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GI 2 Final > Pharm of IBD and IBS - Segars > Flashcards

Pharm of IBD and IBS - Segars Flashcards

1
Q

what is the primary goal of IBD therapy?

A

achieve and maintain remission (few to no symptoms)

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2
Q

what is the secondary goal of IBD therapy?

A
  • preserve intestinal function
  • resolve presence of fistulizing disease (CD)
  • decrease risk of surgery
  • maintain steroid-free remission
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3
Q

what are the major class of drugs used for UC?

A
  • 5ASA
  • Corticosteroids
  • TNF-a Inhibitors
  • a-4 integrin inhibitors
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4
Q

what drugs have –sala- in the middle

A

5-ASA drugs used for UC

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5
Q

What are the TNF-a inhibitors used for UC

A

All end in mab

  • Adalimumab
  • golimumab
  • infliximab
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6
Q

what is the a-4 integrin inhibitor used for UC

A

Vedolizumab

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7
Q

what catregories of drugs are used for Crohns disease?

A
  • IL-12/23 inhibitors
  • Corticosteroids
  • TNF-a inhibitors
  • a-4 integrin inhibitors
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8
Q

What is the IL-12/23 inhibitor used for Crohns

A

Ustekinumab

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9
Q

What TNF-a inhibitors are used for Crohns

A
  • adalimumab
  • certolizumab
  • Infliximab

Adalimumab and infiximab are also used for (UC)

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10
Q

what a-4 integrin inhibitors are used for Crohns

A

Natalizumab and vedolizumab.

vedolizumab is also used for UC

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11
Q

what is the MOA of 5-ASA?

A

Inhibition of PG and LT (tx-A) production via arachidonic acid pathway (similar to aspirin)
- reduce PMN and macrophage chemotaxis (may also inhibit activatio of NF-kB )

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12
Q

what are the contraindications for 5-ASA as used in IBD

A
  • contraindicated in ASA allergy

- Sulfasalazine contraindicated in sulfonamide-allergic pts

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13
Q

what is the indication of 5-ASA

A

mild to moderate active UC and Maintenance of remission of UC.

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14
Q

which 5-ASA agent is only used for maintenance of UC?

A

Olsalazine

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15
Q

which 5-ASA agent is used only for treatment of active disease?

A

Balsalazide

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16
Q

what is the MOA of TNF-a inhibitors?

A
  • neutralize membrane-associated and soluble human TNF-a mediated proinflammatory cell signaling (inhibits TNF-a mediated actions)
  • inhibit expression of pro-inflammatory genes
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17
Q

what is a serious potential side effect of TNF-a inhibitors?

A
  • Infections (TB testing pre-therapy required)
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18
Q

what is the indication of TNF-a inhibitors?

A
  • Adalimumab: UC and CD
  • Infliximab: UC and CD- only one that’s given IV. all other are SQ
  • Golimumab: UC only
  • Certolizumab: CD only
19
Q

what is the MOA for a-4 integrin inhibitors?

A
  • limits integrin-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue
20
Q

Side effect of a-4 integrin inhibitors

A

Infection: PML - 3 risk factors: treatment >2 yrs; prior immunosuppressant, and anti-JC virus antibodies

21
Q

what are the indication for a-4-integrin inhibitors?

A

Natalizumab: Moderate to severe treatment resistant CD and maintenance therapy to prevent relapse

Vedolizumab: Both UC and CD - moderate to severe treatment resistant and maintenance

22
Q

what is the MOA of interluekin (Il12/23) inhibitors?

A

bind to specific subunit of IL-12/23 reeptor located on surface of T cells and natural killer cells and inhibit signal transduction-related activities and production of pro-inflammatory TH1 and 17

23
Q

Side effect of Interleukin (IL12/23) inhibitors:

A

Infection: TB testing pre therapy recommended

24
Q

what is Interluekin (IL12/23) inhibitor used for?

A

treatment resistant CD both active and maintenance

25
Q

In pts with IBS, what drugs are used for abd pain?

A

antimuscarinic agents such as hyoscyamine, dicyclomine, clidnium/chlordiazepoxide

26
Q

what is the MOA for antimuscuarinics used for IBS

A

competitively inhibit autonomic, post-ganglionic cholinergic recetprs (multiple sites)

27
Q

Side effects of antimuscularinics

A

class anticholingeric based effects: dry mouth, urinary retenion, constipation, drowsiness, confusion, blurred vision etc

28
Q

what group of drugs are used for diarrhea in IBS?

A
  • Anti-diarrheals
  • opioids agonists/antagonists
  • Serotonin antagonists
29
Q

what are the anti diarrheal drugs used in IBS

A

loperamide

diphenoxylate

30
Q

what is the opioids used for diarrhea in IBS

A

eluxadoline

31
Q

what is the serotonin antagonist used in iBS for diarrhea

A

alosetron

32
Q

what is the MOA of loperamide?

A
  • interferes with peristalsis by a direction action on circular and longitudinal muscles of intestinal wall, slowing motility
  • also may directly inhibit fluid and electrolyte secretion and/or increase water absorption
33
Q

what is the MOA of alosetron

A

selectively blocks GI-based 5HT3 receptors

34
Q

what is a concerning side effect of alosetron

A

Ischemic colitis

35
Q

what is the indication for alosetron?

A
  • women with chronic severe IBS-D, not responsible to other conventional therapies
36
Q

what is the MOA of Eluxadoline?

A
  • agonist at opioid mu and kappa receptors in GI tract

- antagonist at delta opioid receptors in GI tract

37
Q

Side effects of eluxadoline

A

GI-related

  • hepatic/pancreatic toxicity
  • CNS-related
38
Q

what group of drugs are used for constipation in IBS

A
  • Guanylate cyclase agonist (linaclotide)

- selective chloride channel activators (lubiprostone)

39
Q

what is the MOA of linaclotide

A

binds to guanylate cyclase-C on luminal surface and increase cGMP –> stimulates secretion of Cl/bicarb into intestinal lumen via CFTR ion channel –> increased intestinal fluid and accelerated transit

40
Q

Side effect of Linaclotide

A
  • diarrhea

- Other GI issues

41
Q

Indication of linaclotide

A

IBS-C

- chronic idiopathic constipation (not supported under 17)

42
Q

what is the MOA of lubiprostone

A

activates specific CIC-2 chloride channel in luminal cells of intestinal epithelium –> produce Cl rich intesinal fluid secretion w/o altering serum electrolyte concentration

43
Q

side effects of lubiprostone

A

Nausea, dyspepsia, dizziness

44
Q

Indication of lubiprostone

A

IBS-C

- chronic idiopathic constipation (CIC) in adults

GI 2 Final (11 decks)

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