Gi: Ibd/ibs Rx

Front 1

What is Loperamide used for in IBS?

Back 1

NS tx for pts with predominant diarrhea

Front 2

What drug class is Amitryptaline in?

Back 2

TCA

Front 3

What drug class is Desipramine in?

Back 3

TCA

Front 4

How are TCAs (Amitryptaline and Desipramine) used in IBS?

Back 4

used at doses lower than to tx diarrhea IBS

Front 5

Name 3 SSRIs talked about in this lecture

Back 5

Paroxetine, Fluoxetine, Sertaline

Front 6

What are SSRIs (Paroxetine, Fluoxetine, Sertaline) used for in IBS?

Back 6

May be beneficial in the NS tx of constipation IBS

Front 7

MOA of Alosteron

Back 7

5HT3 antagonist (used to tx diarrhea IBS)

Front 8

MOA of Tegaserod

Back 8

selective 5HT4 agonist (used to tx constipation IBS); stimulate 5HT4 receptor-->CGRP release from myenteric and submucosal plexuses-->peristalsis-->proximal bowel contraction (via ACh and SP) and distal bowel relaxation (NO and VIP)

Front 9

What sets apart Alosteron from the other "sterons" used as antiemetics?

Back 9

Alosteron has a higher affinity and dissociates more slowly from the 5HT3 receptor (LONGER DOA)

Front 10

TU for Alosteron

Back 10

Women with SEVERE diarrhea IBS who have not responded to other therapies

Front 11

SE of Alosteron

Back 11

Constipation in up to 30%; ischemic colitis; SE may be > with concomitant use of CYP1A2 inhibitors (i.e. fluvoxamine-SSRI)

Front 12

Besides being a 5HT4 agonist, how else does Tegaserod tx constipation IBS?

Back 12

activates cAMP dependent Cl- secretion

Front 13

What pts should you use caution in prescribing Tegaserod?

Back 13

those with hepatic or renal impairment (met in liver and excreted in urine)

Front 14

When should pts take Tegaserod and why?

Back 14

Before meals as it has a low bioavailability and food decreases this further

Front 15

TU of Tegaserod in GI?

Back 15

Constipation IBS

Front 16

SE of Tegaserod

Back 16

Voluntarily removed from the market due to cardio effects (prolongation of the QT interval)

Front 17

What drug class is Balsalazide in?

Back 17

Aminosalicylates/Anti-inflammatory

Front 18

What drug class is Mesalamine in?

Back 18

Aminosalicylates/Anti-inflammatory

Front 19

What drug class is Olsalazine in?

Back 19

Aminosalicylates/Anti-inflammatory

Front 20

What drug class is Sulfasalazine in?

Back 20

Aminosalicylates/Anti-inflammatory

Front 21

Why do Balasalazide, Osalazine and Sulfasalazine have more topical effects than Mesalamine?

Back 21

feature some moiety linked to 5-ASA which limits absorption until the bacteria in the colon break down the compounds, releasing 5-ASA

Front 22

MOA of Aminosalicylates

Back 22

Block PG synthesis by inhibiting COX

Front 23

Drugs of choice for 1st line tx of mild-moderately active ulcerative colitis

Back 23

Aminosalicylates (Mesalamine, Balasalazide, Osalazine and Sulfasalazine); suppositories or enemeas are effective

Front 24

Which Aminosalicylate has a high incidence of SE (N/V, headache, arthralgias, BM suppression and malasie)

Back 24

Sulfasalazine (HS rxns also occur)

Front 25

Prednisone and Prednisolone are used in the tx of what? (in regards to GI)

Back 25

moderate to severe active IBD

Front 26

Which corticosteriod results in a local (GI) effect rather than systemic like the others?

Back 26

Budesonide (subject to extensive, rapid 1st pass metabolism)

Front 27

TU of Budesonide

Back 27

Milde to moderate Crohn's disease involving the ileum and proximal colon

Front 28

TU of antimetabolites (Azathioprine, 6-Mercaptopurine, Methotrexate)

Back 28

induction and maintenance of remission of ulcerative colitis and Crohn's

Front 29

Name the anti-TNF alpha antibodies used to tx IBD

Back 29

Infliximab, Adalimumab, Certolizumab

Front 30

Anti-TNF antibodies can lead to symptomatic improvement and remission in pts with what?

Back 30

moderately severe Crohn's

Front 31

Humanized anti-TNF?

Back 31

Adalimumab (Infliximab and Certolizumab are chimeric)

Front 32

Name 2 anti-TNFs that bind to both soluble and receptor bound TNFalpha?

Back 32

Infliximab and Adalmumab (also, Fc promotes complement activation and Ab mediated cellular cytotoxicity of inflammatory cells)

Front 33

Recombinant Ab consisting of a Fab component conjugated to PEG (NO Fc component, thus NO complement activation)

Back 33

Certolizumab

Front 34

SE of anti-TNFaphas

Back 34

Infection, acute, adverse infusion rxns (Infliximab in particular), delayed infusion rxns, hepatic rxns, > risk for lymphoma

Front 35

How may you reduce infusion rxns with anti-TNFalphas?

Back 35

prophylactic administration of acetaminopehn, diphenydramine or corticosteroids