Therapeutics: IBD 2
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What is the enema form of Mesalamine?
What is the suppository form of Mesalamine?
What are the capsule forms of Mesalamine?
What are the tablet forms of Mesalamine?
What are the formulation of Sulfasalazine and what routes of administration are they available in?
- Azulfidine (tablet)
- Sulfazine (tablet)
What are the amino salicylates for IBD?
What is the MOA of Amino Salicylates in IBD?
- Shut down the activity of TNF and Arachadonic acid metabolites
- Prevent the movement of WBC into the gut
- Stop inflammatory process
Sulfasalazine is composed of what?
- Combination of sulfapyridine (antibiotic) and mesalamine (5-aminosalicylic acid)
- Mesalamine is the active component
- Cleaved by gut bacteria to the two components
How is Sulfasalazine excreted?
- Sulfapyridine excreted in urine & thought responsible for most side effect of sulfasalazine
- Mesalamine excreted in stool
What is Sulfasalazine used when Mesalamine is the active component and is available?
Sulfasalazine is much cheaper than any mesalamine formulation
What patient population is Sulfasalazine CI in?
Why is Mesalamine not used for acute exacerbation of IBD?
- Acute exacerbation = decreased transit time
- Less time for formulations to be absorbed or activated
What are the QD Mesalamine products?
Lialda & Apriso
What are the multiple daily dose Mesalamine products?
- Delzicol & Pentasa
- Olsalazine & Balsalazide
What are the Mesalamine products?
- QD: Lialda & Apriso
- Multiple Daily doses: Delzicol & Pentasa, Olsalazine & Balsalazide
Why are Mesalamine productsat the bottom of the pyramid (least aggressive/most used) therapy for IBD?
Potential benefit in reducing risk of colon cancer
When choosing a treatment option for Crohn’s or UC, what would be your first consideration?
Where the drug acts with relation to the site of disease
Where does Asacol work in the GI?
Rectum to Terminal ileum
Where does Pentasa work in the GI?
Rectum to Jejunum (whole GI)
Where does Sulfazalazine/Balsalazide work in the GI?
Rectum to Proximal colon
Where does Rowena enema work in the GI?
Rectum to Proximal colon
Where does a Steroid enema work in the GI?
Recturm to Proximal Comol
Where does Canasa work in the GI?
When would you add Anibiotics as adjunct therapy in IBD?
- Only for Crohn’s
- Usually only if perianal fistulas are present
What would be a typical antibiotic therapy for IBD?
Metronidazole + Ciprofloxacin (Quiolone)
What steroids have acitivity in IBD and when would you use them?
- Corticosteroids (not sure if local or systemic effects)
- Only use during active flares (never long term)
What are the routes of administration for in the treatment of IBD?
What is the dose for Prednisone PO in IBD?
- 40-60 mg/day
- Taper off after 1-2 months
What is the dose for Budesonide PO
- 6 or 9 mg/day
- Taper off after 2-3 months
Why do practitioners often use Budesonide (Entocort) as a maintenance therapy/long term?
Extensive 1st pass metabolism minimizes systemic exposure
What is the dose for Hydrocortisone/Methylprednisolone IV?
- 100-125mg IV Q6-8h
- If successful remission, change to oral prednisone
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