Anti-emetics & IBD Tx - Fitz

Question 1

Which drug is a first line therapy for mild/moderate ulcerative colitis, but is INNEFFECTIVE for Crohn’s Disease?

Answer 1

Aminosalicylates!

Question 2

Which IBD salicylates work in what parts of the GI tract?

Answer 2

Colon only:
Balsalazide, Olsalazine, Sulfasalazine

Small Bowel to Rectum:
Mesalamine

Question 3

The thing you hate the most about meds are their side effects. How do you feel about the aminosalicylates used for IBS?

Answer 3

You love all the aminosalicylates!
With the exception of one!

Sulfasalazine! (YOU LOATHE IT)

• The sulfa that is cleaved off can cause hypersensitivity reaction and decreased folate absorption
• 40% Gi upset, headache, arthralgia, bone marrow suppression

Question 4

What corticosteroids are used for moderate to severe Crohn’s?

Answer 4

Prednisone, prednisolone

Question 5

What is the overall way that corticosteroids and antimetabolites work to treat Crohn’s?

Answer 5

Both work by immune suprression

Question 6

How is Budesonide work differently that other corticosteroids? USed in what severity of Crohn’s?

Answer 6

It has local rather than systemic effect in the lung and GI tract (oral controlled-release)

It is used in mild-moderate CD involving ileum and proximal colon

Question 7

Atimetabolites are given in low doses for maintenance and remission of UC and CD. What are three of these drugs?

Answer 7

Azathioprine
6-Mercaptopurine
Methotrexate

Question 8

How does infliximab work?

Answer 8

It decreases TNF-alpha, which is inappropriately increased in IBD.

Question 9

Why on earth would you test a patient for Tb before gibing them infliximab?

Answer 9

One of the side effects is reactivating Tb.

Infections can be a big problem because you are targeting a suppressing the immune system

Question 10

What cancer problem do you have to worry about when treating with infliximab?

Answer 10

Elevated risk of lymphoma

Question 11

Your 5 year old ingests a very corrosive poison. Your friend rifles through his cabinet and finds some Ipecac. Should you use it?

Answer 11

No!
OTC sales of ipecac are banned,

Administration of ipecac is dangerous is the poison in corrosive, a petroleum distillate, or a rapid-acting anti-convulsant

Question 12

Most effective agent for treatment of motion sickness?

Answer 12

Scopalamine

Question 13

You are an oncologist and are administering cisplatin to a patient with small cell lung cancer. Her biggest complain is the nausea. What drug would be MOST effective to reduce emesis?

Answer 13

The “-setrons”

```
5HT3 Antagonists
Dolasetron
Granisetron
Ondansetron
Palonosetron
~~~

Question 14

What drug is given by transdermal patch to treat motion sickness?

Answer 14

Scopolamine

Its a dopaminergic and muscarinic receptor antagonist in the cerebelleum

Question 15

How does aprepitant and fosaprepitant work?

Answer 15

• Substance P receptor antagonist

- NK1 receptor antagonist

Question 16

Aprepitant shouldn’t be given along with chemo drugs like taxels, etoposides, and Vinca alkalods?

Answer 16

Some chemo agents like those listed are metabolized by CYP3A4.
Aprepitant is also metabolized by CYP3A4, so it can really increase side effects like bone marrow suppression in the antineoplastics

Question 17

What are three of the antihistamines used as antiemetics?

Answer 17

Dimenhydrinate
Diphenhydramine (dramamine)
Meclizine

Question 18

BY what mechanism do drugs like Droperidol, Metoclopramide, and Prochlorperazine work?

Answer 18

D2 receptor antagonists on the D2 receptors of the CTZ

Question 19

Name 2 antiemetics drugs (of the same class) that have side effects of euphoria, hallucinations, sedation, dry mouth, and increased appetite:

Answer 19

Dronabinol and Nabilone

cannabinoids

Question 20

Where is the Chemoreceptive Trigger Zone (CTZ) located?

Be specific:

Answer 20

Located in the Area Postrema on the floor of the 4th Ventricle

REMEMBER: Although the CTZ is in the brainstem, it is found outside the BBB

Question 21

What treatment is used to bind toxins in the upper Gi?

Answer 21

Activated charcoal

Remember you must give it in a 10:1 ratio

Question 22

What treatment would you use for decontaminating the colon of an individual who was trying to sneak drugs over the border in his rectum?

Answer 22

Polyethylene Glycol-Electrolyte Solution

Note: Same thing you give people to prep before an endoscopy

Question 23

2 Weeks after beginning treatment for Ulcerative colitis, a 16 year old girl develops a skin rash and fulminant hepatic failure. Exploratory surgery revealed necrotizing pancreatitis and haptic necrosis consistent with the drug treatment she was on.
What is the drug?

Answer 23

Sulfasalzine!

hate that one…

Question 24

What is the primary site of action of 5HT3 antagonists with respect to their use as antiemetics?

Answer 24

GI tract!

Question 25

What are the primary sites of action for the opioid and NK1 antiemetics?

Answer 25

Opioids - the CTZ (outside the BBB)

NK1 - Inside the BBB (central)

Question 26

Why do drugs like osalazine and basalazine act on a more restircted region of GI than mesalamine does?

Answer 26

They must be modified by colonic bacteria to be activated!

Question 27

What lab test do you perform EVERY TIME before starting infliximab?

Answer 27

Mantoux test!

This drug can lead to TB reactivation!

(Cuz it blocks TNF-Alpha and really suppresses the immune system)

Question 28

Which of the following drugs is LEAST likely to be used for IBD tx?

• Azithoprine
• Infliximab
• Acetylsalicylic Acid
• Methotrexate
• Prednisone

Answer 28

Acetylsalicylic Acid!

The rest can be used, remember only 5-ASA’s can be used for IBD, not normal ASA’s!