Inflammatory Bowel Disease

Name the two types:

How is it caused?:

What is the goal of therapy?

Name the two types: Ulcerative Colitis

- Only in the rectum and colon

-ADR: bloody diarrhea

Crohn's Disease

-anywhere along the GIT (mouth to anus)

-ADR: diarrhea, abdominal pain

 *Both are characterized by exacerbation and remission

How is it caused?: involves TNF-Alpha and inflammatory mediators

What is the goal of therapy? induce and maintian remission of Sx

Drugs used to Treat IBD

Acute and Maintenance Therapy

• Aminosalicylates (Maintenance only)
  • Oral for Crohn's
  • Suppository for Crohn's and Ulcerative C.
•  Corticosteriods (Acute and Maintenance)
  • Oral for Crohn's
  • Suppository for Crohn's and Ulcerative C.
• Others
  • Azathioprine, cyclosporin, methotrexate, Remicade (Immunosupressants for severe stages)
•  ABx
  • Metronidazole, Cipro

NSAIDS Worsen IBD!!!!!!

Sulfasalazine

• Converted to Mesalamine and sulfapyridine in the Colon by intetinal flora
• Mesalamine: Not absorbed
  • active comp for Rx IBD
•  Sulfapyridine: is absorbed
  • may inhibit cytokine production

OR NP 

***take with folic acid to prevent anemia***

• All are aminosalicylate
• oral are coated inorder to reach ileum and colon
  • Pentesa: DR capsules; will be release from the jejunum all the way to colon
  • Asacol: pH sensitive coatin; ileum to colon
• Retacl formulations
  • Rowasa Enema
  • Canasa Suppository
• ADR:
  • diarrhea
  • nephrotoxicity

Second Generation Aminosalicylates

*Designed to deliver mesalamine in the colon w/out sulfapyridine ADR

 *Do not interchange w/ regular derivatives bc each have their own specific drug delivery site

•  Dipendum (olsalazine)
  • two mesalamine;by azo bond
•  Colazal (balsalazide)
  • mesalamine linked to inert substance

ADR: Abdominal Pain and watery diarrhea

•  Entocort EC (budesonide)
  • RX for acute and Maintenance
  • EC, released in small intestine
  • HIgh Firstpass - so the amt that is absorbed will be metabolized so there is little ADR
•  Cortenema (Hydrocortisone rectal enema)
  • Maintenance for severe disease only