IBD DR. J

Question 1

In IBD what two factors are involved to cause a chronic state of dysregulated mucosal immune function?

Answer 1

1. Exogenous
2. Endogenous

Question 2

Transmural inflammation of any part of the GI Tract.

Answer 2

Crohn’s disease

Question 3

Confluent mucosal inflammation of the colon starting at the anal verge and extending proximal for a viable extent

Answer 3

Ulcerative colitis

Question 4

Which disease can affect any part of the GI tract from the mouth to the anus?

Answer 4

CD

Question 5

What part of the GI Tract is often spared in CD?

Answer 5

Rectum

Question 6

Which disease is limited to the mucosa and superficial submucosa, with the deeper layers unaffected except in fulminant disease?

Answer 6

UC

Question 7

What cells reside at the base of the crypts and give rise to all absorptive and secretory cells making up the epithelial layer?

Answer 7

Intestinal stem cells

Question 8

Cells that produce the mucus layer

Answer 8

Goblet cells

Question 9

Cells that produce antimicrobial peptides

Answer 9

Paneth cells

Question 10

Cells that synthesize IgA which prevents invasion by pathogenic organisms and helps to maintain a homeostatic balance

Answer 10

Plasma cells

Question 11

_____ cells and innate immune cells detect micro iota using pattern recognition receptors

Answer 11

Epithelial

Question 12

Commensals in IBD are recognized as what?

Answer 12

Pathogenic

Question 13

TNF alpha and INF gamma are ___inflammatory with ____ effects on barrier function

Answer 13

Pro; negative

Question 14

CD1d, RIPK1 and IL-10 are ____inflammatory with ______ effects.

Answer 14

Anti; protective

Question 15

The CD the cytokine profile is representative of what mediated inflammatory response?

Answer 15

T-helper1 (TH1)

Question 16

The UC inflammatory response is mediated by what pathway?

Answer 16

TH2 pathway

Question 17

What is the TH2 pathway mostly under control of?

Answer 17

IL-4

Question 18

TNF alpha exists in a _____

Answer 18

Stable homotrimer

Question 19

Both ___+_____ TNF can perform their biological function by binding to their receptors

Answer 19

Membrane; soluble

Question 20

What does TNF trigger?

Answer 20

Apoptosis and breaks epithelial barrier

Question 21

What does TNF drive?

Answer 21

Adaptive immune response

Question 22

What produces TNF? What does TNF recruit?

Answer 22

Immune cells

Question 23

What does TNF modulate?

Answer 23

Immune cell function

Question 24

What is the MOA of anti- TNF Biologics?

Answer 24

Bind to homotrimeric TNF alpha to neutralize TNF alpha mediated pro-inflammatory signaling

Question 25

Fully human antibody against IL-12/23 that binds to the p40 subunit

Answer 25

Ustekinumab

Question 26

Small molecule inhibitor of JAK activity that prevents JAK dependent phosphorylation of STAT proteins

Answer 26

Tofacitinib

Question 27

What is sulfasalazines site of delivery?

Answer 27

Colon

Question 28

What are the 3 anti-inflammatory pro drug formulations?

Answer 28

1. Sulfasalazine 2. Olsalazine 3. Balsalazide

Question 29

What are the 3 key factors for drug delivery

Answer 29

1. Mucus 2. pH 3. Commensals

Question 30

The prodrugs all contain what bond?

Answer 30

Azo bond

Question 31

What is the therapeutic moeity of sulfasalazine?

Answer 31

5- ASA

Question 32

5-ASA acts _____ in the colon; ____ absorbed in the mucosa

Answer 32

Topically; poorly

Question 33

5-ASA is highly ____phobic

Answer 33

Lipo

Question 34

What mechanism makes 5- ASA active?

Answer 34

N-acetylation

Question 35

Pentasa has a ________ release

Answer 35

Time dependent

Question 36

Eudragit and Asacol have _____ dependent release

Answer 36

pH

Question 37

Where is Asacol released?

Answer 37

Terminal ileum and cecum

Question 38

What is 5-ASA incorporated into for a time delayed release?

Answer 38

Microparticles of lipophilic matrix dispersed within a hydrophilic matrix

Question 39

The core of 5-ASA microparticles are coated with what?

Answer 39

A pH dependent gastric acid resistant polymer

Question 40

Each APRISO capsule has what type of release dosage form?

Answer 40

Delayed and extended

Question 41

What problems can immunosuppressants cause?

Answer 41

They can increase the risk of infection and malignancies

Question 42

Glucocorticoids are quickly______

Answer 42

Absorbed

Question 43

What is essential for both MC and GC activity?

Answer 43

3-one-4-ene

Question 44

Where does cyclosporine act?

Answer 44

At an early stage in antigen receptor induced differentiation of T cells and blocks their activation

Question 45

What does cyclosporine bind to?

Answer 45

Cyclophilin

Question 46

What does cyclophilin form?

Answer 46

A complex that inhibits the cytoplasmic phosphates calcineurin

Question 47

What does cyclosporine inhibit?

Answer 47

Gene transcription

Question 48

What is the key excipient in sandimmune?

Answer 48

Cremophor

Question 49

Immunosuppressant macrolide antibiotic

Answer 49

Tacrolimus

Question 50

What does tacrolimus bind to?

Answer 50

FK binding protein

Question 51

Living food supplements or components of bacteria that have been shown to have beneficial effects on human health

Answer 51

Probiotics