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GI > Pharmacology Week 2 > Flashcards

Pharmacology Week 2 Flashcards

1
Q

Classes of Treatment for IBD & IBS

A 
Aminosalicylates
Corticosteroids
Antibiotics
Immunosuppressive agents
Biological agents
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2
Q

Characteristics to determine which treatment should be used

A

Severity of disease
UC
Crohn’s lesions locations
Exacerbations vs. maintenance

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3
Q

Drugs used for Treatment of IBD

A 
Aminosalicylates
Corticosteroids
Immunosuppresive agents
IV cyclosporine
Antibiotics
Immune modifiers
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4
Q

When do you use aminosalicylates in the treatment of IBD?

A

Mild to moderate UC & CD exacerbations

Maintenance of remission

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5
Q

When do you use corticosteroids in the treatment of IBD?

A

Treatment of UC & CD exacerbations

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6
Q

When do you use immunosuppressive meds in the treatment of IBD?

A

Maintain remission

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7
Q

When do you use IV cyclosporine in the treatment of IBD?

A

Severe active refractory UC

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8
Q

When do you use antibiotics in the treatment of IBD?

A

Acute exacerbations

Maintenance of remission

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9
Q

When do you use immune modifiers in the treatment of IBD?

A

Maintain remission in steroid refractory UC & CD

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10
Q

Examples of Aminosalicylates

A

Sulfasalazine (Azulfidine)
Mesalamine (Asacol, Pentasa)
Olsalazine (Dipentum)
Basalazide (Colazal)

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11
Q

Clinical Uses for Aminosalicylates

A

Induce/maintain remission in UC

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12
Q

Routes of Administration of Aminosalicylates

A

PO
Enema
Suppository

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13
Q

Suflasalazine (Asulfidine)

A

Preg. B

Converted to mesalamine in the proximal colon

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14
Q

Contraindications of Sulfasalazine (Asulfidine)

A

Sulfa allergy

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15
Q

Mesalamine (Asacol, Pentasa)

A

Preg B

Works like a topical agent due to being poorly absorbed

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16
Q

Drug Release of Asacol Oral Tablets

A

Distal ileum & colon

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17
Q

Drug Release of Pentasa Oral Capsules

A

Proximal small intestine and throughout the colon

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18
Q

Routes of Administration of Melalamine

A

Oral tablets (Asacol)
Oral capsules (Pentasa)
Enema
Rectal suppositories

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19
Q

Where can a mesalamine enema reach?

A

Distal/sigmoid colon

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20
Q

When are melamine rectal suppositories primarily used?

A

UC proctitis

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21
Q

Why are the aminosalicylates banalized (Colazal) and olsalazine (Dipentum) not used frequently?

A

Increased cost

No extra efficacy

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22
Q

MOA of Aminosalicylates

A

Blocks prostaglandin production
Interferes with production of inflammatory cytokines
Inhibit NK cells, lymphocytes & macrophages

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23
Q

Contraindications of Aminosalicylates

A

Aspirin/salicylate allergy

G6PD deficiency

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24
Q

SE of Sulfasalazine

A 
N/V
Photosensitivity
Oligospermia
Skin discoloration
Decreased folate levels
SJS
Crystalluria
Pancreatitis
Hepatitis
Bone marrow suppression
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25
Q

Labs to monitor with Sulfasalazine

A

CBC with diff

LFTs

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26
Q

SE of Mesalamine

A

Headache
Malaise
Abdominal pain
Diarrhea

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27
Q

SE of Olsalazine

A

Headache
Malaise
Abdominal pain
Severe secretory diarrhea

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28
Q

SE of Balsalazide

A 
Headache 
Malaise
Abdominal Pain
Diarrhea
Staining of teeth (capsule opened & sprinkled on food)
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29
Q

Monitoring of Mesalamine

A

Renal function
CBC
Hepatic function

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30
Q

Short Term SE of Steroids

A 
Hyperglycemia
Increased appetite
Insomnia
Anxiety
Tremors
Increased fluid retention
Increased BP
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31
Q

Long Term SE of Steroids

A 
Decreased bone mineral density
Fat redistribution
Ulcers from decreased prostaglandin production
Hypertriglyceridemia
Hirsutism
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32
Q

Examples of Oral Corticosteroids

A

Prednisone (Deltasone)
Prednisolone (Prelone)
Budesonide (Entocort)

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33
Q

What is the treatment of choice in patients with mild to moderate CD?

A

Budesonide (entocort)

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34
Q

Examples of Topical Corticosteroids

A

Cortenema
Cortifoam
Anusol-HC suppositories

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35
Q

Antibiotics used in IBD

A

Ciprofloxacin

Metronidazole

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36
Q

Duration of Ciprofloxacin Therapy in Crohn’s Disease

A

Up to 6 weeks

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37
Q

Duration of Metronidazole (Flagyl) in Crohn’s Disease

A

1-2 months for response

Up to 12 months total

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38
Q

Examples of Immune Modifiers

A

Azathioprine
6-mercaptopurine
Methotrexate
Infliximab

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39
Q

Clinical Use of Azathioprine & 6-Mercaptopurine

A

Induction/maintenance of remission
UC & Crohn’s
Allow reduction of steroids

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40
Q

Pregnancy Category of Azathioprine & 6-Mercaptopurine

A

Preg D

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41
Q

MOA of Azathioprine & 6-Mercaptopurine

A

Inhibition of purine nucleotide metabolism & DNA synthesis & repair
Inhibition of cell division/proliferation

42
Q

SE of Azathioprine & 6-Mercaptopurine

A 
N/V
Diarrhea
Fever, rash
pancreatitis
Bone marrow suppression
Hepatic toxicity
Arthralgias
Malaise
Drug toxicity
43
Q

Routine labs for monitoring Azathioprine & 6-Mercaptopurine

A

CBC

LFTs

44
Q

Dose changes and contraindications of Azathioprine & 6-Mercaptopurine

A

Contraindicated in pregnancy or active liver disease

Decreased dose of CrCl

45
Q

Clinical Use of Methotrexate

A

Induction & maintenance of remission in patients with Crohn’s disease

46
Q

MOA of Methotrexate

A

Inhibits metabolism of folic acid
Interferes with interleukin-1 inflammatory actions
Stimulate apoptosis of activated T lymphocytes

47
Q

Issues with Methotrexate

A

Preg X
Adjust dose for altered renal clearance
Contraindicated in pregnancy and liver disease

48
Q

SE of Methotrexate

A 
Alopecia
Muscositis
Bone marrow depression
megaloblastic anemia
Cirrhosis & liver fibrosis
Pneumonitis
Folic acid deficiency
Rash 
Nausea
Diarrhea
49
Q

Indications for Cyclosporine

A

Acute treatment of severe, steroid refractory exacerbations of UC in hospitalized patients

50
Q

SE of Cyclosporine

A

Nephrotoxicity
Hypomagnesemia
HTN

51
Q

Clinical Use for TNF Inhibitors

A

Symptomatic improvement in 2/3 patients with moderately severe Crohn’s
Disease remission in 1/3 patients with moderately severe or fistulizing Crohn’s
Not responding to steroids, 6-mercaptopurine or methotrexate

52
Q

Examples of TNF Inhibitors

A

Infliximab (Remicade)
Adalimumab (Humira)
Certolizumab Pegol (Cimzia)

53
Q

MOA of Infliximab (Remicade)

A

Dysregulation of the TH1 cell response present in IBD
Antibody to human TNF-alpha
Neutralizes membrane bound TNF

54
Q

Pregnancy Category of Infliximab (Remicade)

A

B

55
Q

SE of Immediate Infusion Reaction to Infliximab (Remicade)

A

Fever, chills
Pruritis, urticaria
Chest pain, dyspnea
Hemodynamic instability

56
Q

SE of Delayed Infusion Reaction to Infliximab (Remicade)

A

Myalgia, arthralgia
Fever
Rash, urticaria
Facial, hand, & lip edema

57
Q

How to treat immediate infusion reaction to Infliximab (Remicade)

A

Prophylactic Tylenol & Benadryl

58
Q

How to treat delayed infusion reaction to Infliximab (Remicade)

A

Antihistamines

Corticosteroids

59
Q

Black Box Warning of TNF Inhibitors

A

Reactivation of latent TB

60
Q

Treatment of Mild Distal UC

A

Oral/rectal aminosalicylate

Rectal corticosteroid

61
Q

Treatment of Mild Extensive UC

A

Oral aminosalicylate

62
Q

Treatment of Mild CD

A

Oral aminosalicylate

Antibiotics

63
Q

Treatment of Moderate Distal UC

A

Oral aminosalicylate

Oral/rectal steroids and/or immunosuppressive

64
Q

Treatment of Moderate Extensive UC

A

Oral aminosalicylate

Oral steroids and/or immunosuppressive

65
Q

Treatment of Moderate CD

A

Oral aminosalicylate

Oral steroid and/or immunosuppressive

66
Q

Treatment of Severe Distal UC

A

IV corticosteroids

IV cyclosporine

67
Q

Treatment of Severe Extensive UC

A

IV corticosteroids

IV cyclosporine

68
Q

Treatment of Severe CD

A

IV corticosteroids

IV cyclosporine

69
Q

Treatment of Remission of Distal UC

A

Oral/rectal aminosalicylate

Oral immunosuppressive

70
Q

Treatment of Remission of Extensive UC

A

Oral/rectal aminosalicylate

Oral immunosuppressive

71
Q

Treatment of Remission of CD

A

Oral aminosalicylate

Oral immunosuppressive

72
Q

Pharmacologic Therapy for IBS

A 
Antispasmodic agents
Antidiarrheal agents
Anticonstipation agents
Psychotropic agents
Serotonin receptor agonists & antagonists
Nonabsorbable antibiotics
Probiotics
73
Q

Pharmacotherapy for Constipation in IBS

A 
Increase fluids, fiber
TCAs or SSRIs
Peppermint oil
Osmotic laxatives
Lubiprostone
74
Q

Pharmacotherapy for Pain in IBS

A

Antispasmodics- anticholinergics
TCAs
SSRIs
Peppermint oil

75
Q

Pharmacotherapy for Diarrhea in IBS

A 
Fiber
Loperamide
Cholestramine
TCAs
Lotronex
SSRIs
76
Q

Types of Antispasmodics

A

Anticholinergics

Belladonna alkaloids

77
Q

Examples of Anticholinergic Antispasmodics

A

Hyoscyamine (Levbid, Levsin SL)

Dicyclomine (Bentyl)

78
Q

Examples of Belladonna Alkaloid Antispasmodics

A

Donnatol

Clidinium (Librax

79
Q

Pregnancy Category of Dicyclomine (Bentyl) and Hyoscyamine (Levsin, Levbid)

A

Pregnancy C

Pregnancy C

80
Q

MOA of Antispasmodics

A

Block acetylcholine at muscarinic cholinergic receptors

81
Q

Cautions of Antispasmodics

A 
Anticholinergic SE
Elderly
BPH
HTN
Hyperthyroidism
82
Q

Contraindications for Antispasmodics

A 
Peptic ulcer
Arrhythmias
CHF
Sever UC
Glaucoma
Myasthenia gravis
COPD
Infants
83
Q

First line Antispasmodic

A

Dicyclomine (Bentyl)

84
Q

Second-line Antispasmodic

A

Hyoscyamine Sulfate (Levbid, Levsin SL)

85
Q

What does antispasmodics treat in IBS?

A

Postprandial abdominal pain
Gas
Bloating
Fecal urgency

86
Q

Anticonstipation Agents in IBS

A

Miralax (polyethylene glycol)
Lubiprostone (Amitiza)
Linaclotide (Linzess)

87
Q

Which anti-constipation medication is an osmotic laxative?

A

Miralax (Polyethylene glycol)

88
Q

Which anti-constipation medications increase intestinal chloride & fluid secretion?

A

Lubiprostone (Amitiza)

Linaclotide (Linzess)

89
Q

MOA of Lubiprostone (Amitiza)

A

Locally acting calcium channel activator that increases intestinal fluid secretion

90
Q

SE of Lubiprostone (Amitiza)

A

Nausea
Diarrhea
Abdominal pain
Abdominal distention

91
Q

MOA of LInaclotide (Linzess)

A

Binds to GC-C receptor on luminal surface of the intestinal epithelium
Affects the chloride and bicarbonate levels in the intestine
Increases intestinal fluid & causes accelerated intestinal transit

92
Q

Examples of TCA’s for Treatment of IBS

A

Amitryptyline (Elavil)
Desipramine (Norpramin)
Imipramine (Tofranil)

93
Q

Examples of SSRI’s for Treatment of IBS

A 
Escitalopram (Lexapro)
Citalopram (Celexa)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
94
Q

MOA of TCA’s

A

Increasing pain threshold in the gut

Prolongs oral0cecal transit time

95
Q

Pregnancy Category of Imipramine, Amitriptyline, Desipramine

A

Pregnancy C
Pregnancy C
Pregnancy C

96
Q

Contraindications for TCA’s

A

Narrow angle glaucoma
Recent MI
MAOI’s or Fluoxetine (Prozac)

97
Q

Reason of SSRI’s in treatment of IBS

A

Lead to improvement in overall sense of well being

Little impact on abdominal pain or bowel symptoms

98
Q

Contraindications of Alosetron (Lotronex)

A

Hx of chronic/severe constipation or sequelae from thereof
Hx of ileus, obstruction, stricture, toxic megacolon
Hx of GI perforation, adhesions
Hx of ischemic colitis, impaired intestinal circulation
Hx of Crohn’s or UC
Hx of Diverticulitis or diverticulosis
Hx of thrombophlebitis or a hypercoagulable state

99
Q

Non-absorbable Antibiotics

A

Rifaximin (Xifaxan)

Refractory symptoms

100
Q

Probiotics that has shown modest improvement in symptoms in small studies

A

Bifodobacterium infantis

GI (20 decks)

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