Inflammatory Bowel Disease

Question 1

these drugs can cause IBD

Answer 1

opiates, NSAIDs, antidiarrheals (loperamide, diphenoxylate/atropine)

Question 2

pt with UC isnt getting many leafy veggies and is taking sulfasalazine. What should you prescribe

Answer 2

Folic acid

Question 3

pt with UC is having considerable rectal bleeding. What should you prescribe?

Answer 3

Oral iron

Question 4

a pt had mild/mod UC but now has mod/severe. What changes in their drug regimen

Answer 4

add prednisone (HUGE DOSE)

Question 5

pt is refractory severe UC. what can i add?

Answer 5

azathioprine or mercaptopurine 6MP

or infliximab if no response

Question 6

fulminant UC. How does therapy change?

Answer 6

hydrocortisone 100mg

if no response, cyclosporine or colectomy

Question 7

Maintenance options for UC

Answer 7

aminosalicylates and/or AZA or 6-MP

or infliximab

Question 8

m/m ileocolonic or colonic crohn tx

Answer 8

sulfasalazine

mesalamine

Question 9

m/m perianal crohn tx

Answer 9

sulfasalazine
mesalamine
metronidazole

Question 10

m/m small bowel crohn tx

Answer 10

mesalamine
metronidazole
budesonide (steroid)

Question 11

m/s crohn tx what changes

Answer 11

follow the m/m protocol but add prednisone
add infliximab if refractory or fistulating
no response: add adalimumab, natalizumab, certolizumab

Question 12

severe/fulminant crohn tx

Answer 12

hydrocortizone
no response- cyclosporin
surgical resection

Question 13

do not use long term corticosteroids for maintenance of crohn. T or F

Answer 13

True

Question 14

first line for maintenance of crohn

Answer 14

azathioprine/6-MP
(infliximab)
(methotrexate)

Question 15

this class is commonly used for inducing and maintaining remission of IBD

Answer 15

aminosalicylates

Question 16

this drug is metabolized by intestinal bacteria to 5-aminosalicylate and suldapyridine (mesalamine)

Answer 16

sulfasalazine

Question 17

this drug is contraindicated in patients with renal impairment (monitor SCr) and in pts with salicylate hypersensitivity

Answer 17

sulfasalasine

Question 18

this drugs SE include N/V heartburn, anorexia, HA, hypersensitivity rxns, blood disorders, folic acid absorption, idiosyncratic rxns (HC injury, agranulocytosis, lupus-like pneumonia), and low sperm counts

Answer 18

sulfasalasine

Question 19

it is mandatory to prescribe a folic acid supplement with this drug

Answer 19

sulfasalasine

Question 20

this drug comes in different formulations so it can better target parts of the colon (suppositories or delayed release formations)

Answer 20

mesalamine

Question 21

SEs include local itching and mild rectal irritation with topical enemas and idiosyncratic reactions (pleuropericarditis, pancreatitis, nephrotic syndrome)

Answer 21

mesalamine

Question 22

these drugs have anti-inflammatory effects to improve symptoms and decrease disease severity

Answer 22

corticosteroids

Question 23

induction of response takes 7-14 days for this drug. it is important to taper

Answer 23

corticosteroids

Question 24

a patient on this class of drug should be monitored for complications of glucose intolerance/metabolic abnormalities (hyperkalemia, hyponatremia, glucose)

Answer 24

corticosteroids

Question 25

pts taking this class have greater risk for adrenal insufficiency and infections. N/V, postural hypotension

Answer 25

corticosteroids

Question 26

If a pt is on this class for over 3 months, monitor bone density and do annual eye exams

Answer 26

corticosteroids

Question 27

this is a prodrug that gets metabolized to 6-mercaptopurine

Answer 27

azathioprine

Question 28

this class provides maintenance therapy that is less toxic than chronic steroid therapy

Answer 28

immunosuppressives

Question 29

this class antagonizes purine metabolism; inhibit DNA, RNA and protein synthesis

Answer 29

immunosuppressives

Question 30

toxic levels of this drug class can cause bone marrow suppression (dose related), lymphoma, pancreatitis, GI effects, fever, rash, arthralgias

Answer 30

immunosuppressives

Question 31

this class can cause disseminated CMV, herpes zoster, pneumonia, Q fever, viral hepatitis

Answer 31

immunosuppressives

Question 32

this class can react with other drugs leading to increased myelosuppression: sulfasalazine, mesalamine, allopurinol, aspirin, furosemide

Answer 32

immunosuppressives

Question 33

this dug is a folic antagonist with anti-inflammatory effects. It reduces the need for steroids and improves disease control

Answer 33

methotrexate

Question 34

ADRs include nausea and ELEVATED TRANSAMINASES (MONITOR LFT)

Answer 34

methotrexate

Question 35

toxic levels of this drug can cause leukopenia, N/V, hypersensitivity pneumonitis, hepatic fibrosis

Answer 35

methotrexate

Question 36

this drug is an absolute contraindication in pregnancy (categoryX). stop therapy 3 months prior to conception

Answer 36

methotrexate

Question 37

this drug inhibits production and release of IL-2 and inhibits activation of T lymphocytes

Answer 37

cyclosporin (neoral or sandimmune)

Question 38

this drug is unable to maintain remission alone. It requires "bridging" with AZA or 6-MP and is recommended to be used concomitantly with IV steroids

Answer 38

cyclosporin (neoral or sandimmune)

Question 39

toxic levels of this drug can cause HTN, hypertrichosis, electrolyte abnormalities, nephrotox, and opportunistic infections (REQUIRES PCP prophylaxis)

Answer 39

cyclosporin

Question 40

this drug comes from a fungus and inhibits T lymphocyte activation

Answer 40

tacrolimus

Question 41

ADRs for this drug tend to be dose related. Include HA, increased serum creatinine, nausea, insomnia, leg cramps, paresthesias, and tremors

Answer 41

tacrolimus

Question 42

this drug is a monoclonal antibody that binds to TNF-alpha. It inhibits inflammatory cytokines, leukocytes migration, and activation of neutrophils

Answer 42

Infliximab

Question 43

Contraindicated in class III/IV heart failure and hepatitis (DC with LFTs 5x ULN)

Answer 43

Infliximab

Question 44

Your body will develop antibodies to this drug, which leaves an increased risk of infusion reaction and a shorter duration or response

Answer 44

infliximab

Question 45

toxic levels of this drug lead to infections (bacterial mycosal mycobacterium) and infusion reactions (NOT through an IgE and NOT at every infusion)

Answer 45

infliximab

Question 46

this drug can cause delayed hypersensitivities 3-14 days after infusion that include myalgia, arthralgia, fever, rash, pruritis, urticaria, HA. Can treat with steroids

Answer 46

infliximab

Question 47

a risk factor for toxic effects with this drug includes long intervals between treatments

Answer 47

infliximab

Question 48

This drug can cause malignancy and lymphoproliferatve disorders in pts with longstanding Crohns who are immunosuppressed

Answer 48

infliximab

Question 49

this drug is a fully human immunoglobulin 1 anti TNF alpha monoclonal antibody

Answer 49

adalimumab

Question 50

evaluate for TB before starting therapy with this drug

Answer 50

adalimumab

Question 51

this drug has a BBW for causing serious infections (TB, invasive fungal) it can cause rash, HA, urticaria, development of autoantibodies risk or reactivating hep B

Answer 51

adalimumab

Question 52

this drug is for moderate to severe crohns in pts with evidence of inflammation who have had inadequate response to or are unable to tolerate conventional therapies

Answer 52

natalizumab

Question 53

this drug is for pts in a specialty program. It is a recombinant immunoglobulin 4 monoclonal antibody

Answer 53

natalizumab

Question 54

dont administer this drug with other immunosuppressants. You should DC if no response in 12 weeks and taper oral steroids as soon as there is a response

Answer 54

natalizumab

Question 55

major adverse effect of this drug includes progressive multifocal encephalopathy

Answer 55

natalizumab

Question 56

this ab is used for treatment of ileocolitis or colitis if there was failure to respond to sulfasalazine

Answer 56

metronidazole

Question 57

ADRs include GI upset, metallic taste, paresthesias, antabuse-like rxn

Answer 57

metronidazole

Question 58

this ab is effective in resistant disease when used in combo with standard treatment

Answer 58

cipro

Question 59

this ab combo can be used to improve and promote closure of fistulas

Answer 59

metronidazole plus cipro

Question 60

this class can provide symptomatic relief of diarrhea by inhibiting excessive GI motility or propulsion

Answer 60

opiates