[Pharm] Treatments for IBD Flashcards
What are the (4) types of drugs used for Ulcerative Colitis?
5-ASA
Janus Kinase (JAK) inhibitors
TNF-alpha inhibitors
Alpha-4 integrin inhibitors
What are the (3) agents for Crohn Disease?
IL-12/23 inhibitors
TNF-alpha inhibitors
Alpha-4 integrin inhibitors
What is the common suffix used in the 5-ASA drugs?
(SALA)
Sulfasalazine
Mesalsamine
Olsalsazine
Balsalazide
What is the (1) JAK inhibitor?
Tofacitinib
What is the MOA of 5-ASA agents?
Inhibition of the PG and LT production via arachadonic acid pathway
What are the components of
Sulfasalazine
Sulfapyridine + 5-ASA
What are the components of
Mesalamine
Single 5-ASA
What are the components of
Olsalazine
2 molecules of 5-ASA
What are the components of
Balsalazide
Inert carrier + 5-ASA
All 5-ASA compounds are contraindicated in?
ASA-allergic patients
Sulfasalazine is contraindicated in?
Sulfa allergic pts.
What are the indications for 5-ASA agents?
Mild to moderate Ulcerative colitis
MOA of TNF-alpha inhibitors?
Binds to and neutralizes membrane associated and soluble TNF-alpha mediated proinflammatory cell signaling
This blocks leukocyte migration to the site of inflammation
What are the (4) TNF-alpha inhibitors?
Adalimumab
Infliximab
Golimumab
Certolizumab
What are the side effects of TNF-alpha inhibitors?
Infections
(Need to do TB testing pre-therapy)
What is a cute way to remember (2) drugs that are TNF-alpha inhibitors that can be used for both U.C and C.D?
Adalimumab
Infliximab
(You can ADD another disease process in to treat. You can INCLUDE another disease process to treat)
In the question stem, what are you looking for that would indicate to use a TNF-alpha inhibitor?
Using after a failed response from other therapy
Disease is moderate to severe
What is the one IV administered TNF-alpha inhibitor?
Infliximab
How are the remaining TNF-alpha inhibitors administered?
SQ
What is the MOA of alpha-4 integrin inhibitors?
Limits integrin’s-associated cell adhesion and subsequent trans-endothelial migration of leukocytes to site of inflammation
What are the (2) alpha integrin inhibitors?
Natalizumab
Vedolizumab
What is the major difference in targets b/w natalizumab and vedolizumab?
Natalizumab can bind to BOTH Alpha4Beta1 and Alpha4Beta7
while…
Vedolizumab can ONLY bind Alpha4Beta7
Describe if these drugs can treat just one or both CD and UC
Natalizumab
Vedolizumab
Natalizumab = CD
Vedolizumab = CD and UC
*Remember: The FEWER binding sites, the LESS specific the drug is
What is the MAJOR side effect of alpha-4 integrin inhibitors?
INFECTIONS
Specifically PML (progressive multifocal luckoencephalopathy)
What would be in the stem of a question that would indicate a alpha-4 integrin inhibitor would NOT be a good choice?
(Key risk factors)
Have been on this treatment for more than 2 years
Prior immunosuppressant treatment
Anti-JC virus antibodies
The family of alpha-4 integrin inhibitors are used for what severity of disease?
Moderate-Severe
What is the MOA of IL12/23 inhibitors?
Binds to the P40 subunit of IL12 and IL23 blocking activation and differentiation of naive T cells and activation of NK cells
What is the ONE IL-12/23 inhibitor?
Ustekinumab
What are the side effects of IL-12/23 inhibitors?
Infections!!!
(TB testing pre-therapy recommended)
MOA of janus kinase (JAK) inhibitors?
Bind to and inhibit JAK-1 and JAK-3
This inhibits gene transcription and more cytokine release
What is the ONE JAK inhibitor?
Tofacitinib
What are the side effects associated with Tofacitinib?
Lymphopenia
Neutropenia
What are the indications for JAK inhibitors?
Moderate to Severe UC
