GI Drugs
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| 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)
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| Nausea, GI upset, arthralgia, myalgia, bone marrow suppression | sulfasalazine
(b/c sulfapyridine metabolite is absorbed systemically)
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| Sulfasalazine | genetically slow acetylators of sulfapyridine genrally have worse side effects
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| 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
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| Budesonide | glucocorticoid, potent synthetic prednisolone analog, PO controlled released for Crohns(released slow in gut)
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| 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
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| 6-MP & Azathioprine SE | N/V, bone marrow suppression, hepatotoxicity, routine blood counts and LFT, be aware of TPMT pharmacogenomics variation
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| Methotrexate | glucocorticoid, inhibit folate synthesis, antiproliferative at high doses, immunosuppressive at low doses, use to induce and maintain remission in Crohns
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| Methotrexate SE at high doses | bone marrow suppression, alopecia, mucositis, hepatic injury
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| What do you give to treat SE of methotrexate at high doses? | Folate supplementation
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| Anti-TNF agents Infliximab, Adalimumab, Certolizumab | monoclonal antibody (binds to 1 site of TNF alpha), given SQ/IV b/c PRO
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| treats acute/chronic of moderate to severe IBD | Infliximab, Adalimumab, Certolizumab
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| TNF tumor necrosis factor | released by T cells
causing inflammation r/t IBD
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| Which antibody/anti-TNF you give IV for induction? | Inflixmab
then SQ every 2wks for maintenance
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| Which 2 antibodies you give SQ for maintenance? | Adalimumab and Certolizumab
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| 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
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| TB test before starting what drugs? | Infliximab, Adalimumab, Certolizumab
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| What do you give for acute infusion reactions with anti-TNF agents | prophylactically acetaminophen, diphenhydramine
(Tylenol, Benedryl)
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cburrows
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