonist - alosetron
sulfasalazine
aminosalicylate 5-ASA
what is first tx for IBD mild/moderate disease?
5-ASA: melsalamine, sulfasalazine
what is second tx for IBD moderate disease?
TNF antagonists
corticosteroids
MTX
6-Mercaptopurine
What is third tx for IBD severe disease?
TNF antagonists, surgery, IV corticosteroids
enema
works topically - a fluid injected in lower bowel by way of rectum
lubiprostone
Cl- Channel activator
used for women w/ constipation predominant IBS
tegaserod
5-HT4 agonist - Women with severe constipation predominant IBS
alosetron
5-HT3 Antagonist
Women with severe diarrhea predominant IBS
dicyclomine, hyscyamine
antispasmodics
used for IBS tx
what to use for acute CINV?
Combination 5-HT3 receptor antagonist NK1 receptor antagonist Glucocorticoid Prochlorperazine Metoclopramide Diphenhydramine Lorazepam
what to use for delayed CINV?
Prevent acute CINV
what to use for anticipatory antiemetic therapy?
Lorazepam, alprazolam, diazepam
general antiemetic therapy?
5HT3 receptor antagonist
Phenothiazines
PONV therapy?
5-HT3 receptor antagonist Glucocorticoid Dimenhydrinate Prochlorperazine Metoclopramide
motion sickness therapy?
Scopolamine
Dimenhydrinate
Promethazine
MOA of psyllium and methycellulose?
bulk forming laxatives: Forms bulky emollient gel which distends colon promoting peristalsis
MOA of docusate
stool softener - Allows water and lipids to penetrate stool
Saline (magnesium citrate, magnesium hydroxide, sodium phosphates) MOA?
osmotic laxatives - Increase stool liquidity due to increase in fecal fluid
Sugars/alcohols (sorbitol, lactulose, PEG) MOA?
osmotic laxatives - Increase stool liquidity due to increase in fecal fluid
