da II exam 3 candy

which IBD type is increased Th1 (cell mediated/T-cell)?

crohn’s disease

which IBD type is increased Th2 (humoral)?

ulcerative colitis

what part of the GI does crohn’s affect?

any part (mostly ileum)

transmucosal

T/F: crohn’s is the continuous one

false - ulcerative colitis

can lifestyle changes (how you eat) help IBD?

yes

sulfasalazine (azulfidine) counseling

bone marrow suppression

needs folic acid

what is the active drug of sulfasalazine?

gut bacteria converts it mesalamine (5-ASA)

sulfasalazine MOA

decreased PG synthesis

decreased inflammatory cytokine production

T/F: purine analogs are the true anti-inflammatories

false - it’s aminosalicylates; the rest are immunosuppressants

purine analog drugs

azathioprine (imura)

6-mercaptopurine (purinethol)

how do purine analogs work?

decrease DNA synthesis → decrease T/B cell function

what happens with slow metabolizers that are taking a purine analog?

myelosuppression (absent TPMT → increased TG)

T/F: purine analogs are useful as anti-inflammatory

false - NO

purine analog DDI

allopurinol → reduce AZA-/6-MP dose to 1/4 to 1/3

what is the active component when describing purine analogs?

6 TG

T/F: 6-TU and 6-MMP are active

false - inactive

infliximab brand

remicade

adalimumab brand

humira

golimumab brand

simponi

certolizumab pegol brand

cimzia - PEG

T/F: ustekinumab (stelara) is not an anti-TNF

true

which monoclonal antibody has lower efficacy?

infliximab due to immunogenicity because it is chimeric (about 30% mouse derived)

can trigger anti-drug antibodies that increase drug clearance and reduce efficacy

mAb ADRs

injection-site/infusion (give benadryl or steroid)

reactivation of latent TB

increased risk of infection

cancer/lymphoma

which drug causes PML?

natalizumab

T/F: an ADR of anti-TNF is peripheral neuropathy

false - it’s an ADR of cyclosporine

T/F: cyclosporine has an ADR of HTN

true

what are the corticosteroids in IBD?

responsive (taper)

dependent (daily low dose → give prednisone)

non-responsive (switch to other drugs)

prednisone ADRs

HTN

osteoporosis

iatrogenic cushing syndrome

hypokalemia

infection

T/F: corticosteroids have ADRs of hypotension and hyperkalemia

false - HTN and hypokalemia

what does ustekinumab (stelara) act as?

IL 12/23 antagonist

what is stelara used for?

IBD

psoriatic arthritis

plaque psoriasis

what is stelara NOT used for?

RA

what do RA interleukins cover?

IL-17

IL-6

IL-1

what is long term effect of stelara?

cancer

what are the integrin receptor antagonists?

natalizumab (tysabri)

vedolizumab (entyvio)

how do integrin receptor antagonists work?

block lymphocytes from migrating into tissue

cyclosporine class

immunosuppressant

calcineurin inhibitor

cyclosporine MOA

binds cyclophilin → complex with calcineurin → NFAT not formed → decreased IL2 → decreased T/B cells

methotrexate low dose indication

IBD

how is methotrexate administered?

once weekly, PO

methotrexate MOA

inhibits AICAR transformylase (and TYMS) → increased adenosine → decreased IL2 → decreased inflammation

what is DHFR inhibition high dose used for?

cancer

JAK inhibitor

tofacitinib (xeljanz)

drug with -tinib acts as what?

kinase inhibitor

how is tofacitinib administered?

PO

what is tofacitinib used for?

RA

IBD

what are drugs that increase prolactin?

DA antagonists (antipsychotics, metoclopramide, prochlorperazine)

T/F: DA agonists do not raise PRL

true

what are the DA agonists?

bromocriptine

cabergoline

what is the effect of DA agonist?

decrease PRL release

decrease GH in acromegaly

what is the cheapest option but not most effect?

DA agonists

DA agonist ADR

orthostatic hypotension

who cannot benefit from bromocriptine?

patients with psychosis

cabergoline advantages over bromocriptine

more effective at decrease PRL and tumor size

restores gonadal function

long half life

high selectivity

better tolerated

dosed 1-2 per week

an except question, choose one thats not on the list

which DA is preferred in pregnancy?

bromocriptine, NOT cabergoline

acromegaly drug classes

GH antagonist (pegvisomant)

somatostatin analogs

DA agonists

somatostatin analog agents

octreotide

lanreotide

how do somatostatin analogs work?

inhibitory

decrease GH/IGF

decrease insulin/glucagon

SSA ADRs

diarrhea/GI discomfort

blood glucose - hyperglycemia in type 2 while hypoglycemia in type 1 (DM)

what are GH related agents?

somatropin (rhGH)

somatomedin (IGF)

T/F: somatostatin is not a GH related agent

true

somatropin ADRs

intracranial ADRs

insulin resistance/hyperglycemia

which growth hormone receptor antagonist used to treat acromegaly can cause hepatotoxicity?

pegvisomant

spironolactone class

aldosterone (mineralocorticoid receptor) antagonists

spironolactone indication

cushing syndrome

aldosteronism

hirsutism in women

HF

what does spironolactone NOT treat?

addison’s disease

aldosteronism treatment

spironolactone

eplerenone

amiloride

what drug is not used to treat with aldosteronism?

fludrocortisone - used for addison’s

which hormones are decreased in addison’s disease?

glucocorticoids

mineralocorticoids

sex steroids

signs of addison’s disease

fatigue

hyperpigmentation (high ACTH/MSH)

salt craving

hyperkalemia

low sodium

hypotension

dehydration

treatment for addison’s disease

glucocorticoid (hydrocortisone)

mineralocorticoid (fludrocortisone)

DHEA in women

what are some cholesterol derivatives?

glucocorticoids

mineralocorticoids

sex steroids (progesterone, estrogen, testosterone)

glucocorticoids ADRs

adrenal/growth suppression

HTN

hypokalemia

T/F: glucocorticoids can cause hyperkalemia

false - NO

what should be given as supplement when taking glucocorticoids?

potassium

calcium

vit d/c/b6

protein

cushing syndrome treatment

steroidogenesis inhibitors - metyrapone (metopirone), mitotane (lysodren), mifepristone (korlym)

ketoconazole/levoketoconazole (recorlev)

osilodrostat (isturisa)

which cushing syndrome treatment is only given in the hospital?

mitotane (lysodren)

mitotane class

adrenolytic

mitotane (lysodren) MOA

cellular destruction of adrenal cortex → adrenal cortex atrophy and decreased cortisol production

how is metyrapone classified?

steroidogenesis inhibitor, not adrenolytic

which neuromodulator works by decreasing ACTH in cushing syndrome?

cyproheptadine (periactin)

mifepristone (korlym) classification

antiprogesterone

glucocorticoid receptor antagonist

NOT steroidogenesis inhibitor

diseases/disorders related to pituitary

hyperprolactinemia

acromegaly

short stature

hypogonadism

diseases/disorders related to adrenal

cushing syndrome

aldosteronism

addison’s

CAH

how does CAH differ from addison’s?

androgens are high (decreased cortisol/aldosterone, increased androgens)

when is CAH diagnosed?

newborns

CAH treatment

glucocorticoid ± mineralocorticoid PRN

crinecerfont (crenessity) - for androgen control

how does crinecerfont work?

CRF-1 receptor antagonist → decreases androgens