Inflammatory Bowel Disease (IBD) Flashcards
What 2 diseases make up Inflammatory Bowel Disease (IBD)
Crohn’s and ulcerative colitis are both diseases in IBD
IBD: Goals of Treatment
4
No cure
- Suppress inflammatory response–Chronic inflammation can cause permanent damage
- Induce remission
- Prevent complications
- Maintain remission
IBD: Drug Classes (5)
- 5-aminosalicylic acid derivatives (5-ASA)
- Steroids: topical and systemic
- Antibiotics
- Immunomodulators
- Biologics
what is 5-ASA MOA?
o Decrease PG and leukotriene synthesis
o Inhibit cytokine synthesis
o Free radical scavenging
o Immunosuppressive activity
IS 5-ASA mainly for UC or Chron’s
UC
5-ASA Drug products (4)
o Sulfasalazine
o Mesalamine: actual 5-ASA moiety
o Olsalazine (Dipentum)
o Balsalazide (Colazal)
5-ASA: ADRs
- Worse with sulfasalazine but any can have
- Idiosyncratic: hypersensitivity rash, fever, pancreatitis, bone marrow suppression, hepatitis
- Dose-related: n/v/d, HA, anorexia, dyspepsia
- Sulfasalazine: oligospermia (reversible)-means low sperm count
oligospermia is associated with what 5-ASA?
Sulfasalazine
if pts have ADRs on 5-ASA should you rechallenge the medication?
no
What are corticosteroids mainly used for in Inflammatory Bowel Disease
Mainly used to induce remission during acute episodes
should you use topical corticosteroids in chron’s or UC
UC
Can’t do topical if problem is in small intestine, usually do per rectum for UC
For UC flares, best to try ______ application if patient tolerates
intraluminal
what is the drug name of the corticosteroid commonly used for IBD
Budesonide (Entocort)
what is the formulation of Budesonide (Entocort)
controlled ileal release formulation
Antibiotics helped with what in IBD?
Helps with acute flares
Good for septic complications and some for primary disease processes
What antibiotics are commonly used in combination to treat IBD
Metronidazole + ciprofloxacin
Rationale for using antibiotics in IBD
o Decrease concentrations of bacteria in gut lumen
o Alter composition of gut flora
o Decrease bacterial tissue invasion and treat microabscesses
o Decrease bacterial translocation
When is Immunomodulator Therapy used in IBD?
Used for refractory disease
what are the drug names of the Immunomodulators
- Azathioprine (AZA): prodrug of 6-MP
- 6-mercaptopurine (6-MP)
- Methotrexate
MOA of Immunomodulators
DNA synthesis inhibitors
Immunomodulators ADRs
o Bone marrow suppression, liver dysfunction, hypersensitivity reactions, nausea
o Increased risk for infections and cancer
Biologics drug names all end in
MAB
Biologics: ADRs
- Injection site/infusion reactions
- Neutropenia
- Infections
- Heart failure
- Malignancy
- Demyelinating disease
