Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHARM 346 - Other > Inflammatory Bowel Disease Drug Effects > Flashcards

Inflammatory Bowel Disease Drug Effects Flashcards

1
Q

Where do the different IBD Drugs act

A

Sulfasalicyclates:
- Directly on Large/Small Bowel Lining

Corticosteroids
- On adrenal gland

Immunosuppressants
- On Large/Small bowel

Biologics:
- On Large/Small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aminosalicylates
- Efficacy

A

Onset 2-4 weeks

Response 4-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Aminosalicylates
- Role

A

New diagnosis or mild symptoms
- Induction Therapy: Mild to Moderate UC>CD (Sulfasalazine only for CD)
- Maintenance Therapy: Remission UC (Sulfasalazine only for CD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Aminosalicylates
- Dose for Induction vs Maintenance Therapy

A

Higher dose for Induction Therapy
Lower dose for Maintenance Therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Aminosalicylates
- MOA

A

Acts directly on lining of small and large bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aminosalicylates
- Route

A
  • Oral
  • Rectal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sulfasalazine
- Adverse Effects

A

Dose Related
- Nausea
- Dizziness

Non-Dose Related
- Hypersensitivity

  • Slow acetylators have greater adverse effects
  • Reduces Folate absorption (Supplementation needed in pregnancy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

5-ASA
- Adverse Effects

A
  • Flatulence
  • Abdominal pain
  • Thrombocytopenia
  • Olsalazine (Diarrhea)

Used when pt can not tolerate SSZ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Aminosalicylates
- Considerations

A
  • For Chron’s disease only Sulfasalazine is usable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Aminosalicylates
- Choosing a Route

A

Use suppositories for distal disease
- Mezera
- Salofalk
- Pentasa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Corticosteroids
- MOA

A

Anti-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Corticosteroids
- Routes

A
  • Oral
  • Rectal
  • Injection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Corticosteroids
- Choosing a Route

A

In acute severe disease where oral prednisone has failed or if pt is hospitalized use injection formulation
- Once pt returns back to normal can switch back to oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Corticosteroids
- Role

A

Anti-inflammatory used in moderate to severe relapses
- Induction Therapy: Moderate to Severe UC/CD
- Maintenance Therapy: No role

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Corticosteroids
- Onset

A

Oral: Fast (Within 1-2 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prednisone
- Considerations

A
  • Take in the morning to avoid difficulty sleeping
  • Taper 5 mg weekly or 5 mg every 2-3 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Budesonide
- Considerations

A

Entocort
- Induction therapy for mild to moderate CD (For up to 3 months)

Cortiment
- Induction therapy for mild to moderate UC (Reassess 1-2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Prednisone vs Budesonide

A

Budesonide has less systemic AE
- Extensive first pass metabolism d
- Decreased systemic levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Corticosteroids
- Adverse Effects

A

Short Term
- Increases infections
- Hyperglycemia
- Dyspepsia
- Acne
- Mood

Long Term
- HPA Axis Suppression
- Cushing’s
- Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HPA Axis Suppression
- Symptoms

A
  • Difficulty sleeping
  • Feeling cold
  • Anxiety
  • Depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Immunosuppressants
- MOA

A

Decreases immune system response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Immunosuppressants
- Routes

A
  • Oral
  • Injection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Thiopurines
- Onset

A

2-6 months (Slow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Thiopurines
- Role

A

Severe Symptoms or if Steroid Dependent
- Induction: Moderate to Severe (UC)
–> Have to be combined with steroids

  • Maintenance: UC/CD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Thiopurines
- Adverse Effects

A

Dose-Related
- Nausea, diarrhea
- Bone marrow suppression
- Elevated liver enzymes

Non-Dose Related
- Hypersensitivity
- Sun Sensitivity
- Pancreatitis
- Hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Thiopurines
- Considerations

A

TPMT inactivates AZA/6-MP
- Poor TPMT metabolizers = Increased bone marrow suppression and adverse effects

Drugs that inhibit xanthine oxidase increases active metabolites
- Allopurinol, Febuxostat = Increases severe adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Thiopurines
- Contraindications

A
  • Cancer
  • Immunodeficiency
  • Blood Disorders
  • Liver Failure
  • Pregnancy/Breastfeeding (However AZA is often used)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Methotrexate
- Dose

A

Given weekly
- Reduce dose by 50% if CrCl is 10-50 mL/min
- May avoid if CrCl is less than 30 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Methotrexate
- Onset

A

Onset 2-4 weeks
Symptomatic Response in 12-16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Methotrexate
- Role

A

Severe Symptoms or if Steroid Dependent
- Induction: Moderate to Severe (CD)
- Maintenance: CD

Only use in UC is to combine with biologics to reduce antidrug antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Methotrexate
- Adverse Effects

A

Common:
- Nausea
- Fatigue, Malaise, Difficulty concentrating

Less Common
- Photosensitivity
- Hair Loss

Rare:
- Pneumonitis (Hypersensitivity)
- Cancer (Reversible Lymphoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Methotrexate
- Managing Adverse Effects

A

Nausea / Vomiting, ALT/AST Elevation, Low WBC/Platelets
- Folic Acid

Fatigue, Malaise, Difficulty Concentrating 24-48h after dose
- Dextromethorphan

Photosensitivity,
- Sunscreen

Hair Loss
- Folic Acid, Vit B12, Biotin, Collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Folic Acid
- MOA

A

Acts as a rescue agent for rapidly dividing cells
- Works against MTX inhibition of dihydrofolate reductase

34
Q

Dextromethorphan
- MOA

A

Blocks neurostimulation of homocysteine at NMDA receptors in brain
- Preventing headaches, malaise, lethargy

35
Q

Methotrexate
- Considerations

A
  • Avoid binge drinking and drinking alcohol 24h after dose
  • Avoid 3 months prior to conception
36
Q

Methotrexate
- Drug Interactions

A

NSAIDs, Penicillins, PPIs (Considered safe to combine)
- Though may reduce renal excretion of MTX –> Hematological adverse effects

Trimethoprim (Avoid combined use)
- Both increases hematological adverse effects
- Decreases renal excretion of MTX –> Hematological adverse effects

37
Q

Biologics
- MOA

A

Binds or blocks specific targets

38
Q

TNFa Inhibitors
- Onset

A

Onset 2-4 weeks
Symptomatic Response 8-12 weeks

39
Q

TNFa Inhibitors
- Role

A

Can combine with MTX or AZA
- Moderate to Severe (UC/CD) and not respondign to other therapy

Effective at healing fistulas

40
Q

TNFa Inhibitors
- Continuing Therapy

A

If responding can continue TNFi for long term
- Increase dose

Can also switch to immunomodulatory therapy after achieving remission with TNFi
- Step-down therapy

41
Q

Adalimumab
- Indication

42
Q

Certolizumab
- Indication

A

UC
- Not covered

43
Q

Golimumab
- Indication

44
Q

Infliximab
- Indication

45
Q

TNFa Inhibitors
- Specific Adverse Effects

A

Acute Infusion Reactions
- Infliximab

Injection Side Reaction
-Adalimumab and Golimumab:

Delayed Hypersensitivity Reaction
- Infliximab

46
Q

Acute Infusion Reaction

A

Within 10 mins, up to 4 hours

  • Mild: Pain, itching, fever, chills, flush
  • Severe: Hypotension, chest pain, dyspnea

Treatment:
- Premedicate with Cetirizine/Loratadine and Acetaminophen +/- Steroid
- Discontinue infusion

47
Q

Injection Site Reaction

A

Occurs within 24-48h
- Common with 2nd and 3rd injection, then disappears

  • Mild: Red, itchy, painful

Treatment:
- Treat with Cetirizine/Loratadine
- If long lasting use Montelukast

48
Q

Delayed Hypersensitivity Reaction

A

Occurs 24h to 14d after repeated infliximab infusion

  • Fever, hives, malaise, joint pain

Treatment:
- Antihistamine, acetaminophen x3 days
- Use steroid if needed
- Avoid further infliximab use

49
Q

TNFa Inhibitors
- Adverse Effects

A

Common:
- Upper Respiratory Tract Infections, GI, aches

Uncommon:
- Lupus, skin conditions

Rare:
- Reactivation of infections (Test for TB and Hep B/C)
- Serious infections (Can be masked)

50
Q

TNFa Inhibitors
- Contraindications

A
  • Current infection
  • Moderate to severe heart failure
  • Demyelinating disorder (MS)
  • Live attenuate vaccines (Mumps, measles, rubella)
  • Other biologics / targeted therapy

Caution in:
- Family history of demyelinating disorders
- Lymphoma, skin cancer

51
Q

Anti-Integrin Therapy
- MOA

A

Binds alpha4beta47 integrin on memory T lymphocytes of the gut
- Selectively inhibits adhesion to mucosal addressin cell adhesion molecule 1

52
Q

Anti-Integrin Therapy
- Onset

A

UC: Symptomatic improvement 8-14 weeks
CD: Symptomatic improvement 10-15 weeks

53
Q

Anti-Integrin Therapy
- Role

A

Can be combined with MTX or AZA
- Used in moderate to severe UC or CD where TNFi are not working

54
Q

Anti-Integrin Therapy
- Adverse Effects

A

Similar to TNFi
- Upper Respiratory Tract Infections, GI, Aches
- Increase in bilirubin and liver enzymes

55
Q

IL-12/23i
- MOA

A

Antagonist to p40 subunit shared by IL-12 and IL-23

56
Q

IL-12/23i
- Onset

A

Symptomatic improvement 6-10 weeks

57
Q

IL-12/23i
- Role

A

Can combine with MTX or AZA
- Moderate to Severe CD/UC when TNFi therapy has failed

58
Q

IL-12/23i
- Adverse Effects

A

Similar to TNFi
- Upper Respiratory Infections, GI, Aches

59
Q

IL-12/23i
- Contraindications

A
  • Current infection
  • Live vaccines
  • Other biologic/targeted therapy
60
Q

IL-23i (Mirikizumab)
- MOA

A

Binds p19 subunit of IL-23

61
Q

IL-23i (Mirikizumab)
- Onset

A

Symptomatic response at 12 weeks

62
Q

IL-23i (Mirikizumab)
- Role

A

Can be combined with MTX or AZA
- Used in moderate to severe UC when biologic or JAKi do not work

63
Q

IL-23i (Mirikizumab)
- Adverse Effects

A

Similar to TNFi
- Upper respiratory infection, GI, Aches

64
Q

IL-23i (Mirikizumab)
- Contraindications

A
  • Current infection
  • Live attenuated vaccine
  • Other biologic/targeted therapy
65
Q

IL-23i (Risankizumab)
- MOA

A

Selectively binds p10 subunit of IL-23

66
Q

IL-23i (Risankizumab)
- Role

A

Can be combine with MTX or AZA
- Used in moderate to severe CD when biologics have failed and/or if steroid dependent

67
Q

IL-23i (Risankizumab)
- Adverse Effects

A

Similar to TNFi
- Upper respiratory infection, GI, Aches

May cause liver enzyme elevation

68
Q

JAK Inhibitors
- MOA

A

Inhibits JAK-induced pro-inflammatory cytokine production

69
Q

JAK Inhibitors
- Role

A

Can be combined with MTX or AZA
- Used in moderate to severe UC/CD when biologics have failed

70
Q

JAK Inhibitors
- Considerations

A
  • Risk of GI perforation with history of diverticulitis
  • Baricitinib can cause VTE, closely monitor for all JAKs
  • CV risks and Cancer risks
  • Contraindicated in pregnancy (D/C 6 weeks prior)
71
Q

Tofacitinib vs Upadacitinib

A

Tofacitinib
- Moderate to Severe UC
- D/C if not responding by week 16
- AE: Diarrhea, Bradycardia

Upadacitinib
- Moderate to Severe UC/CD
- D/C if not responding

72
Q

JAK Inhibitors
- Adverse Effects

A

Common:
- URTI, Headache

Less Common:
- Serious infections
- Decreased WBC and Hb
- Masks elevated cholesterol (Does not affect cholesterol itself though)
- ALT/AST elevations

73
Q

SP-1 Receptor Agonist
- MOA

A

Activates Sphingosine 1-phosphate receptor modulator on lymphocyte
- Reduces lymphocyte release into intestine

74
Q

SP-1 Receptor Agonist
- Onset

A

D/C if no benefit by week 10

75
Q

SP-1 Receptor Agonist
- Role

A

Used in moderate to severe UC when biologic therapy has failed

76
Q

SP-1 Receptor Agonist
- Adverse Effects

A

Similar to TNFi
- Upper respiratory infection, GI, Aches

  • Decrease in Absolute Lymphocyte Count
  • Serious infections
  • Decrease Heart Rate
  • Macular Edema
  • Increase Liver Enzymes
77
Q

SP-1 Receptor Agonist
- Contraindications

A
  • Recent CV Event
  • AV block
  • Active infection
  • Use of MAOi
78
Q

Cyclosporine
- Onset

A

Rapid response within 1-2 weeks

79
Q

Cyclosporine
- Role

A

Induction for acute severe UC refractory to corticosteroids
- Not used much in CD

80
Q

Antibiotics
- Onset

A

Short 2-4 week courses (can be repeated)

81
Q

Antibiotics
- Role

A

Used in CD with perianal or colonic involvement
OR
Used in CD with fistulas

82
Q

Surgery
- Role

A

Used in:
- Strictures, abscesses
- Fistulae in CD
- Colectomy Curative in UC (Removal of diseased parts of colon)

PHARM 346 - Other (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions