IBD (Exam 3)

Question 1

Immunologic etiology of IBD

Answer 1

TNF-alpha is increased in mucosa + intestinal lumen
Dysregulation of cytokines
Autoimmune features directed against mucosal epithelial cells

Question 2

In which disease is smoking cigarettes considers protective?

Answer 2

Ulcerative colitis
reduces severity + frequency of flares

Question 3

Mesalamine (5-ASA)

Answer 3

Topical anti-inflammatory drugs that are absorbed from small intestine

Question 4

Sulfasalazine (Azulfidine)

Answer 4

Pro drug combination of 5-ASA and sulfapyridine

Question 5

_____ matters with ADRs from sulfapyridine

Answer 5

Acetylator status

Question 6

Sulfasalazine (Azulfidine) main ADR

Answer 6

Oligospermia = low sperm count in men

Question 7

Olsalazine (Dipentum)

Answer 7

5-ASA + 5-ASA

Question 8

Balsalazide (Colazal)

Answer 8

5-ASA + inert carrier

Question 9

pH/extended release mesalamine compound

Answer 9

Asacol
pH of 7
72% released into colon

Question 10

Sustained release mesalamine compound

Answer 10

Pentasa
50% before colon, 50% after

Question 11

Safety considerations of 5-ASA agents

Answer 11

Nephrotoxicity/AKI

Question 12

Glucocorticoids

Answer 12

Prednisone (oral)
Hydrocortisone (enema or suppository)

Question 13

IV hydrocortisone is reserved for _____

Answer 13

Severe-fulminant active disease
First line in hospitals

Question 14

Budesonide (Entocort EC) is another steroid that can be considered but has ______

Answer 14

low bioavailability

Question 15

Immunomodulators

Answer 15

Azathiporine (Imuran, Azasan)
Methotrexate

Question 16

Azathiporine (Imuran, Azasan)

Answer 16

prodrug of 6-mercaptopurine

Question 17

What test should be done before giving Azathiporine (Imuran, Azasan)

Answer 17

TPMT testing (thiopurine methyltransferase)

Question 18

Azathiporine (Imuran, Azasan) ADRs

Answer 18

bone marrow depression
leukopenia
thrombocytopenia
lymphomas (rare)

Question 19

What should you monitor in methotrexate?

Answer 19

Blood (CBC, platelets)
Liver (LFTs)
Pulmonary (Chest x-ray)

Question 20

Infliximab (Remicade) indications

Answer 20

moderate to severe UC + CD, steriod dependent, fistulizing disease

Question 21

Infliximab (Remicade) dosing

Answer 21

5 mg/kg every 8 weeks

Question 22

What should you do if begin to develop antibodies to biologic?

Answer 22

Increase the dose or shorten the interval between treatments

Question 23

Adalimumab (HUMIRA) advantage

Answer 23

Given subq + at home

Question 24

Anti-TNF side effects

Answer 24

delayed infusion reaction
rare risk of lymphoma

Question 25

Which drug has an increased risk for JC virus and PML?

Answer 25

Natalizumab
Test for JCV antibodies before treatment

Question 26

IL-23 Inhibitors (Biologics)

Answer 26

RIsankizumab (Skyrizi)
Mirikizumab (Omvoh)

Question 27

JAK Inhibitors (Small Molecules)

Answer 27

Tofacitinib (Xeljanz)
Upadacitinib (Rinvoq)

Question 28

Tofacitinib (Xeljanz)

Answer 28

oral JAK 1 & 3 inhibitor

Question 29

Upadacitinib (Rinvoq)

Answer 29

oral JAK 1 inhibitor

Question 30

Upadacitinib (Rinvoq) ADRs

Answer 30

Cs = cardiac, cancer, clots

Question 31

S1P Modulators (Small Molecules)

Answer 31

Ozanimod (S1P1, S1P5)
Estrasimod (S1P1, S1P4, S1P5)

Question 32

Monitor in S1P modulators

Answer 32

yearly ophthalmologic exam