MOdule 2.7

What do ICAM and VCAM attract to the mucosa?

Tcells to release interferons

Where do aminosalicylates work? (bodywise)

act topically on intestinal mucos

Which condition mostly uses aminosalicylates?

ulcerative colitis for induction and maintance

5ASA have different MOA but which one is unique to this class?

Free radical scaveging

5ASA MOA'S

inhibit NFkB , cytokines, leukotrienes, tcells, leukocyte adhesion

which two main groups of meds are part of 5ASA?

Mesalamine and Azo Compounds

main dosage form of azo compounds?

orally

Which are the two form of inflamatory bowel disease?

ulcerative colitis and crohn's disease

Whats the start of the pathigenesis of someone with IBD?

bacteria turns on macrophages through NfkB THEN THIS ACTIVATES MAROPHAGES To release cytokines.

which are the main cytokines invOlved in IBD and whats their contribution in IBD?

IL-12 and IL-23 they promote the expression of ICAM and VCAM on endothelial cells

Mesalamine : ER Capsule ethyl cellulose membrane brand name

Pentasa

Mesalamine: DR tablet ( pH dependent) pH 7

Asacol, Lialda, delzicol

Mesalamine: DR and ER tablet ( pH dependent) pH 5.5

Apriso

Mesalamine enema:

Rowasa (4g)

Mesalamine suppository:

Canasa

what are some drugs under azo compounds?

sulfasalazine, olsalazine, balsalazide

Which compound from the sulfasalazine drug is responsible for its side effect?

the sulfapyridine byproduct

Whats an unique side effect of the drug Olsalazine?

can cause secretory diarrea

Sulfasalazine AE:

HA, nausea, Fatigue, sulfa allergic reactions, nephrotoxicity

where is azo compounds site of action?

proximal colon

where does mesalamine pentasa site of action?

jejunum

where does suppository reach?

rectum

where does mesalamine enema reach

distal colon

what are corticosteroids used for ?

used in severe UC or CD

which ones are systemic corticosteroids?

prednisone , methylprednisolone and hydrocortisone

hydrocortisone topical rectal foam brand name

cortifoam

hydrocortisone topical Enema brand name

Colocort

Uceris is what corticosteroid and for which IBD is used?

Budesonide oral and its for ulcerative colitis

ADE of corticosteroids

Hypertension

Hyperglycemia

Dyslipidemia

Osteoporosis

Glaucoma

Hypertension

Cushingoid face

Cataracts

Leukocytosis

drug interactions with corticosteroids

live vaccines, cyp450 inhibitors , acid suppressants that raise pH 5.5

which budesonide oral can be use for both CD and UC?

Entocort

what are immunomodulator used for?

maintenance of remission for both UC or CD

What's the MOA of Azathioprine?

impacts tcell prevents APC interaction and tcell apoptosis

AZA is a prodrug of _____

6-MP

6-MP converts to 6MMP depending on what enzyme?

TPMT

active metabolite of azathiprone is by which product?

6-TG

6-MP is the prodrug of _____ and its metabolized by _____ enzyme

6TG, HPRT

AE of excess 6-MMP

hepatotoxicity

AE of excess 6-TG

bone marrow suppresion

AZA/6MP can interact with which drug regarding xanthine oxidase?

Allopurinol

when is JAX/STAT inhibitors given or to who?

are given to moderate to severe IBD in patients with anti-TNFa intolerance

which JAX is exclusively for UC?

Tofacitinib

AE of Jax Inhibitors

increased risk of infections especially herpes zoster, risk of PE , elevated lipid serum

what two drugs are S1P modulators?

Ozanimod and Etrasimod

whats a contraindication for S1P modulators?

persons with recent cardiac events o cerebrovascular events, Class III/IV HF, heart conduction abnormalities

drug interactions with S1P?

QTc prolongation drugs, immunosupresants

Whats a specific contraindication with Ozanimod?

can't be administer with MAO inhibitors

TNFa blocker drugs for UC/DC

infliximab and Adalimumab

TNFa blocker drugs for CD only?

Certolizumab

TNFa blocker drugs for UC only?

Golimumab

whats the role of TNFa blockers in IBD?

induction and maintenance of moderate to severe or high risk IBD

TNFa MOA

binds membrane bound and deactivates soluble TNFa , stops the vicious cycle

AE of TNFa blockers

antibody formation, nausea, rash

whats a risk or AE specific with tnf a blockers?

activation of latent TB and pcp also icrease risk of tcell lymphoma

what class of drug is 4 integrin anatgonist consider?

Biologic

what are the two approved FDA integrin antagonist?

Natalizumab and Vedolizumab

which biologic TNFa is exclusively for CD

Certolizumab

which biologic Integrin inhibitor is exclusively for CD

Natalizumab

which biologic IL 12/ IL 23 inhibitor is exclusively for UC

Mirikizumab, Guselkumab

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