IBD, UC and Crohns Drugs

Question 1

What are the drugs used in Crohn’s disease and Ulcerative Colitis?

Answer 1

Aminosalicylates 
Glucocorticoids
Immunosuppressants 
Anti-TNF alpha drugs 
Anti-integrins

Question 2

First up are the aminosalicylates, what are these drugs?

Answer 2

Sulfasalazine, Balsalazide and Mesalamine
MOA of sulfasalazine:
–inhibits the pro inflammatory mediators like IL1 and TNF alpha
In GIT, sulfapyridine (abx) and 5-Aminosalicyclic Acid (5-ASA) (anti-inflammatory): released by sulfasalazine by colonic bacteria
Used in mild to moderate Crohn’s disease or UC
Note: Sulfasalazine is used on proximal, distal colon and rectum (so UC for rectum) (Crohns for Anus)

Question 3

What are adverse effects of Sulfasalazine?

Answer 3

N/V/D
Hypersensitivity and reversible oligospermia
Bone marrow suppression (Related to sulfapyridine release from sulfasalazine)

Question 4

What is the MOA for Balsalazide?

Answer 4

Prodrug

–releases mesalamine (5-ASA) in the large intestine at the site of UC

Question 5

Next drug for Crohns and UC are glucocorticoids. What are some features?

Answer 5

Hydrocortisone, Prednisone, Prednisolone, Budesonide
–Corticosteriods: are generalized anti-inflammatory drugs used in acute cases
–inhibit TNFalpha, IL-1, IL-8
Budesonide: controlled released formulation in the distal ileum and colon

Question 6

Next drugs for Crohns and UC are Immunosuppressants. what are some features?

Answer 6

6-mercaptopurine (6-MP), Azathioprine (prodrug of 6-MP) and Methotrexate (MTX) –these are not first line agents

• –6-MP may promote apoptosis of immune response. MTX blocks dihydrofolate reductase (DHFR)
• -Used in moderately severe to severe Crohn;s Disease and UC
• -Hepatotoxicity can occur with 6-MP

Question 7

Next drugs for Crohns and UC are Anti-TNF alpha drugs called Infliximab and Adalimumab.What is the MOA?

Answer 7

MOA for Infliximab:
–monoclonal antibody targets TNFalpha, a principal mediator in Crohns Disease
–used in conditions associated with flare up of IBD: particularly in Crohns related fistulas and acute flares. It is also used in RA
MOA for Adalimumab:
–TNF alpha inhibitor

Question 8

What are adverse effects of Infliximab?

Answer 8

Reactivation of latent TB and other infections
–given IV
Antibodies to infliximab may develop

Question 9

Finally the last drug for Crohns and UC is Natalizumab, what is the MOA?

Answer 9

MOA:

–Natalizumab: blocks leukocyte integrins can produce multifocal leukoencephalopathy

Question 10

Lastly are the drugs used for IBS, what are the features of IBS?

Answer 10

Irritable Bowel Syndrome:
–characterized by diarrhea or constipation or alternating
Chronic symptoms with no structural abnormalities
Frequent Abdominal Pain with:
altered stool frequency, pain gets better after defecation, alteration in stool appearance

Question 11

What are the drug treatment of IBS?

Answer 11

Anticholinergics
5-HT3 antagonists
Opioid Agonists
Chloride Channel Activators

Question 12

What are the anticholinergics used in IBS?

Answer 12

Hyoscyamine, Dicyclomine, Glycopyrrolate and Methscopalamine

• -non selective action on the gut
• -anti-cholinergic effects on GI, UT, RT, eye, secretions and on heart

Question 13

What is the 5-HT3 antagonist in IBS?

Answer 13

Alosetron

• -with long duration of action, has high potency
• -reduces smooth muscle activity in the gut
• -recommended for severe diarrhea associated with IBS
• -rare, serious constipation; ischemic colitis and infarction may occur

Question 14

What is the opioid agonist in IBS?

Answer 14

Loperamide
–acts via GI mu-opioid receptors
Inhibits acetylcholine release and decrease peristalsis
–used in IBS with diarrhea

Question 15

What is the chloride channel activator in IBS?

Answer 15

Lubiprostone

–used in constipation associated IBS

Question 16

Finally there are two drugs used in Pancreatic Insufficiency, the first is Pancrelipase, what are some features of this drug?

Answer 16

A replacement enzyme from animal pancreatic extract
–improve the digestion of dietary fat, protein and carbs. and increases A,D,E,K vit absorption
Use:
patients with chronic pancreatitis, after pancreatectomy, steatorrhea and CF associated insufficiencies