[Pharm] Treatments for IBD

Question 1

What are the (4) types of drugs used for Ulcerative Colitis?

Answer 1

5-ASA

Janus Kinase (JAK) inhibitors

TNF-alpha inhibitors

Alpha-4 integrin inhibitors

Question 2

What are the (3) agents for Crohn Disease?

Answer 2

IL-12/23 inhibitors

TNF-alpha inhibitors

Alpha-4 integrin inhibitors

Question 3

What is the common suffix used in the 5-ASA drugs?

Answer 3

(SALA)

Sulfasalazine

Mesalsamine

Olsalsazine

Balsalazide

Question 4

What is the (1) JAK inhibitor?

Answer 4

Tofacitinib

Question 5

What is the MOA of 5-ASA agents?

Answer 5

Inhibition of the PG and LT production via arachadonic acid pathway

Question 6

What are the components of

Sulfasalazine

Answer 6

Sulfapyridine + 5-ASA

Question 7

What are the components of

Mesalamine

Answer 7

Single 5-ASA

Question 8

What are the components of

Olsalazine

Answer 8

2 molecules of 5-ASA

Question 9

What are the components of

Balsalazide

Answer 9

Inert carrier + 5-ASA

Question 10

All 5-ASA compounds are contraindicated in?

Answer 10

ASA-allergic patients

Question 11

Sulfasalazine is contraindicated in?

Answer 11

Sulfa allergic pts.

Question 12

What are the indications for 5-ASA agents?

Answer 12

Mild to moderate Ulcerative colitis

Question 13

MOA of TNF-alpha inhibitors?

Answer 13

Binds to and neutralizes membrane associated and soluble TNF-alpha mediated proinflammatory cell signaling

This blocks leukocyte migration to the site of inflammation

Question 14

What are the (4) TNF-alpha inhibitors?

Answer 14

Adalimumab

Infliximab

Golimumab

Certolizumab

Question 15

What are the side effects of TNF-alpha inhibitors?

Answer 15

Infections

(Need to do TB testing pre-therapy)

Question 16

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?

Answer 16

Adalimumab

Infliximab

(You can ADD another disease process in to treat. You can INCLUDE another disease process to treat)

Question 17

In the question stem, what are you looking for that would indicate to use a TNF-alpha inhibitor?

Answer 17

Using after a failed response from other therapy

Disease is moderate to severe

Question 18

What is the one IV administered TNF-alpha inhibitor?

Answer 18

Infliximab

Question 19

How are the remaining TNF-alpha inhibitors administered?

Answer 19

SQ

Question 20

What is the MOA of alpha-4 integrin inhibitors?

Answer 20

Limits integrin’s-associated cell adhesion and subsequent trans-endothelial migration of leukocytes to site of inflammation

Question 21

What are the (2) alpha integrin inhibitors?

Answer 21

Natalizumab

Vedolizumab

Question 22

What is the major difference in targets b/w natalizumab and vedolizumab?

Answer 22

Natalizumab can bind to BOTH Alpha4Beta1 and Alpha4Beta7

while…

Vedolizumab can ONLY bind Alpha4Beta7

Question 23

Describe if these drugs can treat just one or both CD and UC

Natalizumab

Vedolizumab

Answer 23

Natalizumab = CD

Vedolizumab = CD and UC

*Remember: The FEWER binding sites, the LESS specific the drug is

Question 24

What is the MAJOR side effect of alpha-4 integrin inhibitors?

Answer 24

INFECTIONS

Specifically PML (progressive multifocal luckoencephalopathy)

Question 25

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)

Answer 25

Have been on this treatment for **more than 2 years** Prior **immunosuppressant treatment** **Anti-JC virus antibodies**

Question 26

The family of **alpha-4 integrin inhibitors** are used for what severity of disease?

Answer 26

Moderate-Severe

Question 27

What is the MOA of **IL12/23 inhibitors?**

Answer 27

Binds to the **P40 subunit** of **IL12** and **IL23** blocking activation and differentiation of naive T cells and activation of NK cells

Question 28

What is the ONE IL-12/23 inhibitor?

Answer 28

Ustekinumab

Question 29

What are the side effects of **IL-12/23 inhibitors?**

Answer 29

Infections!!! (TB testing pre-therapy recommended)

Question 30

MOA of **janus kinase (JAK) inhibitors?**

Answer 30

Bind to and inhibit **JAK-1** and **JAK-3** This inhibits gene transcription and more cytokine release

Question 31

What is the ONE **JAK inhibitor?**

Answer 31

Tofacitinib

Question 32

What are the side effects associated with **Tofacitinib?**

Answer 32

Lymphopenia Neutropenia

Question 33

What are the indications for **JAK inhibitors?**

Answer 33

Moderate to Severe **UC**