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Drug Treatment of Inflammatory Bowel Disease PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "DRUG TREATMENT OF INFLAMMATORY BOWEL DISEASE".

This medical PowerPoint presentation talks about the mechanism of action, pharmacokinetics and adverse effects of drugs in Inflammatory Bowel Disease (IBD).

Tags : pharmacokinetics in Inflammatory Bowel Disease, Inflammatory Bowel Disease, Digestive System, Digestive System PowerPoint presentation

Published on : Mar 28, 2023 | Views : 763 | Downloads : 0

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Slide 1-

DRUG TREATMENT OFINFLAMMATORY BOWEL DISEASE
Slide 2-

Objectives Describe the mechanism of action, pharmacokinetics and adverse effects of drugs in IBD
Slide 3-

INFLAMMATORY BOWEL DISEASE Ulcerative Colitis Crohn’s disease
Slide 4-

Inflammatory bowel disease Inappropriate inflammatory response to intestinal microbes in a genetically susceptible host
Slide 5-

Ulcerative colitis - diffuse mucosal inflammation - limited to colon - defined by location (eg proctitis;pancolitis)
Slide 6-

ppt slide no 6 content not found
Slide 7-

Crohn’s disease - patchy transmural inflammation - fistulae, strictures - any part of GI tract
Slide 8-

AIMS OF THERAPY Suppress inflammatory response Suppress the immune reaction
Slide 9-

Aminosalicylates corticosteroids Acute maintenance acute
Slide 10-

Aminosalicylates precise MOA unknown act on epithelial cells anti-inflammatory modulate release of cytokines and reactive oxygen species
Slide 11-

Aminosalicylates Local effect on mucosa in reducing inflammation
Slide 12-

Sulfasalazine Mesalamine Olsalazine Aminosalicylates
Slide 13-

Sulfasalazine Mesalamine Olsalazine Aminosalicylates
Slide 14-

Sulphasalazine Broken down by gut bacterial azoreductase to 5-aminosalicylate & sulphapyridine
Slide 15-

SULFASALAZINE Bacterial Flora (Colon) Bacterial azoreductase Sulfapyridine 5-aminosalicylic Acid Absorbed Acts through the lumen Systemic Adverse Effect Anti-inflammatory Effect
Slide 16-

Aminosalicylates 5-ASA absorbed in small intestine Acetylated by N- acetyltransferase-1 Excreted in urine
Slide 17-

Indications Maintaining remission in UC Reduce risk of colorectal cancer by 75% (long term Rx for extensive disease) Less effective for maintenance in CD Inducing remission in mild UC/CD (higher doses)
Slide 18-

Contraindications/cautions 5-ASA - Salicylate hypersensitivity Sulfapyridine - G6PD deficiency (haemolysis) - Slow acetylator status ( risk of hepatic and blood disorders)
Slide 19-

Adverse effects Dose-related Idiosyncratic (rare) - blood disorders - skin reactions – lupus like syndrome; Stevens-Johnson syndrome; alopecia
Slide 20-

Blood disorders Agranulocytosis; aplastic anaemia; leucopenia; neutropenia; thrombocytopenia; methaemoglobinemia Patients should advised to report any unexplained bleeding; bruising; purpura; sore throat; fever or malaise
Slide 21-

Steven’s Johnson syndrome immune-complex–mediated hypersensitivity erythema multiforme target lesions, mucosal involvement
Slide 22-

Newer formulations Mesalazine (5-ASA) Balsalazide (a prodrug of 5-ASA) Olsalazine (5-ASA dimer)
Slide 23-

Mesalazine Available as Enteric-coated tablets (for ileal Crohn’s disease) Slow release tablets (for proximal bowel Crohn’s) Enemas, suppositories (for distal colonic disease) Used when sulphasalazine can not be tolerated
Slide 24-

Sulfasalazine Oral use Mesalamine (5-aminosalicylic acid). Oral delayed release capsules Enema Olsalazine. 5-ASA-n=n-5-ASA Bacterial flora breaks it into 5-ASA Aminosalicylates
Slide 25-

Anti-inflammatory &Immunosuppressive Drugs Corticosteroids Prednisolone Hydrocortisone
Slide 26-

Corticosteroids USES Remission Induction Route of Administration Oral Intravenous Topical (Enema)
Slide 27-

Indications Moderate to severe relapse UC & CD No role in maintenance therapy Combination oral and rectal Indications
Slide 28-

Immunomodulators Azathioprine Cyclosporine Infliximab (Anti-TNF-)
Slide 29-

Thiopurines Azathioprine MOA: inhibit ribonucleotide synthesis; induce T cell apoptosis by modulating cell (Rac1) signalling
Slide 30-

Indications Steroid sparing agents Active disease CD/UC Maintenance of remission CD/UC Generally continue treatment x 3-4years
Slide 31-

Ciclosporin MOA:inhibitor of calcineurin preventing clonal expansion of T cells Indicated in Severe UC No value in CD
Slide 32-

Methotrexate MOA: inhibitor of dihyrofolate reductase; anti-inflammatory Inducing remission/preventing relapse in CD Refractory to or intolerant of Azathioprine
Slide 33-

Infliximab Indicated active and fistulating CD - in severe CD refractory or intolerant of steroids & immunosupressants - for whom surgery is inappropriate MOA: anti-TNF monoclonal antibody Potent anti-inflammatory
Slide 34-

Antibiotics Metronidazole Ciprofloxacin Clarithromycin “Probiotics” (administration of “healthy” bacteria)
Slide 35-

Summary
Slide 36-

Drugs for IBD Aminosalicylates Glucocorticoids Immunosuppressives Cytokine modulators Antibiotics
Slide 37-

Management of UC to induce remission oral +- topical 5-ASA +- oral corticosteroids Azathioprine iv steroids/Colectomy/ ciclosporin (severe)
Slide 38-

Maintaining remission oral +- topical 5-ASA +- Azathioprine (frequent relapses)
Slide 39-

Management of CD to induce remission oral high dose of 5-ASA +- oral corticosteroids reducing over 8/52 Azathioprine iv steroids/ metronidazole/elemental diet/surgery/infliximab
Slide 40-

Maintaining remission +- Azathioprine (frequent relapses) Methotrexate (intolerant of azathioprine) Infliximab infusions (8 weekly)