IBD related Facts@

Question 1

AZO 5-ASAs (Sulfasal,balsal) have greatest effect where?

Answer 1

The colon

Question 2

Which ASAs start release in TI?

Answer 2

Asacol, Lialda, Delzicol, Apriso

Question 3

WHat is best predictor of pouchitis after IPAA?

Answer 3

NSAID use

Question 4

Other predictors of pouchitis?

Answer 4

Indet colitis, extenisve dz, pANCA+, PSC, preop extraintestinal dz

Question 5

TNF induced psoriasis tx?

Answer 5

Topical CCS, cont TNF initially and see if can control

Question 6

How to regress colonic dysplasia in IBD pts?

Answer 6

No known way - if confirmed at repeat chromo need colectomy

Question 7

What is the goal 6-TG for AZA tx?

Answer 7

> 235

Question 8

What is the standard goal AZA dose?

Answer 8

2-3 mg/kg/day

Question 9

T/F: Demyelinating disease is a contraindication to anti-TNF tx in IBD pts.

Answer 9

true - can worsen disease and sxs

Question 10

Which SEs are caused by 6TG and 6MMP and which are not related to either?

Answer 10

6TG - myelosuppression
6MMP - hepatotoxicity
Neither - AP, lymphona, skin CA

Question 11

What is the MOA of golimumab?

Answer 11

Anti TNFa

Question 12

Bile acid diarrhea MOA? What would stool osm gap be?

Answer 12

Secretory diarrhea - osm gap < 50

Question 13

At what week range should anti-TNF tx be stopped in pregnancy?

Answer 13

Weeks 24-32

Question 14

IBD pts tend to get mono, pauci, or polyarticular dz?

Answer 14

Pauci-articular (<5 jts)

Question 15

Which skin condition in IBD tends to parallel dz activity?

Answer 15

EN

Question 16

Which skin condition in IBD tends to have +pathergy?

Answer 16

Pyoderma gangrenosum

Question 17

Which eye condition in IBD tends to affect visual acuity?

Answer 17

Uveitis more so than episcleritis

Question 18

What are vaccine recs in babies delivered to IBD pt on anti-TNF?

Answer 18

Delay live vaccines 6 months, otherwise give vaccines normally

Question 19

What is the risk of teduglutide?

Answer 19

Inc risk of colon polyps

Question 20

What causes D-lactic acidosis?

Answer 20

CHO mal-assimilation - needs colon in continuity with SI to get this

Question 21

What leads to Ca oxalate stones in IBD?

Answer 21

Fat mal-assimilation - Ca binds to FFA in the gut lumen and so have increase in free oxalate which is absorbed and can form stones

Question 22

What is the principal regulator of iron homeostasis?

Answer 22

Hepcidin

Question 23

How does hepcidin work?

Answer 23

Decreased hepcidin due to low iron –> better absorption. Inc hepcidin in high iron state –> dec absorption. If inflamed, hepcidin can go up and limit absorption even in low Fe state, so would need Iv replacement

Question 24

Name features of acute colon inflammation.

Answer 24

LP edema, vasc congestion, acute inflamm cells, cryptitis/abscesses, goblet cell depletion

Question 25

Name features of chronic colon inflammation.

Answer 25

Distal colon paneth cells, LCs and plasma cells in crypts, crypt dropout

Question 26

What is the effect of high TPMT level?

Answer 26

tend to have more 6MMP which can lead to HPTox

Question 27

What is the effect of low TPMT level?

Answer 27

Tend to have more cytopenias and BM suppression

Question 28

What should be done if considering AZA and high TPMT

Answer 28

Either switch to MTX or add allopurinol

Question 29

sulfasalazine SEs

Answer 29

headaches, nausea (due to sulfa portion)

Question 30

name the azo-bonded 5ASAs and where do they have effect?

Answer 30

Sulfasal, olsalazine, balsalazide -effects in the colon

Question 31

name the pH dependent 5ASAs and where do they have effect?

Answer 31

Delzicol, Azacol, Apriso, Lialda - effect starts in TI - release when pH at 6-7

Question 32

Which 2 5-ASAs have the most even distribution of drug in colon?

Answer 32

Lialda and Apriso

Question 33

T/F: Oral + rectal mesalamine superior to oral alone in induction of remission as well as MOR in left sided and pan-UC pts.

Answer 33

True

Question 34

Name RFs for pouchitis in UC pt with pouch.

Answer 34

Postop NSAID use, indet colitis, extensive colonic dz with backwash ileitis, pANCA+, PSC, preop EI manifestations

Question 35

T/F: Tobacco use is a RF for post op pouchitis.

Answer 35

False - it may be protective

Question 36

Which type of IBD is more genetic?

Answer 36

Crohns

Question 37

T/F: Sulfasalazine can lead to male and female infertility.

Answer 37

False, male only- affects sperm but not female fertility

Question 38

T/F: Mothers on AZA during pregnancy and breast feeding do not need to have kids on alternate vaccine schedule.

Answer 38

True

Question 39

HST pneumonitis AW what drug?

Answer 39

MTX

Question 40

Pt with latent TB and want to start anti TNF. What needs to happen first?

Answer 40

Tx with 1 month of INH and vit B6 with plan for 9 month course

Question 41

Which IBD EIMs are not related to dz activity?

Answer 41

AS, PSC, and uveitis