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Treat UC/Crohns

GI Drugs

QuestionAnswer
Aminosalicylates Sulfasalazine related to ASA 5-aminosalicyclic (5-ASA), acts topically in gut, inhib production of inflammatory mediators, used to induce and retain remission of IBD, excreted via kidneys, very acidic (ASA)
Nausea, GI upset, arthralgia, myalgia, bone marrow suppression sulfasalazine (b/c sulfapyridine metabolite is absorbed systemically)
Sulfasalazine genetically slow acetylators of sulfapyridine genrally have worse side effects
Glucocorticoids Hydrocortisone enemas, budesonide, azathioprine, 6-mercaptopurine (6-MP), methotrexate IV/PO, potent anti-inflammatory and immune suppressing agents, moderate to severe active IBD, use for short-term r/t SE 1-2 weeks
Budesonide glucocorticoid, potent synthetic prednisolone analog, PO controlled released for Crohns(released slow in gut)
6-MP & Azathioprine glucocorticoid, azathioprine is converted to 6-MP after absorption, immunosuppressive, use for induction and maintenance of remission in UC/Crohns, reduce/eliminate steroid use
6-MP & Azathioprine SE N/V, bone marrow suppression, hepatotoxicity, routine blood counts and LFT, be aware of TPMT pharmacogenomics variation
Methotrexate glucocorticoid, inhibit folate synthesis, antiproliferative at high doses, immunosuppressive at low doses, use to induce and maintain remission in Crohns
Methotrexate SE at high doses bone marrow suppression, alopecia, mucositis, hepatic injury
What do you give to treat SE of methotrexate at high doses? Folate supplementation
Anti-TNF agents Infliximab, Adalimumab, Certolizumab monoclonal antibody (binds to 1 site of TNF alpha), given SQ/IV b/c PRO
treats acute/chronic of moderate to severe IBD Infliximab, Adalimumab, Certolizumab
TNF tumor necrosis factor released by T cells causing inflammation r/t IBD
Which antibody/anti-TNF you give IV for induction? Inflixmab then SQ every 2wks for maintenance
Which 2 antibodies you give SQ for maintenance? Adalimumab and Certolizumab
Anti-TNF agents SE: Infliximab, Adalimumab, Certolizumab anaphylaxis, immunosuppression: bacterial sepsis, TB, URTI, fungal infections, reactivation of hepatitis B, lymphoma risk, suppress T cell function; acute infusion reactions: feve, HA, dizziness, chest pain
TB test before starting what drugs? Infliximab, Adalimumab, Certolizumab
What do you give for acute infusion reactions with anti-TNF agents prophylactically acetaminophen, diphenhydramine (Tylenol, Benedryl)
Created by: cburrows