Therapeutics: IBD 3

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Therapeutics: IBD 3
2014-04-27 14:51:38
Therapeutics IBD
Therapeutics: IBD 3
Therapeutics: IBD 3
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  1. When would you use Hydrocortisone/Methylprednisolone IV for IBD?
    For severe disease only
  2. If there is no response to Hydrocortisone/Methylprednisolone IV after 5-7 days of high dose treatment, what would you try next for severe IBD?
    Change to immunosuppressive agent
  3. Which steroids used in IBD will work from the Doudenem/Jejunem all the way to the Anus/Rectum?
    Beclomethasone and Prednisone, PO or IV
  4. What part of the GI will Budesonide work in?
  5. What part of the GI will Entocort EC and Budesonide work in?
    Ileum through the rectum
  6. What are the Immunosuppresants for IBD?
    • Mercaptopurine (Purinethol)
    • Azathioprine (Imuran)
    • Methotrexate (Rheumatrex, Trexall) (only for Crohn’s)
    • Cyclosporine (Sandimmune)
  7. When are immunosupressants used for IBD?
    Usually reserved for patients refractory to or dependant on steroids
  8. What are the general characteristics of immunosuppressant treatment in IBD?
    • Steroid-sparing effect
    • Takes several months to see clinical benefit
  9. What is the dose for Azathioprine (Imuran)?
    2 mg/kg PO daily
  10. Azathioprine brand name:
  11. What is the dose for Mercaptopurine (Purinethol)?
    2 mg/kg given PO daily
  12. Mercaptopurine brand name:
  13. How do mercaptopurine and Azathiopurine compare?
    Mercaptopurine is usually better tolerated than azathioprine
  14. What is the dose for Methotrexate (Rheumatrex, Trexall)?
    15-25mg given IM, SUBQ, or PO once weekly
  15. Methotrexate brand name:
    Rheumatrex, Trexall
  16. What are the general characteristics of Methotrexate treatment of IBD?
    Data to support use in CD, but not UC
  17. What is the dose for Cyclosporine (Sandimmune)?
    Typically IV, 2-4 mg/kg/day
  18. When is Cyclosporine (Sandimmune) used?
    Reserved for fulminant active disease
  19. Cyclosporine brand name:
  20. What are the biological agents for IBD?
    • Infliximab (Remicade) – CD and UC
    • Adalimumab (Humira) – CD
    • Certolizumab (Cimzia) – CD
    • Natalizumab (Tysabri) – CD
  21. Which biologic can be used against both UC and CD?
    Infliximab (Remicade)
  22. What are the IV Biologics?
    • Infliximab (Remicade)
    • Natalizumab (Tysabri)
  23. What are the SQ Biologics?
    • Adalimumab (Humira)
    • Certolizumab (Cimzia)
  24. What is the MOA of Biologics for IBD?
    • Directed against TNF-α
    • Except Tysabri which is directed against alpha-4 integrin protein, inhibits leukocyte adhesion and migration
  25. When is Natalizumab (Tysabri) used?
    Used when patient unresponsive to all other therapies
  26. What are the SE for Sulfasalazine?
    N/V/D, Headache, Impaired folic acid absorption (should supplement with oral folic acid)
  27. What are the SE for Mesalamine?
    80-90% of those intolerant to sulfasalazine will tolerate a mesalamine product
  28. What are the SE for Corticosteroids?
    HTN, Hyperglycemia, fluid retention, psychosis, osteoporosis, acne, muscle wasting
  29. What are the SE for Azathioprine/Mercaptopurine?
    Malaise, arthralgia, N/V, pancreatitis, myelosuppression
  30. What are the SE for TNF-α Inhibitors?
    Infusion reactions (premedication with APAP/Benadryl), neurological events, lymphoma, predispose to infections
  31. What drugs are only used for Ulcerative colitis?
    • Balsalazide
    • Olsalazine
    • Sulfasalazine (May only be used in Crohns with colonic involvement)
  32. What drugs are only used in Crohn’s disease?
    • Methotrexate
    • Adalimumab (Humira)
    • Certolizumab (Cimzia)
    • Natalizumab (Tysabri)