PHRM 864: Therapeutics IV > IBD > Flashcards

IBD Flashcards

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1
Q

What is Inflammatory Bowel Disease?

A
  • Chronic or recurring immune response and inflammation of the gastrointestinal tract
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2
Q

What are the two types of of IBD?

A
  • Ulcerative Colitis [UC]
  • Crohn’s Disease [CD]
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3
Q

What is Ulcerative Colitis?

A
  • Inflammation limited to the rectum and colon [only in large intestines]
  • Smoking protects it??
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4
Q

What is Crohn’s Disease?

A
  • Inflammation of the GI tract that can affect any part from the mouth to the anus [has fistulas]
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5
Q

What is the treatment overview for IBD?

A
  • induce and maintain remission
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6
Q

What are some of the non-pharmacoloic therapies of IBD?

A
  • Nutrition Support: EN, PN [last line], Vitamins
  • Surgery: Proctocolectomy cures UC [removing colon = removed disease]
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7
Q

What are some of the classes that are used in the treatment of IBD?

A
  • ASAs
  • Corticosteroids
  • Immunomodulators
  • Biologics
  • Antimircrobials
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8
Q

What is are the ASA agents that are used in IBD?

A
  • Sulfasalazine = Sulfpyridine + 5-ASA [mesalamine]
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9
Q

What is the MOA for Sulfasalzine in IBD?

Which is ACTIVE or INACTIVE?

A
  • Cleaved by colon bacteria to release the sulfpyridine [absorbed] & 5-ASA [stays in lumen]
  • Sulfpyridine is INACTIVE
  • 5-ASA is ACTIVE [causing inflammation]
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10
Q

What is important to know about giving Mesalamine alone in IBD?

Indication? Dosage Forms?

A
  • Rapidly and completely absorbed in intestine BUT not in colon
  • Topical [enema: left-sided disease], Suppository [Proctitis], Oral
  • Topical > Oral; can combo
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11
Q

What are some of the Adverse Drug Reactions for ASA agents?

A
  • Sulfasalazine: N/V, Headache, rash, Hypersensitivity [SULFA]
  • Mesalamine: N/V, Headache, increased bleeding [no antiplatelet/coags/NSAIDS], pH affects [PPIs/H2RAs/Antacids]
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12
Q

What are Cortcosteroids good for in IBD?

MOA? Main Use?

A
  • MOA: anti-inflammatory
  • Used for induction NOT maintenance
  • Suppositories [Proctitis] & Enema [Left-sided disease]
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13
Q

What is the corticosteroid that is used?

A
  • Budesonide
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14
Q

What is important to know about Budsonide for IBD?

A
  • First pass metabolism [CYP3A inhibitor: ketoconazole, grapefruit = INCREASE exposure]
  • PO and Foam
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15
Q

What are the Systemic Cortiosteroids that are used in IBD?

A
  • Oral Prednisone & Prednisolone [IV methylprednisolone too]
  • TAPER
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16
Q

What are some of the Adverse Drug Reaction for Systemic Corticosteroids in IBD?

Short Term or Long Term?

A
  • Short Term: Hyperglycemia, Gastrits, Mood Swings, Increased BP
  • Long Term: Cataracts, Obesity, Growth Failure, Osteoporosis
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17
Q

What are the Immunosuppresive agents that are used in IBD?

A
  • Azathioprine [AZA]
  • Mercaptopurine [6-MP]
  • Cyclosporine
  • Methotrexate
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18
Q

What are Azathioprine & Mercaptopurine good for in IBD?

Place in treatment? Other Info?

A
  • Long Term treatment of UC & CD [for those that have faild 5-ASA & steriods] - good for Maintanence
  • AZA becomes 6-MP [Prodrug]
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19
Q

What are some of the Adverse Drug Reactions for Azathioprine & Mercaptopurine in IBD?

A
  • N/D/V, Bone Marrow Suppression, Hepatotoxicity, Fever, Rash
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20
Q

What are some Monitoring to know for Azathiopurine & Mercaptopurine in IBD?

A
  • TMPT, CBC, LFTs
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21
Q

What is important to know about Cyclosporine in IBD?

Indication? Dosage Forms?

A
  • NOT CD but good at Inducing remission in UC [not long term]
  • NOT for those that fail AZA & 6-MP
  • IV or PO
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22
Q

What are the Adverse Drug Reactions for Cyclosporine in IBD?

A
  • Nephrotoxity, Neurotoxicity, HTN, GI upset
  • Drug interactions: CYP3A & PGP
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23
Q

What are some of the Monitoring to do for Cyclosporine in IBD?

A
  • BP [bc of HTN], BUN/Scr, LFTs
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24
Q

What is important to know about Methotrexate in IBD?

Indication? Dosage Forms?

A
  • Used in CD for induction
  • SubQ or IM
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25
What are the Adverse Drug Reactions for Methotrexate in IBD? | Just like in RA?
- **Bone Marrow Suppression** [add folic acid], N/V/D, cirrhosis, rash, **TERATOGENIC**
26
What are some Monitoring to do for Methotrexate in IBD? | Just like in RA?
- CXR [chest xray], CBC, SCr, LFTs
27
What are the biologics that are used in IBD? | Three Categories?
- TNF-a Antagonist [**Infliximab**, Adalimumab, Golimumab, Cartolizumab] - Others [Natalizumab, Vedolizumab, Ustkinumab, Risankizumab, Mirikizumab] - Small Molecules [Tofacitnib, Upadacitinib, Ozanmiod, Estrasimod]
28
What are some of the general Adverse Drug Reactions for the TNF-a Inhibitors in IBD? | Just like in RA?
- Increased risk of infection [**PPD, CXR, Hep B/C; Up to date vaccines, NO live vaccines**] - **SubQ or IV** - Risk of Lymphoma, CHF
29
What are some of the general Monitoring for TNF-a Inhibitors in IBD? | Monitoring for basically ALL Biologics! Just like in RA?
- **CXR, PPD, Infections**, UA, CBC, SCr, LFT **Hep B & C**
30
What is important to know about Infliximab [Remicade] in IBD? | MOA? Indication? Place in Treatment?
- **UC & CD** for induction and maintenance - **IV** - Forming Antibodies [decrease response, D/C] | TNF a- Antagonist
31
What is some extra Monitoring for Infliximab in IBD?
- Infections, Vitals, Infusion Reactions, TDM
32
What is Adalimumab [Humira] good for in IBD? | Types of IBD? Dosage?
- **UC & CD** for inducation and maintenance of **Mod-Severe UC/CD** - Those that Failed Inflixumab - **SubQ** - Forming Antibodies | TNF-a Antagonist
33
What is important to know about Golimumab [Simponi] in IBD?
- **ONLY in UC** for induction and maintenance - **SubQ** - Forming Antibodies
34
What is important to know about Certolizumab [Cimzia] in IBD?
- **ONLY in CD** for induction and maintenance - **SubQ** - Forming Antibodies
35
What is Natalizumab [Tysabri] good for in IBD? | MOA? Type of IBD? Dosing?
- MOA: Anti-a-subunit [decrease inflammation] - **ONLY in CD** for induction and maintaining remission, those that fail TNF - **IV**
36
What are the Adverse Drug Reactions for Natalizumab in IBD? | One MAIN one
- **PML** [test for JC virus] - Similar to other biologics
37
What is Vedolizumab [Entyvio] good for in IBD? | MOA? Type of IBD? Dosage?
- Anti-a4b7 antinbody - **UC & CD** for induction and maintanence - **IV** - ADRs like biologics | "Other" Biologics
38
What is important to know about Ustekinumab [Stelara] in IBD? | MOA? Indication? Place in treatment?
- **IL-12 and IL-23** antagonist [IL is important for inflammation] - **UC & CD** for inducation [**IV**] and maintenance [**SubQ**]
39
What is important to know about Risankizumab-rzaa [Skyrizi] in IBD? | MOA? Indication? Dosage Forms?
- IL-23 antagonist - **CD** those that failed biologics including **Ustekizumab** for Induction [**IV**] and maintenance [**SubQ**]
40
What are the Adverse Drug Reactions for Risankizumab in IBD?
- **Headache, Nasopharyngitis, Abdominal Pain, Anemia, Nausea** - Forming Antibodies [PPD, Vaccines?, avoid live vaccines]
41
What is some of the monitoring for Risankizumab in IBD? | Typical ones?
- CXR, PPD, Hep B/C, Lipids, LFTs
42
What is important to know about Mirilizumab-mrkz [Omvoh] in IBD? | MOA? Indication? Dosage Forms?
- IL-23p19 antagonist - **UC** for those that failed biologics or JAK; induction [**IV**] and maintenance [**SubQ**]
43
What are the Adverse Drug Reactions for Miriklizumab in IBD?
- **Headache, Rash, injection site reactions** - Forming Antibodies [PPD, Vaccine?, Avoid live vaccine]
44
What are some monitoring to do for Mirikizumab in IBD?
- CXR, PPD, Hep B/C, Lipids, LFTs
45
What is the TDM of Biologics? | Think Table?
- Sub-therapeutic & Detect: Change drug same class - Sub-theraputic & Undetect: increase dose - Therapeutic & Detect: Change drug out of class - Theraputic & undetect: Change drug out of class
46
What is important to know abourt Tofacitinib [Xeljanz] in IBD? | MOA? Indication? Dosage Forms?
- **ORAL** JAK inhibitor [enzymes involved in immune signaling] - **ONLY of UC** for those that failed TNF and Biologics - NOT used with Immunosuppressants or biologics [combo]
47
What are the Adverse Drug Reactions of Tofacitinib in IBD?
- Diarrhea, increased cholesterol, headahce, herpes, rash, increased infection [**PPD, CXR, Hep B/C, Vaccine?, Avoid Live Vaccines**] - BLACK BOX WARNING: Cardiovascular issues
48
What are some monitoring for Tofacitnib for in IBD?
- CXR, PPD, Hep B/C, **ANC**, CBC, Lipids, LFTs, Infections
49
What is Upadacitinib [Rinvoq] good for in IBD? | MOA? Type of IBD? Dosage?
- **ORAL** JAK1 inhibitor [JAK is good for immune signaling] - **UC [8w] & CD [12w]** for those that have fail TNF
50
What are the Adverse Drug reactions for Upadacitinib in IBD? | Basically the same as Tofacitinib, Black Box Warning?
- **URT infection, Ance, Increased Cholesterol, Headache, Shingles** - BLACK BOX WARNING: Cardiovascular - Increased infections risk [**PPD, CXR, Hep B/C, Vaccine?, Avoid Live Vaccines**] | Only changeD for Tofactinib & URT/Ance Infections for Upadacitinib
51
What are some of the Monitoring to do for Upadacitinib in IBD?
- CXR, PPD, Hep B/C, **ANC/ALC**, CBC, Lipids, LFTs Infections | Has ANC?? what other one does too?
52
What is Ozanimod [Zeposia] good for in IBD? | MOA? Type of IBD? Place in Treatment
- **Oral S1P modulator** that prevents lymphocyte mobilization in inflammatory sites - **ONLY for UC** - **Induction and maintenance** | New Small Molecules
53
What are some contraindications for Ozanimod in IBD?
- Cardio issues - **Sleep Apnea** - Taking MAO inhibitors
54
What are the Adverse Drug Reactions for Ozanimod in IBD?
- **Increased Infection risk,PML** [really with the other drugs in this class so maybe with this one too], **Increased BP, Edema, Bradycardia** - Drug Interactions: MAO, CYP2C8 inhibitors and inducers
55
What are some of the monitoring for Ozanimod in IBD?
- CXR, PPD, Hep B/C, CBC, LFTs, Infections, **BP**, ECG | -imods have BP
56
What is important to know about Estrasimod [Velsipity] in IBD? | MOA? Indiction? Place in Treatment?
- **Oral S1P modulator**: prevents lymphocyte mobilization in inflammatory sites - **ONLY for UC** for **induction and maintenance** [10/2023] | Same as Ozanimod
57
What are some Adverse Drug Reactions for Estrasimod in IBD? | Like Ozanimod?
- **Increased infection risk, PML** [with other drugs within the same class], **Increased BP, Bradycardia, Edema** - Sleep Apnea? | Sleep Apnea is a contraindication?
58
What are some monitoring for Estrasimod in IBD?
- CXR, PPD, Hep B/C, CBC, LFTs, Infections, **BP**, ECG | -imods have BP
59
What are some Antimicrobials that are in IBD?
- Ciprofloxacin, metronidazole, Rifamycin - Maybe used in **CD with fistulas** - C. Diff
60
What dosage form to use for what UC issue in Mild-Moderate Active UC?
- **left-sided = enema** - **proctits = supp.** - **extensive = systemic**
61
What is some Oral and/or Topical medications to use for Mild-Moderate Active UC?
- ASA [Mesalamine > sulfasalazine] - **Extensive** --> oral 5-ASA - **Left-sided** --> Enema - **proctits** --> Supp. - Combo oral/topical is better
62
What should you do if 5-ASA is unresponsive in Mild-Moderate Active UC?
- Changing Formulation [increase dose, do Combo, change product]
63
What steroids might be used in Mild-Moderate Active UC?
- CR Budesonide [or pred] in oral or topical 5-ASA fails - PO corticosteroid - **NOT for maintenance, only for remission**
64
What is important to know about Moderate-Severe Active UC?
- **4-6 stools per day, +/- bloody stools** - **NO** methotrexate for induction or maintenance - **COMBO** TNF, Vedolizumab, or Ustekinumab with Thiopurine or MTX [decrease antibodies
65
What are some treatment options for Moderate-Severe Active UC?
- 5-ASA for moderate **NOT** severe - Systemic Corticosteroids [moderate use PO Budesonide] - Consider TNF [those that failed ASA & Steroids]
66
What are some medication class that are used in Moderate-Severe Active UC?
- TNF Inhibitor, Anti-Integrin, IL12/IL23 inhibitors, JAK inhibitors, S1P inhibitor
67
What is important to know about Severe-Fulminant Active UC?
- **6-10 Bowel Movements, NPO?** - Parenteral Corticosteroids [Methylprednisolone or Hydrocortisone x3-7d] - TNF [**Infliximab**] or Cyclosporine if failed IV steroids
68
What should you used for Maintenance of Remission in UC?
- Basically used what got you into remission [ASA, TNF, Azathioprine, or 6-MP] - Failed ASA or Steroids = Azathioprine or 6-MP
69
What is important to knwo about 5-ASA and Sulfasalazine in Mild-Moderate Active CD?
- Sulfasalamine = slight effect - 5-ASA = no effect
PHRM 864: Therapeutics IV
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