IBD

Question 1

infliximab indications

Answer 1

UC and CD
may be preferred for UC induction or fulminant UC

Question 2

adalimumab indications

Answer 2

UC and CD induction and mx
can use in pts with poor response to infliximab

Question 3

TNF inhibitors ADRs

Answer 3

1. increased risk of infection
2. injection site rxns
3. risk of malignancy
4. risk of demyelinating disease
5. CHF exacerbation

Question 4

golimumab indications

Answer 4

UC ONLY - induction and mx

Question 5

certolizumab indications

Answer 5

CD ONLY - induction and mx

Question 6

ozanimod and estrasimod indications

Answer 6

UC ONLY - moderate-severe

Question 7

varicella vaccine is recommended prior to starting which treatments?

Answer 7

ozanimod and estrasmiod

Question 8

which drugs are metabolized by CYP3A and therefore need to be monitored with CYP3A inducers/inhibitors ?

Answer 8

tofacitinib
upadacitinib

Question 9

In which patients would you consider use of Xeljanz or Rinvoq?

Answer 9

in patients who had an inadequate response or are intolerant to TNF blockers

Question 10

Ozanimod is contraindicated with what?

Answer 10

MAOIs

Question 11

vedolizumab and ustekinumab indications

Answer 11

UC and CD - induction and mx

Question 12

CDAI 150-220

Answer 12

mild-moderate CD, ambulatory with minimal symptoms

Question 13

CDAI 220-450

Answer 13

moderate-severe CD, patient who fail therapy for mild-moderate or with major symptoms

Question 14

CDAI > 450

Answer 14

severe-fulminant CD, persistent symptoms despite steroid or biologic use, presence of cachexia, obstruction, or abscess

Question 15

Fistulas are common in: CD or UC?

Answer 15

CD

Question 16

The inflammation is deeper in: CD or UC?

Answer 16

CD

Question 17

What is the most common affected site in CD?

Answer 17

terminal ileum

Question 18

What is the active and inactive component of sulfasalazine?

Answer 18

inactive = sulfapyridine (associated with ADRs)
active = 5-ASA (mesalamine)

Question 19

What dosage forms is mesalamine typically in? Which dosage form is usually most effective?

Answer 19

-topical (enema)
-suppository
-oral DR/CR tablet

topical is generally more effective than oral

Question 20

ASA agents - ADRs

Answer 20

N/V, headache, anorexia, rash

Question 21

How to avoid ADRs with ASA agents

Answer 21

initiate at low dose and increase slowly over 1-2 weeks

Question 22

ASA agents drug interactions

Answer 22

-antiplatelets/anticoagulants
-NSAIDs
-> may increase bleeding risk
-agents affecting gastric pH (PPIs, H2RAs, antacids) - could affect release of drug

Question 23

Which ASA agent has the highest incidence of diarrhea?

Answer 23

Olsalazine

Question 24

Which routes are corticosteroids used for IBD?

Answer 24

oral, rectal, parenteral
*rectal hydrocortisone common

Question 25

What supplements should be given while on steroids?

Answer 25

calcium and vitamin D

Question 26

Azathioprine and 6-MP indications

Answer 26

-long-term tx of UC and CD - maintenance -maintain remission, steroid-sparing -reserved for pts who fail 5-ASA tx or pts dependent on steroids

Question 27

Azathioprine and 6-MP ADRs

Answer 27

N/V/D, anorexia bone marrow suppression hepatotoxicity fever, rash

Question 28

Methotrexate indications

Answer 28

CD - assist in inducing remission, steroid-sparing effects

Question 29

Methotrexate ADRs

Answer 29

bone marrow suppression, mucositis, cirrhosis, pneumonitis, rash, alopecia, teratogenic

Question 30

TNF-a antagonists

Answer 30

1. infliximab 2. adalimumab 3. golimumab 4. certolizumab

Question 31

Infliximab has an increased risk of which malignancy?

Answer 31

hepatosplenic T-cell lymphoma

Question 32

Which biologics require an infusion?

Answer 32

-infliximab -natalizumab -vedolizumab

Question 33

Corticosteroids short-term adverse effects

Answer 33

1. hyperglycemia 2. gastritis 3. mood changes 4. elevated BP

Question 34

Corticosteroids long-term adverse effects

Answer 34

1. aseptic necrosis 2. cataracts 3. obesity 4. growth failure 5. osteoporosis

Question 35

Methotrexate contraindications

Answer 35

1. pregnancy 2. immunodeficiency 3. blood dyscrasias 4. chronic liver disease 5. pleural effusions 6. leukopenia/thrombocytopenia 7. CrCl < 40

Question 36

ozanimod and estrasimod ADRs

Answer 36

1. increased risk of infection 2. bradycardia/AV conduction delays 3. potential risk of PML 4. increased BP 5. increased LFTs/liver injury 6. macular edema 7. respiratory effects 8. reversible posterior leukoencephalopathy syndrome

Question 37

T/F: 5-ASA therapy may be used for severe UC

Answer 37

FALSE - used for moderate disease