Chapter 74: Inflammatory Bowel Disease

Question 1

Types of Inflammatory Bowel Disease (IBD)

Answer 1

Ulcerative Colitis and Crohn’s Disease

Question 2

Classic symptom of IBD

Answer 2

bloody diarrhea

Question 3

Which class of drugs can cause IBD flares

Answer 3

NSAIDs

Question 4

What is the difference between IBS and IBD

Answer 4

IBS does not cause inflammation and is not as serious

Question 5

Ulcerative colitis is characterized by mucosal inflammation confined to the

Answer 5

rectum and colon with superficial ulcerations

Question 6

When UC is limited to the descending colon and rectum, it is called ___ and can be treated with ____

Answer 6

distal disease
topical (rectal) treatment

Question 7

Inflammation limited to the rectum is called

Answer 7

proctitis

Question 8

Are fistulas/strictures are common in crohn’s disease or ulcerative colitis?

Answer 8

CD

Question 9

Where is Crohn’s Disease located

Answer 9

Entire GI tract

Question 10

Crohn’s Disease depth is

Answer 10

Transmural

Question 11

CD pattern vs UC pattern

Answer 11

CD is non-continuous
UC is continuous

Question 12

diagnosis of IBD

Answer 12

colonoscopy with tissue biospy

imaging can be useful as well

Question 13

lifestyle management to help IBD

Answer 13

smaller, more frequent meals, low fat and dairy diet, drink plenty of water, avoid alcohol and caffeine

Question 14

useful OTC agents in IBD

Answer 14

antidiarrheals or antispasmodic (careful)
vitamin supplements
probiotics

Question 15

What is commonly used to treat acute exacerbations in both UC and CD

Answer 15

short courses of oral or IV steroids

used until remission and tapered 8-12 weeks

Question 16

What is used for maintenance therapy in UC (distal or mild extensive disease)

Answer 16

aminosalicylates

ie. 5-ASA

Question 17

What is preferred for mild CD that is limited to the ileum and proximal colon

Answer 17

Budesonide for ≤ 3 months

After this course, d/c treatment or change to thiopurine or MTX

Question 18

What can be used for moderate-severe CD for maintenance of remission

Answer 18

Anti-TNF agents (Humira, Remicade, Cimzia)
Thiopurine
MTX
Stelara (IL receptor antagonist)

Question 19

What can be used for refractory treatment or steroid dependent CD

Answer 19

Vedolizumab or natalizumab (integrin receptor antagonists)

Question 20

What can be used for mild UC for maintenance of remission

Answer 20

Mesalamine (5-ASA) rectal and/or oral preferred

Question 21

What can be used for moderate-severe UC for maintenance of remission

Answer 21

Anti-TNF agents (Humira, Remicade, Simponi)
Thiopurine
Cyclosporine
Stelara (IL antagonist)
Xeljanz (JK inhibitor)

Question 22

What can be used for refractory treatment or steroid dependent UC

Answer 22

Vedolizumab (integrin receptor antagonist)

Question 23

Budesonide brand name

Answer 23

Entocort EC (for CD only)
Uceris (for UC only)

Question 24

If steroids are used long than ___ weeks, they must be tapered

Answer 24

2 weeks

Question 25

Which drug can be used for both induction and maintenance of UC and CD

Answer 25

Budesonide

Question 26

Rectal steroids (hydrocortisone and budesonide rectal foam) are indicated for __ only

Answer 26

UC | use for 3 months in maintenance

Question 27

When using budesonide, must avoid strong and moderate ____ of which CYP enzyme, including ____

Answer 27

inhibitors 3A4 grapefruit juice and grapefruit products

Question 28

mesalamine ER capsules brand name

Answer 28

Pentasa

Question 29

mesalamine ER tablets brand name

Answer 29

Asacol HD

Question 30

mesalamine enema brand name

Answer 30

Rowasa

Question 31

mesalamine suppository brand name

Answer 31

Canasa

Question 32

Which formulations does mesalamine come in

Answer 32

oral (caps, tabs) and rectal (enema, suppository)

Question 33

Induction with mesalamine for UC oral therapy is used for ___ weeks and rectal therapy for ___ weeks

Answer 33

6-8 weeks oral 3-6 weeks rectal

Question 34

Mesalamine rectal suppository should be retained in the rectum for at least ___ hours

Answer 34

1-3h

Question 35

Mesalamine enema should be retained in the rectum for how long

Answer 35

Overnight (~8h)

Question 36

Mesalamine CI

Answer 36

hypersensitivity to salicylates or aminosalicylates

Question 37

For distal disease/proctitis in UC, which formulation of mesalamine is more effective

Answer 37

Rectal

Question 38

Mesalamine ER tablet (Asacol) and ER capsule (Delzicol) can

Answer 38

Leave a ghost tablet in the stool

Question 39

Sulfasalazine CI

Answer 39

salicylate and sulfa allergy

Question 40

Balsalazide can cause

Answer 40

staining of the teeth/tongue

Question 41

Which genetic deficiency is checked for azathioprine? | what's the risk?

Answer 41

TPMT | are at increased risk of myelosuppression

Question 42

Methotrexate can be used for induction & maintenance of remission in mod-severe

Answer 42

CD (in pts who cannot tolerate azathioprine)

Question 43

How is MTX dosed in CD

Answer 43

once weekly by IM or SC route

Question 44

Which immunosuppressive drug is recommended for severe UC

Answer 44

Cyclosporine

Question 45

Natalizumab is only approved for

Answer 45

CD

Question 46

How often is natalizumab given

Answer 46

every 4 weeks

Question 47

Natalizumab should be d/c if no response by ___ weeks

Answer 47

12

Question 48

Vedolizumab is approved for

Answer 48

UC and CD

Question 49

Vedolizumab should be d/c if no response by ___ weeks

Answer 49

14

Question 50

Natalizumab boxed warning

Answer 50

PML

Question 51

Natalizumab is only available through

Answer 51

REMS TOUCH program

Question 52

Natalizumab brand name

Answer 52

Tysabri

Question 53

Vedolizumab brand name

Answer 53

Entyvio