Pharm for IBD and IBS

Question 1

What are the categories of drugs used for UC?

Answer 1

• 5-ASA
• Corticosteroids
• TNF-a inhibitors
• a-4 integrin ihibitors

Question 2

What is the “phrase” that helps you identify a 5-ASA for UC

Answer 2

SALA

Question 3

“phrase” in TNF-alpha inhibitors

Answer 3

MAB at the end

Question 4

what is the one a-4 integrin inhibitor used for UC?

Answer 4

Vedolizumab

Question 5

What is the one category of drug used for Crohns and not UC and what does it replace?

Answer 5

IL-12/23 inhibitors in place of the 5-ASAs used for UC

Question 6

what is the one IL-12/23 inhibitor for CD?

Answer 6

Ustekinumab

Question 7

What are the 2 TNF a inhibitors that are used for BOTH UC and CD

Answer 7

• Adalimumab

- Infliximab

Question 8

What is the 1 TNF a inhibitor only used for UC?

Only for CD?

Answer 8

Golimumab

Certolizumab (C with C)

Question 9

What is the extra a-4 integrin inhibitor that is used for CD and NOT UC?

Answer 9

Natalizumab

-Vedolizumab is used for both

Question 10

3 routes of administration for 5-ASA and how they relate to extent of UC

Answer 10

• Oral (may be released through GI tract)
• Rectal Enema (may reach splenic flexure)
• Rectal suppository (reach the upper rectum)

Question 11

MOA of 5-ASA

Answer 11

• inhibition of PG and LT production through COX and LOX pathways (arachindonic acid pathways)
• Reduction of PMN and macrophage chemotaxis
• may also inhibit NFkB

Question 12

Contraindications for 5-ASAs

Answer 12

• ASA allergic patients

- Sulfasalazine contraindicated in sulfonamide-allergic patients

Question 13

Indication for 5-ASA agents

Answer 13

-Mild to moderate active UC and maintenance of remission of UC

Question 14

Which 5-ASA ONLY for maintenance therapy?

ONLY for treatment of active disease?

Answer 14

• Olsalazine

- Balsalazide

Question 15

What is the other thing that sulfasolazine is indicated for?

Answer 15

Juvenile arthritis

Question 16

TNF-a inhibitors are what monoclonal antibodies?

except which one that is a fragment (Fab)?

Answer 16

IgG

Cerolizumab

Question 17

Side effects of TNF-a inhibitors

Answer 17

-infections . . TB testing pre therapy

Question 18

Indications for TNF-a inhibitors

Answer 18

Moderate to severe disease . . Active and maintenance

Question 19

TNF-a inhibitor: route is SQ every other week

Answer 19

Adalimumab

Question 20

TNF-a inhibitor: route is IV infusion every 8 weeks

Answer 20

Infliximab

Question 21

TNF-a inhibitor: route is SQ every 4 weeks for UC

Answer 21

Golimumab

Question 22

TNF-a inhibitor: route is SQ every 4 weeks for CD

Answer 22

Certolizumab

Question 23

Side effects for a-4 integrin inhibitors

Answer 23

-Infections . . . PML (progressive multifocal leukoencephalopathy)

Question 24

What are the risk factors for PML associated with a-4 integrin inhibitor treatment

Answer 24

• Treatment >2 years
• Prior immunosuppressant treatment
• anti-JC virus antibodies (JCV)

Question 25

Indication for a-4 integrin inhibitors

Answer 25

- moderate to severe treatment resistant CD and UC - Natalizumab for CD - Vedolizumab for BOTH

Question 26

Which a-4 integrin inhibitor is IV every 4 weeks? IV every 8 weeks?

Answer 26

- Natalizumab | - Vedolizumab

Question 27

Side effect of IL12/23 inhibitor

Answer 27

infections - TB testing pre therapy

Question 28

Indications for IL12/23 inhibitors

Answer 28

moderate to severe treatments resistant CD . . both active disease and maintenance

Question 29

administration of the IL-12/23 inhibitor Ustekinumab

Answer 29

- IV single infusion or | - SQ every 8 weeks for maintenance

Question 30

What are the different categories of drugs used for IBS?

Answer 30

- Antimuscarinic agents - Laxative agents - Anti-diarrheals - Opioid agonists/antagonists - Serotonin (5-HT) antagonists - Guanylate cyclase-C agonists - Selective chloride (C2) channel activators

Question 31

Which IBS category of drugs is used to treat the abdominal pain

Answer 31

anti muscarinics

Question 32

What are the 3 antimuscarinics used for IBS?

Answer 32

- Hyoscyamine - Dicyclomine - Clidinium/Chlordiazepoxide

Question 33

the 3 categories of IBS drugs that are used for Diarrhea and their specific names

Answer 33

- Anti-diarrheals (Loperamide Diphenoxylate . . Bismuth) - Opioid Agonist/Antagonist (Eluxadoline) - Serotonin (5-HT) antagonist (Alosetron)

Question 34

side effects of Loperamide

Answer 34

-typical anticholinergic effects

Question 35

Side effects of Alosetron . . 5-HT inhibitor

Answer 35

- Ischemic colitis | - also constipation

Question 36

Indication for Alosetron use

Answer 36

-WOMEN with chronic, severe IBS-D not responsive to other conventional therapies

Question 37

What are the IBS drug categories used for Constipation and what are the specific names

Answer 37

- Guanylate cyclase-C agonists (Linaclotide) | - Selective Chloride (C2) channel activators (Lubiprostone)