IBD Pharm

Question 1

Drug Classes for UC

Answer 1

• 5-ASA**
• Corticosteroids
• TNF-alpha inhibitors
• alpha-4 integrin inhibitors

Question 2

Drug Classes for CD

Answer 2

• IL-12/23 inhibitors**
• Corticosteroids
• TNF-alpha inhibitors
• alpha-4 integrin inhibitors

Question 3

UC- 5-ASA- drugs

Answer 3

-SulfaSALAzine (sulfapyridine + 5-ASA)
-MeSALAmine (single 5-ASA)
-OlSALAzine (2 molecules of 5-ASA)
-BalSALAzide (inert carrier + 5-ASA)
(SMOB)

Question 4

UC- TNF-alpha inhibitors- drugs

Answer 4

• AdalimuMAB
• GolimuMAB
• InflixiMAB

Question 5

UC- alpha-4 integrin inhibitors- drugs

Answer 5

-VedolizuMAB

Question 6

CD- IL-23 inhibitors- drug

Answer 6

-UstekinuMAB

Question 7

CD- TNF-alpha inhibitors- drugs

Answer 7

(same as UC)

• AdalimuMAB
• GolimuMAB
• InflixiMAB

Question 8

CD- alpha-4 integrin inhibitors- drugs

Answer 8

• NatalizuMAB

- VedolizuMAB (also in UC)

Question 9

5-ASA- moa

Answer 9

-inhibition of PG and LT production via arachidonic acid pathway- COX and LIPOX

Question 10

5-ASA- contraindications

Answer 10

• ALL contraindicated in ASA-allergic pts

- Sulfasalazine- contraindicated in sulfonamide-allergic pts!!!

Question 11

5-ASA agents- indications

Answer 11

• mild to moderate Active UC
• maintenance (of remission) of UC
• except- Olsalazine- only maintenance
• except- Balsalazide- only for active

Question 12

TNF-alpha inhibitors- moa

Answer 12

• neutralizes TNF-alpha-mediated pro-infl cell signaling

- inhibits expression of pro-infl genes

Question 13

TNF-alpha inhibitors- SE

Answer 13

• infections!!!

- TB testing pre-therapy!!!

Question 14

TNF-alpha inhibitors- indications

Answer 14

• all moderate to severe
• Adalimumab and Infliximab- UC and CD! (All and Inclusive)
• Golimumab- UC (doesnt start with C)
• Certolizumab- CD (starts with C)

Question 15

TNF-alpha inhibitors- dosing

Answer 15

• Adalimumab- SQ- every other week
• Infliximab- IV (starts with I)- every 8 wks
• Golimumab- SQ- every 4 wks
• Certolizumab- SQ- every 4 wks

Question 16

alpha integrins- role in what?

Answer 16

lymphocyte migration!!

-alpha4B7- esp migration into GI tract

Question 17

alpha-4 integrin inhibitors- moa

Answer 17

-limits integrin’s-associated cell adhesion, transendothelial migration, and immune cell activation within inflamed tissue

Question 18

alpha-4 integrin inhibitors- SE

Answer 18

-infections
-PML(progressive multifocal leukoencephalopathy)!!! (esp natalizumab)- opportunistic infection of brain- risk factors: tx > 2yrs, prior immunosuppressant tx, anti-JC virus ab’s
(doctor must be in TOUCH prescribing program)

Question 19

alpha-4 integrin inhibitors- indications

Answer 19

• both moderate-to-severe and maintenance
• Natalizumab- CD
• Vedolizumab- CD and UD

Question 20

alpha-4 integrin inhibitors- dosing

Answer 20

• Natalizumab- IV- 4 wks

- Vedolizumab- IV- 8 wks

Question 21

Interleukin (IL-12/23) inhibitors- moa

Answer 21

-bind to IL-12/23 R- inhibit signal transduction activities and production of pro-infl Th1 and Th17 cells

Question 22

Interleukin inhibitors- SE

Answer 22

• infections!!

- TB testing pre-therapy recommended

Question 23

Interleukin inhibitors- indications

Answer 23

• moderate-to-severe treatment resistant CD! (active and maintenance)
• for pts intolerant or resistant to initial CD therapies, including TNF-alpha inhibitors

Question 24

Interleukin inhibitors- dosing

Answer 24

• Ustekinumab
• IV (single infusion)- for induction
• SQ (every 8 wks)- for maintenance

Question 25

Steroids- indications, dosing

Answer 25

- Acute and/or severe UC and CD uncontrolled by other conventional medications - LOWEST dose for SHORTEST duration possible

Question 26

IBS (irritable bowel syndrome)

Answer 26

- constipation - diarrhea - abd pain

Question 27

Abdominal pain- use what drug class?

Answer 27

``` Antimuscarinic agents! -Hyoscyamine -Dicyclomine -Clidinium/Chlordiazepoxide (HDC) ```

Question 28

Antimuscarinic agents- drugs

Answer 28

-Hyoscyamine -Dicyclomine -Clidinium/Chlordiazepoxide (HDC)

Question 29

Antimuscarinic agents- moa

Answer 29

- dec GI motility and spasms | * for Abd pain/spasms!

Question 30

Antimuscarinics- SE

Answer 30

classic antimuscarinics

Question 31

IBS- drug classes for diarrhea

Answer 31

- anti-diarrheals - opioid agonists/antagonists - serotonin (5HT3) antagonists

Question 32

Anti-diarrheals- drugs

Answer 32

- Loperamide | - Diphenoxylate

Question 33

Opioid Agonists/Antagonists- drug

Answer 33

-Eluxadoline

Question 34

Serotonin antagonists drug

Answer 34

Alosetron

Question 35

Loperamide- moa

Answer 35

-interferes with peristalsis- direct action of circular/longitudinal m's of intestinal wall

Question 36

Diphenoxylate- moa

Answer 36

- locally and centrally on GI smooth m cells - inhibits GI motility and slows excess GI propulsion - atropine added to discourage abuse

Question 37

Alosetron- moa

Answer 37

-blocks GI-based 5HT3 R's

Question 38

Alosetron- SE

Answer 38

-ischemic colitis!!!

Question 39

Alosetron- indication

Answer 39

- women with chronic, severe IBS-diarrhea, not responsive to other conventional therapies - Dr's must enroll in prescribing program

Question 40

Eluxadoline- moa

Answer 40

- agonist at opioid mu and K R's in GI tract (slows peristalsis/delays digestion) - antagonist at delta opioid R's in GI tract- secretionsdecreased

Question 41

Drug classes for Constipation

Answer 41

- Guanylate Cyclase-C agonists | - Selective Chloride (C2) Channel Activators

Question 42

Guanylate Cyclase-C agonists- drug

Answer 42

-Linaclotide

Question 43

Selective Chloride (C2) Channel Activators- drug

Answer 43

-Lubiprostone

Question 44

Linaclotide- moa, indications

Answer 44

Guanylate Cyclase-C agonist | -for IBS-Constipation!

Question 45

Lubiprostone- moa, drug

Answer 45

- selective Chloride (C2) Channel Activator | - IBS-Constipation (women)