Tx for IBD Flashcards
what are the side effects of TNF-a inhibitors
black box warning for serious INFXN (-mab at the end)
DO TB TEST BEFORE THERAPY BC COULD ACTIVATE LATENT TB
liver toxicity (increased enzyme)
rare but severe = derm (EM, SJS, TEN) or malignancies
what drug classes are indicated for CD
IL-12/23 (-)
TNF-a (-)
a-4 integrin (-)
What are side effects of JAK (-)
lymphopenia/lymphocytosis
neutropenia/anemia
increases in LDL & HDL
rare = malignancies / serious infxn
what is the MOA of a-integrin (-)
limit integrin’s associated cell adhesion and subsequent trans-endothelial migration of leukocytes to site of inflam
a4B1 (CNS) & a4B7 (GI)
what agents are classified as 5-ASA & what are indications/contraindications
list special charachteristics for each if they have any
sulfaSALAzine = sulfa + 5-ASA = DO NOT USE IN PT W/ SULFA ALLERGY
meSALAmine= single
olSALAzine= 2 molecules - ONLY for maintenance
balSALAzide = inert carrier + 5-ASA - ONLY for active dz
=mild-mod UC (active/maintenance)
ALL contraindicated in ASA-allergic pts
what is the MOA JAK (-)
what drug is the under this classification & what is the indication
bind to (-) free-floating and bound JAK-1 & JAK-3 - thereby ultimately (-) gene transcription & (-) cytokine release
tofacitinib -inhibit JAK-1 & 3 - active & maintainence mod-severe UC; po
what are the side effects of IL-12/23 (-)
INFXN
test pt for TB prior to prescribing
infusion/injxn related allergic rxn
rare = malignancy
what drug classes are used for UC
5-ASA (-sala-)
JAK (-)
IL-12/23 (-)
TNF-a (-)
a-4 integrin (-)
what is the MOA of 5-ASA
(-) PG & LK via arachindonic acid path ( - COX & LIPOX)
reduce PMN & macrophage chemotaxis –> (-) NF-KB activation
what is the MOA of IL-12/23 (-)
what is the medication under this classification & its use?
bind p40-subunit of IL-12 & 23 –> block activation & differentiation of naive T cells & activation of NK cells -> inhibit pro-inflam cytokines
=Ustekinumab = active & maintenance of mod - severe BOTH; subQ injxn 8 wks
for pt intolerant or resistant to conventional immune modulators, steroids or TNF-a (-)
what are the side effects of a-4 integrin (-)
INFXN (-mab)
Black box warning: PML associated w/ john cunningham virus) ; RF = >2 yr tx, prior immunosuppressant tx, anti-JCV Ab
infusion related SE
anti-med Ab (decrease efficacy)
rare - increased risk malignancy (vedolizumab)
list the TNF-a (-) & thier respective indications
adalimumab (BOTH)
infliximab (IV). (BOTH)
golimumab (UC only)
certolizumab (CD only)
all = SQ injxn except infliximab (IV)
all = mod-severe (active/maintenance) EXCEPT infliximab for UC (only severe)
what is the MOA of TNF-a (-)
bind & neutralize membrane associated & soluble TNF-a –> prevent upregulation of VCAM, E-selectin & MAdCAM –> block leukocyte migration
(use after inadequate response to conventional/immunosuppressant therapy)
what are the a-4 integrin (-)
natalizumab (a4B1 & a4B7) = mod - severe CD; IV- 4 wk
vedolizumab (a4B7 only) mod - severe BOTH; IV 8 wk
active/maintenance
recommended for use after inadequate response to TNF-a (-)
= natalizumab not as combo w/ immunosuppressant
what are the formulation choices of 5-ASA
oral = varies by agent - released in distal/terminal ileum, colon, of thru-out GI tract
rectal enema: may reach splenic flexure ; do not freq concentrate in rectum
rectal suppositories - reach upper rectum (local therapy)
