Pharm of IBD and IBS - Segars Flashcards
what is the primary goal of IBD therapy?
achieve and maintain remission (few to no symptoms)
what is the secondary goal of IBD therapy?
- preserve intestinal function
- resolve presence of fistulizing disease (CD)
- decrease risk of surgery
- maintain steroid-free remission
what are the major class of drugs used for UC?
- 5ASA
- Corticosteroids
- TNF-a Inhibitors
- a-4 integrin inhibitors
what drugs have –sala- in the middle
5-ASA drugs used for UC
What are the TNF-a inhibitors used for UC
All end in mab
- Adalimumab
- golimumab
- infliximab
what is the a-4 integrin inhibitor used for UC
Vedolizumab
what catregories of drugs are used for Crohns disease?
- IL-12/23 inhibitors
- Corticosteroids
- TNF-a inhibitors
- a-4 integrin inhibitors
What is the IL-12/23 inhibitor used for Crohns
Ustekinumab
What TNF-a inhibitors are used for Crohns
- adalimumab
- certolizumab
- Infliximab
Adalimumab and infiximab are also used for (UC)
what a-4 integrin inhibitors are used for Crohns
Natalizumab and vedolizumab.
vedolizumab is also used for UC
what is the MOA of 5-ASA?
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 )
what are the contraindications for 5-ASA as used in IBD
- contraindicated in ASA allergy
- Sulfasalazine contraindicated in sulfonamide-allergic pts
what is the indication of 5-ASA
mild to moderate active UC and Maintenance of remission of UC.
which 5-ASA agent is only used for maintenance of UC?
Olsalazine
which 5-ASA agent is used only for treatment of active disease?
Balsalazide
what is the MOA of TNF-a inhibitors?
- neutralize membrane-associated and soluble human TNF-a mediated proinflammatory cell signaling (inhibits TNF-a mediated actions)
- inhibit expression of pro-inflammatory genes
what is a serious potential side effect of TNF-a inhibitors?
- Infections (TB testing pre-therapy required)
what is the indication of TNF-a inhibitors?
- Adalimumab: UC and CD
- Infliximab: UC and CD- only one that’s given IV. all other are SQ
- Golimumab: UC only
- Certolizumab: CD only
what is the MOA for a-4 integrin inhibitors?
- limits integrin-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue
Side effect of a-4 integrin inhibitors
Infection: PML - 3 risk factors: treatment >2 yrs; prior immunosuppressant, and anti-JC virus antibodies
what are the indication for a-4-integrin inhibitors?
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
what is the MOA of interluekin (Il12/23) inhibitors?
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
Side effect of Interleukin (IL12/23) inhibitors:
Infection: TB testing pre therapy recommended
what is Interluekin (IL12/23) inhibitor used for?
treatment resistant CD both active and maintenance
