Clinical Questions

Question 1

What is the classic symptom of ulcerative colitis?

Answer 1

Bloody Stools

Question 2

What is the difference between IBD and IBS?

Answer 2

IBS does not cause inflammation and is not a serious condition

Question 3

A patient’s colonoscopy found continuous pattern of muscosal inflammation in the colon. What is most likely the diagnosis?

Answer 3

Ulcerative Colitis

Question 4

A patient has ulcerative colitis. He presents to the ER with 7 bloody stools per day, temperature of 38 degrees Celcius, and HR of 112 bpm. How would you classify his UC? How would you induce remission?

Answer 4

Severe UC
Induce with Anti-TNF
Systemic Steroids with 5-ASA
IV Cyclosporine
Ustekinumab (Stelara)
Tofacitinib (Xeljanz)

Question 5

Methotrexate is an approprate induction or maintenance option for which IBD diagnosis?

Answer 5

Crohn’s Disease

Question 6

Cyclosporine is an appropriate induction or maintenance option for which IBD diagnosis?

Answer 6

Ulcerative Colitis

Question 7

Mesalamine is an appropriate induction or maintenance option for which IBD diagnosis?

Answer 7

Ulcerative Colitis

Question 8

What are the different formulations for Mesalamine and which one is the best for proctitis?

Answer 8

ER capsules (Pentasa)
ER tablets (Asacol HD)
Enema (Rowasa)
Suppository (Canasa)

**rectal formulations are the best for distal disease(proctitis)

Question 9

What would be some counseling points for someone with UC who is on Mesalamine (Asacol HD) ER tablets for induction?

Answer 9

-Take oral 5-ASA for 6-8 weeks for induction
- Asacol HD may leave ghost tablets in stools
- Do not crush or chew tablet
- may cause hypersentivity reaction
- Other side effects: abdominal pain, nausea, headache, flatulence, eructation (belching)

Question 10

When is it appropriate to give budesnide for UC and CD?

Answer 10

Budesonide (Uceris) may be used for UC for induction ONLY

Budesonide (Entocort) may be used for CD induction or maintenance

Question 11

Which anti-TNF agent is only indicated for CD?

Answer 11

Certolizumab (Cimzia)

Question 12

Which Integrin receptor antagonist is indicated for CD (only) and multiple sclerosis?

Answer 12

Natalizumab (Tysabri)

Question 13

Which IBD has nicotine replacement therapy as a possible protective treatment?

Answer 13

Ulcerative Colitis

**may exacerbate Crohn’s

Question 14

Which treatment for Crohn’s disease has a boxed warning for PML?

Answer 14

Natalizumab (Tysabril)

Question 15

Which Anti-TNF agents are approved for CD?

Answer 15

Adulimumab (Humira)
Infliximab (Remicade)
Certolizumab (Cimzia)

Question 16

What Anti-TNF agents are approved for UC?

Answer 16

Adulimumab (Humira)
Infliximab (Remicade)
Golimumab (Simponi)

Question 17

What are options for induction of CD?

Answer 17

Steroids + Antimetabolite
Anti-TNF +/- Thiopurine
Ustekinumab (Stelara)

Question 18

What is the recommended maintenance treatment for mild UC?

Answer 18

Mesalamine

Question 19

What is the recommended maintenance trearment for mild CD?

Answer 19

Oral budesonide (Entocort) for </= 3 months

Question 20

What induction and maintenance option for CD has increased risk for myleosuppression with TPMT deficiency?

Answer 20

Azathioprine

Question 21

Which integrin receptor antagonist is approved for both Crohn’s and UC?

Answer 21

Vedolizumab (Entyvio)