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RxPrep > GI Conditions > Flashcards

GI Conditions Flashcards

1
Q

A 32 y/o female pt is using naproxen 250 mg BID for Achilles’ tendon pain. She was a long-distance runner but was forced to stop d/t the painful heel injury. After using the med for about a month, she began to experience stomach upset, and her Dr prescribed misoprostol 100 mcg QID. The Dr stated that he didn’t wish to begin chronic acid suppression therapy in a young female pt d/t recent reports of increased fracture risk. Which of the following statements is correct?

a. This med should be avoided in women of childbearing potential
b. The brand name of misoprostol is Reglan
c. This med can cause constipation
d. This med should be taken on an empty stomach
e. The brand name of misoprostol is Arthrotec

A

a

Misoprostol can induce abortion and has a BBW for being an abortifacient. It’s safest to avoid misoprostol in women of childbearing age.

Pt adherence to misoprostol therapy is poor d/t significant diarrhea and cramping.

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2
Q

Which of the following are the only PPIs available as IV?

a. Pantoprazole
b. Esomeprazole
c. Lansoprazole
d. Omeprazole
e. Rabeprazole

A

a, b

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3
Q

Use of PPIs during hospitalization can increase the chances of a pt developing:

a. Pneumonia
b. Stroke
c. Hepatotoxicity
d. Myocardial infarction
e. Anemia

A

a

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4
Q

What is the MOA of magnesium hydroxide when used for heartburn?

a. Neutralizes pepsin in the stomach via hydroxylation
b. Neutralizes acid in a buffering reaction (producing salt and water)
c. Inhibits (reversibly) the histamine-2 receptors on gastric parietal cells
d. Irreversibly binds to the H+/K+-ATPase pump in gastric parietal cells
e. Blocks the 1st step in acid production high up in the pathway

A

b

-Magnesium hydroxide is an antacid
-Antacids increase gastric pH by neutralizing acid in a buffering reaction, producing salt and water

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5
Q

Which of the following are lifestyle modifications for GERD?

a. Avoid foods that can aggravate heartburn, including spicy foods, caffeine and chocolate
b. Elevate the head of the bed with a wedge to help nocturnal symptoms
c. Instead of snacking close to bedtime, eat 1 large meal late in the evening
d. Losing weight could significantly improve symptoms (if overweight of recently gained weight)
e. Lie down on the right side immediately after eating

A

a, b, d

Avoid eating high fat meals within 2-3 hours of bedtime

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6
Q

In addition to lifestyle modifications, which of the following is the best initial tx for GERD?

a. Endoscopy
b. Empirically treat with famotidine x 6 weeks
c. Empirically treat with esomeprazole x 8 weeks
d. Empirically treat with sucralfate x 2 weeks
e. Take scheduled antacids indefinitely

A

c

An 8-week course of a PPI is recommended for GERD (symptoms occur at least twice weekly)

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7
Q

How should a pharmacist counsel a pt on Dexilant administration?

a. Take 1 capsule daily without regard to meals
b. Take 1 capsule daily - 60 min before breakfast
c. Take 1 capsule daily at bedtime
d. Take 1 capsule daily on an empty stomach
e. Take 1 capsule daily with a high-fat meal

A

a

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8
Q

All of the following PPIs come in capsules that can be opened and mixed in applesauce EXCEPT:

a. Pantoprazole
b. Lansoprazole
c. Esomeprazole
d. Dexlansoprazole
e. Omeprazole

A

a

The PPIs dexlansoprazole, esomeprazole, lansoprazole, omeprazole, and rabeprazole have capsules that can be opened and sprinkled in applesauce.

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9
Q

An elderly female has HTN, renal insufficiency (CrCl = 32), mild memory loss, Parkinson disease, and frequent episodes of GERD. She presents at the pharmacy with a prescription for metoclopramide 10 mg QID. Which of the following statements is/are correct?

a. Her Parkinson disease symptoms will worsen
b. Metoclopramide is a preferred tx for GERD
c. She could experience more fatigue and sleepiness
d. Metoclopramide is safe to use at the current dose prescribed
e. Metoclopramide is a dopamine antagonist

A

a, c, e

-Should be avoided, at any dose, in patients with Parkinson disease
-Can worsen symptoms of Parkinson disease and has side effects of drowsiness and fatigue
-It’s not a preferred guideline-recommended tx for GERD
-If metoclopramide is used in someone with a CrCl < 40, the dose should be decreased by 50% to reduce the risk of CNS side effects or EPS

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10
Q

A medical resident asks the pharmacist why cimetidine is used less frequently than other histamine-2 receptor blockers. Which responses from the pharmacist are correct?

a. Cimetidine can cause gynecomastia
b. Cimetidine can cause impotence
c. Cimetidine has more drug interactions than other agents in the class
d. Cimetidine is more expensive than other agents in the class
e. Cimetidine is no longer available on the US market

A

a, b, c

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11
Q

SD is a 35 y/o male seen by his PCP for an annual checkup. SD reports daily stomach pain that’s somewhat relieved by food.
Allergies: Penicillin (rash), ciprofloxacin (numbness)
PMH: None
Meds: Has tried self-treating the pain with OTC Prilosec with no improvement
Tests: Urea breath test (negative)

The provider suspects SD has H. pylori. What is the best indicator that his suspicions are correct based on the info provided?

a. H. pylori occurs more frequently in patients with quinolone allergies
b. The negative urea breath test
c. Eating lessens the pain
d. Eating worsens the pain
e. H. pylori occurs more frequently in patients with penicillin allergies

A

c

-Usually with H. pylori infections, the pain will be lessened by eating, especially if the ulcer is in the duodenum
-Although SD has a negative urea breath test, he has been using a PPI which can cause a false negative result
-PPIs, antibiotics, and bismuth products must be discontinued 2 weeks prior to testing

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12
Q

Choose the correct statement that best describes H. pylori.

a. It’s an invasive fungi
b. It’s a protozoal organism
c. It’s a G+ cocci seen in pairs
d. It’s a spiral-shaped G- bacterium
e. It’s an oblong-shaped viral organism

A

d

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13
Q

SD is a 35 y/o male seen by his PCP for an annual checkup. SD reports daily stomach pain that’s somewhat relieved by food.
Allergies: Penicillin (rash), ciprofloxacin (numbness)
PMH: None
Meds: Has tried self-treating the pain with OTC Prilosec with no improvement
Tests: Urea breath test (negative)

SD is diagnosed with H. pylori via endoscopy sampling. Choose the most appropriate therapeutic regimen for SD.

a. Lansoprazole 30 mg BID + Amoxicillin 1000 mg BID + Clarithromycin 500 mg BID x 14 days
b. Lansoprazole 30 mg BID + Clarithromycin 500 mg BID + Metronidazole 500 mg TID x 7 days
c. Lansoprazole 30 mg BID + Bismuth subsalicylate 525 mg QID + Metronidazole 500 mg QID + Tetracycline 500 mg x 7 days
d. Lansoprazole 30 mg BID + Bismuth subsalicylate 300 mg QID + Metronidazole 250 mg QID + Tetracycline 500 mg QID x 14 days
e. Lansoprazole 30 mg daily + Amoxicillin 1000 mg BID + Clarithromycin 500 mg BID + Metronidazole 500 mg BID x 14 days

A

d

-Regimens with amoxicillin should be avoided because this pt has a penicillin allergy.
-When treating H. pylori, metronidazole may be used for triple therapy if the pt has a penicillin allergy, but the tx duration should be 14 days

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14
Q

A pt who suffers from heartburn was using an OTC H2RA. He went to his Dr complaining of continuing heartburn symptoms. The Dr suggested trying OTC omeprazole. He told the pt that omeprazole is stronger than the med he’s been taking. What is the MOA of omeprazole?

a. Neutralizes pepsin in the stomach via hydroxylation
b. Neutralizes acid in a buffering reaction (producing salt and water)
c. Reversibly the histamine-2 receptors on gastric parietal cells
d. Irreversibly binds to the H+/K+-ATPase pump in gastric parietal cells
e. Blocks the 1st step in acid production high up in the pathway

A

d

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15
Q

Which of the following statements concerning NSAIDs is correct?

a. All NSAIDs can cause gastric ulcers when used chronically
b. COX-2 selective NSAIDs have an increased risk of GI side effects
c. All NSAIDs should be used cautiously in patients with a hx of CV or renal disease
d. COX-2 selective NSAIDs have an increased risk of causing CV events
e. Antacid use (taken concurrently with the NSAID) will protect the GI lining

A

a, c, d

The COX-2 selective drugs have less GI risk but increased CV risk

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16
Q

A pregnant female is asking the pharmacist for a recommendation for heartburn symptoms. The symptoms began during the 3rd month of pregnancy (she’s currently 14 weeks pregnant). She states that whenever she eats anything, she has heartburn. She takes a daily prenatal vitamin. She gets adequate calcium from the vitamin and a cheese stick she eats with lunch. Choose the most appropriate recommendation.

a. Tagamet
b. Protonix
c. Tums
d. Misoprostol
e. Metoclopramide

A

c

Calcium antacids are considered 1st line in pregnancy

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17
Q

What is the MOA of misoprostol?

a. Prokinetic agent
b. Coats the stomach with a protective lining
c. Histamine-2 receptor antagonist
d. Prostaglandin analog
e. PPI

A

d

Provides gut protection by replacing the GI-protective prostaglandins depleted by chronic NSAID therapy

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18
Q

Metoclopramide is most commonly used for which condition?

a. GERD
b. Gastroparesis
c. Peptic ulcer disease
d. H. pylori-induced ulcers
e. Diarrhea

A

b

-Metoclopramide accelerates gastric emptying (increases peristalsis)
-It shouldn’t be used routinely for GERD; use is typically reserved for patients with gastroparesis
-It’s dosed before meals and at bedtime

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19
Q

What is the MOA of sucralfate?

a. Dopamine blocker
b. Prokinetic agent
c. Provides a protective barrier for the gut
d. Prostaglandin analog
e. Phosphodiesterase inhibitor

A

c

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20
Q

What is the physical (mechanical) cause of GERD?

a. The histamine receptors over-secrete acid
b. The parietal cells over-secrete acid
c. Food gets stuck in the esophagus
d. Lower esophageal sphincter tone is reduced
e. The gastric muscle contracts suddenly

A

d

GERD occurs when the stomach contents leak backward, through the LES, into the esophagus.

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21
Q

KG has chronic constipation despite a fiber-rich diet and adequate fluids. It’s “idiopathic.” She’s had constipation for years and says she’s learned to live with it. As she’s getting older, she experiences occasional heartburn after eating. Choose a good option for KG to help with the heartburn.

a. Milk of Magnesia
b. Maalox
c. Tums
d. Famotidine
e. Omeprazole

A

a

Milk of Magnesia will provide benefit for both the heartburn and make the stool somewhat softer in a patient with chronic constipation.

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22
Q

What is the MOA of famotidine?

a. Neutralizes pepsin in the stomach via hydroxylation
b. Neutralizes acid in a buffering reaction (producing salt and water)
c. Reversibly the histamine-2 receptors on gastric parietal cells
d. Irreversibly binds to the H+/K+-ATPase pump in gastric parietal cells
e. Blocks the 1st step in acid production high up in the pathway

A

c

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23
Q

Alarm symptoms in GERD that may warrant additional testing include:

a. Cough, chest pain, bloody stools
b. Unintentional weight loss, dysphagia, hematemesis
c. Hypersalivation, cough, sore throat
d. Regurgitation, heartburn, choking
e. Cough, hypersalivation, acid tast

A

b

Alarm symptoms: Odynophagia (painful swallowing), dysphagia, frequent N/V, hematemesis, black bloody stools, unintentional weight loss

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24
Q

HL, a pregnant 33 y/o female, comes to your pharmacy with a Rx for Pylera. Her med profile consists of CitraNatal DHA prenatal vitamin. The pt has a noted allergy to codeine and iodine. The pt is symptomatic, and the prescriber confirms that tx will be used. Which of the following components of Pylera could cause tooth discoloration of the baby’s teeth and can interfere with bone development?

a. Bismuth subsalicylate potassium
b. Metronidazole
c. Tetracycline
d. Amoxicillin
e. Clarithromycin

A

c

Tetracycline isn’t indicated in pregnancy or children < 8 y/o

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25
Q

OG enters the pharmacy asking for a recommendation for heartburn. He’s been taking Tums and Alka-Seltzer with increasing frequency and asks if he should take them on a daily basis so that he doesn’t have to deal with heartburn. Which of the following statements is correct?

a. If he takes too many Tums, he could get constipation.
b. He should be warned that antacids that contain aspirin can cause serious bleeding.
c. He shouldn’t self-treat his heartburn for > 2 weeks.
d. He should switch to an aluminum-based antacid to avoid constipation.
e. He should continue the Tums and Alka-Seltzer if it’s relieving his symptoms.

A

a, b, c

Aluminum and calcium-containing antacids are constipating.

26
Q

Which of the following monoclonal antibodies are approved for the tx of Crohn’s disease?

a. Infliximab
b. Natalizumab
c. Golimumab
d. Adalimumab
e. Cartolizumab
f. Etanercept

A

a, b, d, e

Monoclonal antibodies approved for Crohn’s: Adalimumab, infliximab, certolizumab, ustekinumab, vedolizumab, natalizumab

27
Q

Which of these meds would require a reduced dose of Entocort EC?

a. Prozac
b. Norvasc
c. Yaz
d. Diflucan
e. None of these meds interact with Entocort EC

A

d

Budesonide is a major CYP3A4 substrate. Potent 3A4 inhibitors (like fluconazole) used concomitantly may necessitate a budesonide dose reduction.

28
Q

A common side effect of Milk of Magnesia is:

a. Headache
b. Suicidal ideation
c. Euphoria
d. Electrolyte imbalance
e. Hearing loss

A

d

Magnesium hydroxide and other osmotic laxatives can cause electrolyte imbalances.

29
Q

CD is a 54 y/o male who comes to the pharmacy to get his meds refilled. He comes to the counter with a tub of Metamucil powder. After asking CD some questions and reviewing his profile, you learn that his diet consists of largely processed and sugary foods, with little fruit or veggie intake. He drinks 3-4 cups of coffee daily and rarely consumes other liquids. He doesn’t exercise.
Allergies: Bactrim, erythromycin, ciprofloxacin, gentamicin eye drops

Choose the correct statement/s concerning the OTC product CD is purchasing.

a. Based on his allergies, this isn’t a safe option.
b. It’s the 1st line tx for constipation.
c. It’s an emollient laxative that will soften the stool.
d. It should be taken with plenty of fluids.
e. It contains calcium and should be separated from select drugs.

A

b, d

Metamucil is a bulk forming drug.

30
Q

CD is a 54 y/o male who comes to the pharmacy to get his meds refilled. He comes to the counter with a tub of Metamucil powder. After asking CD some questions and reviewing his profile, you learn that his diet consists of largely processed and sugary foods, with little fruit or veggie intake. He drinks 3-4 cups of coffee daily and rarely consumes other liquids. He doesn’t exercise.

CD should be counseled to implement which of the following measures to help his GI condition?

a. Increase physical activity
b. Consume more fiber
c. Drink more water
d. Eat more refined foods
e. Drink more caffeine

A

a, b, c

Non-drug tx includes increasing fluid intake (more water and less caffeine and alcohol), physical activity, and fiber intake (with fruits, veggies, and whole-grain products). Refined/processed foods should be avoided.

31
Q

CD is a 54 y/o male who comes to the pharmacy to get his meds refilled. He comes to the counter with a tub of Metamucil powder. After asking CD some questions and reviewing his profile, you learn that his diet consists of largely processed and sugary foods, with little fruit or veggie intake. He drinks 3-4 cups of coffee daily and rarely consumes other liquids. He doesn’t exercise.
Meds: Lisinopril, Lipitor, Verelan PM, Metformin, Celexa

Which of the CD’s meds could be contributing to his GI condition?

a. Verelan PM
b. Lisinopril
c. Lipitor
d. Metformin
e. Celexa

A

a

Non-DHP CCBs (especially verapamil) can cause constipation.

32
Q

Use of loperamide to provide symptomatic relief is acceptable in which scenario?

a. C. difficile pseudomembranous colitis
b. Irritable bowel syndrome with diarrhea
c. Bloody diarrhea and fever while traveling
d. Toxigenic E. coli infection of the GI tract
e. Age < 2 years with acute diarrhea and dehydration

A

b

Loperamide is contraindicated in children < 2 years and those with acute dysentery (blood diarrhea and high fever), acute ulcerative colitis, pseudomembranous colitis (caused by C. diff), and bacterial enterocolitis caused by invasive organisms (such as E. coli, Salmonella, and Shigella).

33
Q

Which medication is most likely to cause a side effect of diarrhea?

a. Diphenhydramine
b. Clonidine
c. Colchicine
d. Calcium carbonate
e. Amitriptyline

A

c

The other drugs listed cause constipation.

34
Q

CK is pregnant with her 1st child. She didn’t suffer from constipation until the 2nd trimester of her pregnancy. Choose the preferred tx.

a. PEG 3350
b. Docusate
c. Psyllium
d. MiraLax
e. Milk of Magnesia

A

c

Fiber is the 1st line tx for constipation during pregnancy.

35
Q

A pt with opioid-induced constipation has failed multiple trials of stimulant laxatives. An order is written for a peripherally acting mu-opioid receptor antagonist. Which of the following meds is indicated for this condition and works by this mechanism?

a. Linaclotide
b. Lubiprostone
c. Alvimopan
d. Naloxegol
e. Tegaserod

A

d

-Naloxegol (Movantik) is a PAMORA indicated for OIC after 1st line treatments have failed.
-Alvimopan is a PAMORA, but it has a different indication.
-Lubiprostone is indicated for OIC but has a different MOA.

36
Q

Which best describes the MOA of MiraLax?

a. Adds fluid to the stool which creates more bulk
b. Draws fluid into the gut by osmosis and increases peristalsis
c. Directly stimulates colon neurons causing peristalsis
d. Acts as an emollient, reducing the surface tension of the stool
e. Lubricates the bowel and stool by coating with a waterproof film

A

b

37
Q

MV is a 52 y/o Hispanic female with HTN, anemia, dyslipidemia, chronic HF, and renal insufficiency d/t IgA nephropathy. Her CrCl is estimated at 18 mL/min. She’s been seen by a gastroenterologist for abdominal pain, and a colonoscopy is recommended. Which of the following is an osmotic laxative for bowel prep that’s contraindicated in MV?

a. MiraLax
b. OsmoPrep
c. Fleet Enema
d. Relistor
e. Milk of Magnesia

A

b

38
Q

Which dosing regimen is correct for self-tx with loperamide?

a. 8 mg after first loose stool; 4 mg after each subsequent stool; max 24 mg/day
b. 4 mg after first loose stool; 4 mg after each subsequent stool; max 16 mg/day
c. 4 mg after first loose stool; 2 mg after each subsequent stool; max 8 mg/day
d. 4 mg after first loose stool; 2 mg after each subsequent stool; max 16 mg/day
e. 2 mg after first loose stool; 4 mg after each subsequent stool; max 8 mg/day

A

c

Self-tx shouldn’t exceed 48 hours. Overuse of loperamide has resulted in cardiac arrest and sudden death.

39
Q

A pt being beginning tx with Amitiza should be counseled on which common side effect?

a. Constipation
b. Hyponatremia
c. HTN
d. Somnolence
e. Nausea

A

e

40
Q

Which meds can be prescribed for irritable bowel syndrome with constipation in a 35 y/o female if OTC tx options have failed?

a. Linzess
b. Methylnaltrexone
c. Amitiza
d. Eluxadoline
e. Bentyl

A

a, c

Plecanatide (Trulance) is also indicated in IBS-C

41
Q

Which brand and generic drug names are correctly matched?

a. Benefiber - glycerin
b. Fleet Enema - mineral oil
c. Senokot - docusate
d. FiberCon - calcium polycarbophil
e. NuLytely - sodium phosphates

A

d

42
Q

A pt presents with complaints of dizziness, dry mouth, and blurred vision. Which med is most consistent with these side effects?

a. Bentyl
b. Lactulose
c. Linzess
d. Loperamide
e. Tenapanor

A

a

The Beers Criteria recommend avoiding anticholinergic drugs, such as dicyclomine (Bentyl), in patients >/= 65 y/o

43
Q

What is the MOA of eluxadoline?

a. Serotonin 5HT-4 receptor agonist
b. Peripherally-acting mu-opioid receptor agonist
c. Sodium-hydrogen exchanger inhibitor
d. Gut chloride channel activator
e. Guanylate cyclase C agonist

A

b

44
Q

Which of the following best describes the criteria for use of Entereg?

a. Long-term for constipation induced by chronic opioid use
b. Short-term in hospitalized surgery patients at risk for ileus
c. Long-term for irritable bowel syndrome with constipation
d. Short-term in outpatients preparing for a colonoscopy
e. Short-term for irritable bowel syndrome with diarrhea

A

b

-Alvimopan (Entereg) is indicated for short-term use only (no more than 15 doses) to prevent post-op ileus in patients undergoing surgery.
-A REMS program is required, as long-term use has a risk for myocardial infarction.
-It’s contraindicated in those taking opioids > 7 days.

45
Q

TL is a 23 y/o female who presents with frequent and recurrent constipation that occurs with abdominal bloating and discomfort. Her symptoms are only relieved once she has a bowel movement. She has tried some OTC meds but thought it was time to see a medical professional. She denies fevers, nausea, or vomiting.
Allergies: Peanuts (hives)
Meds: Zyrtec QHS, Flonase daily, Citrucel daily, Ex-Lax PRN, Tylenol PRN

Which condition is TL most likely experiencing?

a. C. diff infection
b. Opioid-induced constipation
c. Irritable bowel syndrome with constipation
d. Lactose intolerance
e. Viral gastroenteritis

A

c

IBS-C typically presents with constipation of unknown (idiopathic) cause associated with abdominal discomfort that’s relieved upon defecation.

46
Q

Which drug is a controlled substance?

a. Lomotil
b. Imodium A-D
c. Lubiprostone
d. Dicyclomine
e. Relistor

A

a

Lomotil is diphenoxylate + atropine. It’s a C-V drug. The atropine component is used to discourage abuse, but it can cause anticholinergic effects (e.g., sedation, tachycardia, flushing, urinary retention) if used at higher than recommended doses.

47
Q

Prucalopride and tegaserod are serotonin 5HT-4 receptor agonists that have a warning for:

a. Suicidal ideation
b. Atropinism
c. Teratogenicity
d. Hypocalcemia
e. Phenylketonuria

A

a

48
Q

A 35 y/o male has been using Pepto-Bismol several times daily. His other meds include aspirin, lisinopril, metformin, and glipizide. He’s at an increased risk for which AE?

a. Reye’s syndrome
b. Pancreatitis
c. Tinnitus
d. Hyperglycemia
e. Aspiration pneumonitis

A

c

Pepto-Bismol and aspirin are both salicylates. They can cause ringing in the ears, which is a sign of toxicity.

49
Q

A mother asks the pharmacist what to use to help her 4 y/o daughter have a bowel movement. The mother states the child “forgets to go” when she’s playing, and now it seems too late. The child is squirming and crying. The mother is anxious to help relieve the problem urgently. Choose the best recommendation.

a. Docusate syrup
b. Glycerin suppository
c. Methylcellulose powder
d. Bisacodyl tablet
e. Loperamide liquid

A

b

For a child with constipation who needs to go quickly, a glycerin suppository (pediatric size) will work right away. If not, a second dose can be administered.

50
Q

Which of the following are true statements regarding mesalamine enemas?

a. Empty the bowels immediately after use
b. Patients should ideally retain the drug in the rectum overnight (8 hours)
c. Topical mesalamine is preferred for proximal disease
d. The med is generally prescribed 1 week at a time because it’s poorly tolerated
e. Each bottle can be used multiple times until it’s empty

A

b

-Mesalamine enemas should be administered once daily at bedtime and, ideally, retained for 8 hours.
-The bowels should be emptied immediately before use.
-Topical products aren’t effective for proximal disease.
-Each bottle is single-use.

51
Q

Which of the following meds are aminosalicylates?

a. Mesalamine
b. Olsalazine
c. Balsalazide
d. Tofacitinib
e. Mercaptopurine

A

a, b, c

Mesalamine, sulfasalazine, balsalazide, and olsalazine are all aminosalicylates used in the tx of ulcerative colitis.

52
Q

A pt has a prescription for mesalamine rectal suppositories for distal ulcerative colitis symptoms. Which of the following is a correct instruction for use?

a. Insert 4x daily and retain in the rectum for 1-3 hours each time
b. Roll the suppository between your hands into a point prior to insertion
c. Insert each night and keep in the rectum for at least 1-3 hours
d. Insert daily, first thing in the morning upon waking
e. Insert at the first sign of a UC flare

A

c

Suppositories melt quickly and should be handled as little as possible. When the pt is lying down, the medication will be retained in the body for a longer period of time.

53
Q

Which medication can be used once weekly to treat Crohn’s disease?

a. Tofacitinib
b. Methotrexate
c. Tysabri
d. Tacrolimus
e. Cyclosporine

A

b

-Cyclosporine and tofacitinib are only indicated for severe UC
-Tysabri (natalizumab) is dosed every 4 weeks

54
Q

What is meant by the term”distal” ulcerative colitis?

a. Near the duodenum
b. Near the rectum
c. Near the ileum
d. Near the lower esophageal sphincter
e. Adjacent to the stomach

A

b

Refers to the disease occurring near the rectum (can include the most distal part of the colon, called the sigmoid colon, or the most distal portion of the descending colon.

55
Q

Which of the following describes the MOA of infliximab?

a. Mab that binds to integrin
b. Mab against interleukin-1
c. Mab that binds to TNF
d. Mab that depletes CD20 B cells
e. Mab that inhibits T cell activation

A

c

56
Q

Proctitis refers to inflammation of the following:

a. Small intestine
b. Gall bladder
c. Liver
d. Rectum
e. Esophagus

A

d

-Can be caused by IBD, STDs, or radiation of certain cancers
-Patients often complain of feeling like they need to have a bowel movement constantly
-Tx is directed at the underlying cause

57
Q

Which of the following is a first-line tx option for a pt newly diagnosed with distal mild ulcerative colitis?

a. PO sulfasalazine
b. PO azathioprine
c. Mesalamine suppository
d. Infliximab injection
e. PO methotrexate

A

c

-Aminosalicylates are the recommended first-line tx for UC.
-In distal disease, rectal options are preferred.

58
Q

Which of the following is correct regarding budesonide for the tx of Crohn’s disease?

a. The brand name is Uceris
b. Budesonide doesn’t interact with other meds
c. Budesonide has a decreased risk of side effects compared to other steroids (e.g., prednisone)
d. Budesonide should be used indefinitely and shouldn’t be discontinued
e. Budesonide works better than prednisone in treating the disease symptoms

A

c

-Budesonide is a PO steroid that’s less absorbed systemically than prednisone. It isn’t more effective than prednisone but has fewere severe AEs because of the limited absorption.
-Uceris - for UC only
-Ideally, steroids should be used for 8-12 weeks for an acute flare then tapered off to avoid long-term AEs.

59
Q

Which steroids are available as rectal foam products for IBD?

a. Prednisone and budesonide
b. Budesonide and dexamethasone
c. Hydrocortisone and prednisone
d. Hydrocortisone and methylprednisolone
e. Budesonide and hydrocortisone

A

e

60
Q

Which of the following is an interleukin receptor antagonist approved for the tx of Crohn’s disease and UC?

a. Ustekinumab (Stelara)
b. Mercaptopurine (Purixan)
c. Olsalazine (Dipentum)
d. Belimumab (Benlysta)
e. Ocrelizumab (Ocrevus)

A

a

Stelara is approved for Crohn’s disease, UC, and psoriasis.

RxPrep (51 decks)

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