Pharm Of Ibd

Front 1

Mesalamine MOA

Back 1

5-ASA

local effect - disigned to release only in ileum or colon

inhibits arachidonic acid conversion to prostaglandin (via COX)

interfere with leukotriene synth

inhibit activation of NFkB

Front 2

sulfasalazine

Back 2

5-ASA - older

limited use due to sulfa side effects

Front 3

5-ASA contraindications

Back 3

salicylic hypersensitivity

hypersensitivity to suppository vehicle

renal disease

dont use with pH release agents or antacids, H2RA, PPI

dont use with azathioprine - bone marrow suppression

Front 4

5-ASA adverse effects

Back 4

pericarditis, lupus

acute intolerance syndrome - worsen colitis

Front 5

prednisone

Back 5

corticosteroid

broad systemic anti-inflamatory effects

use for induction of remission
not for maintainence

side effects limit use - avoid steroid dependence

Front 6

prednisone side effects

Back 6

moon face, acne, obesity

diabetes, htn, adrenal suppression

osteoporosis

psychosis, sleep disorder

neuropathy

Front 7

budesonide

Back 7

prefered drug for crohn

corticosteroid

local effects in intestine

absorption has high amount of first-pass metabolism so less systemic side effects than prednisone

can be used for maintainence

Front 8

treatment of collagenous colitis

Back 8

budesonide

Front 9

budesonide interactions

Back 9

grapefruit juice, antacids, milk, pH modifiers,

Front 10

azathioprine

Back 10

metabolizes to 6mercaptopurine

used for maintainence of UC or Crohn

antineoplastic agent - analog of purine (guanine) needed for DNA synth

effect of drug depends on individual's enzymes TPMT

Front 11

TPMT

Back 11

converts 6-MP to 6-MMP which is hepatotoxic

always measure TPMT before giving drug

Front 12

Xanthine oxidase

Back 12

converts 6-MP to inactive

don't give azathioprine or 6-MP with allopurinol (xanthine oxidase inhbitor) will give too much 6-MP -> bone marrow suppression

Front 13

6-MP indications

Back 13

steroid sparing agent in treatment of IBD

induction, maintainence of remission

slow onset

Front 14

6-TGN

Back 14

suppresses T cells and bone marrow

metabolite of 6-MP

Front 15

6-MP toxicity

Back 15

myelosuppression

hepatotoxicity

acute pancreatitis


thus...measure TPMT before use and dont use with allopurinol

Front 16

infliximab

Back 16

anti-TNFalpha inhibitor

induction and matenance of remission

Front 17

infliximab contraindication

Back 17

hypersensitivity reactions

hep B reactivation

neoplastic disease

infections - reactivate TB, opporunistic pathogens