UC

Question 1

sulfasalazine (azulfidine)

Answer 1

1st line tx and maintenance of UC
sulfpyridine abx absorbed and mesalamine in colon as anti-inflammatory
SE: allergic rxn to sulfa, HA, NV, folic acid deficiency
-not expensive

Question 2

mesalamine capsules (pentasa)

Answer 2

1st line for tx and maintenance of UC
can be used in crohn’s
SE: HA, NV

Question 3

mesalamine tabs (asacol, apriso, lialda)

Answer 3

1st line in tx and maintenance of UC
asacol- tid wf
apriso- qd w/o meal
lialda- qd wf
-more specific to colon than sulfasalazine

Question 4

mesalamine suppositories and rectal suspension (canasa and rowasa)

Answer 4

1st line agent for UC if significant rectal involvement

Question 5

olsalazine caps (dipentum)

Answer 5

more costly agent used to tx UC if pts can’t tolerate sulfasalazine
dimer of mesalamine
SE: diarrhea

Question 6

balsalazide caps (colazal)

Answer 6

more $ for pts who can’t take sulfasalazine

mesalamine bound with azo bond, but quicker remission than mesalamine

Question 7

hydrocortisone retention enema (cortenema)

and hydrocorisone intrarectal foam (cortifoam)

Answer 7

tx of UC patients that primarily have rectal disease
don’t use for maintenance
AE: pituitary axis suppression

Question 8

transdermal nicotine

Answer 8

combined with mesalamine for UC

Question 9

systemic glucocorticoids and ACTH

Answer 9

for UC in pts that don’t respond to msalamine or patients with moderate to severe disease
don’t use in maintenance

Question 10

Azathioprine (imuran)

Answer 10

metabolized to 6MP that interferes with DNA/RNA synthesis
used for maintenance of UC with mesalamine
SE: leucopenia, infections, pancreatitis
interaction: allopurinol inhibits XO which inactivates 6MP

Question 11

Methotrexate

Answer 11

immunosuppressive- # dihydrofolate reductase- leads to impaired DNA synthesis
used if azathioprine not tolerated
SE: bone marrow suppression, liver dysfxn, diarrhea, infections

Question 12

infliximab (remicade)

Answer 12

tx of moderate to severe UC that is refractory or intolerant to steroids
MAb to TNF
SE: infections, tb, hepatitis, sepsis, increased risk of lymphoma, can worsen heart failure, liver failure, very $$

Question 13

adalimumab (humira)

Answer 13

tx of moderate to severe UC that is refractory or intolerant to conventional tx
MAb to TNF
SE: URT infections, tb, hepatitis, sepsis, malignancies, worsening heart failure, $$

Question 14

cyclosporine (sandimmune, neoral)

Answer 14

immunosuppressive that # IL2 and gamma IFN
used to tx UC refractory to steroids- not used as maintenance
SE: nephrotoxicity, hypertension, tremor
lots of drug interactions