Inflammatory Bowel Disease

Question 1

characteristics of UC

Answer 1

confined to the rectum and colon
superficial ulcers
bloody diarrhea
continuous appearence

Question 2

smoking is protective in _____, but a risk factor in _____

Answer 2

protective in UC
risk factor in CD

Question 3

CD characteristics

Answer 3

can be anywhere in the GI tract
deep ulcers with a cobblestone appearance (non-continuous)
can lead to strictures and fistulas
common in ileum and colon

Question 4

non-pharm management of UC and CD

Answer 4

smaller, more frequent meals
low fat, low dairy
lots of water
avoid alcohol, caffeine, carbonation
probiotics
fish oils
peppermint
chamomile
horehound
wheatgrass

Question 5

what vitamins/supplements may need to be given in IBD

Answer 5

B12, folate, Ca, Vit D, iron, zinc

Question 6

what is/are tx recommendation for mild UC

Answer 6

mesalamine rectal +/or oral

Question 7

what is/are tx recommendation for mild CD

Answer 7

budesonide PO x </= 3mo then changes to MTX or thiopurine

Question 8

what is/are tx recommendation for moderate-severe UC

Answer 8

anti-TNF
- adalimumab (Humira)
- infliximab (Remicade)
- golimumab (Simponi)

thiopurine (AZA, mercaptopurine)
cyclosporine
IL-R antag Stelara

Question 9

what is/are tx recommendation for moderate-severe CD

Answer 9

anti-TNF
- adalimumab (Humira)
- infliximab (Remicade)
- golimumab (Simponi)

thiopurine (AZA, mercaptopurine)
MTX
IL-R antag Stelara

Question 10

what is/are tx recommendation for refractory / steroid-dependent UC

Answer 10

vedolizumab (Entyvio)
JAK-i (Tofacitinib/Xeljanz)

Question 11

what is/are tx recommendation for refractory / steroid-dependent CD

Answer 11

vedolizumab (Entyvio)
natalizumab (Tysabri)

Question 12

prednisone dosing for induction

Answer 12

5-60mg PO QD

Question 13

budesonide PO dosing
is this for UC or CD?

Answer 13

induction: UC and CD
9mg PO QD am x</= 8 weeks

maintenance CD only:
6mg PO QD x3 months then taper

Question 14

why is budesonide used for UC and CD

Answer 14

extensive first pass metabolism with limited systemic absorption which is desirable since the target tissue(s) is the GI tract!

Question 15

mesalamine
for UC or CD?
MOA
dosage forms
SE/pearls
how long is induction?

Answer 15

for mild UC
5-ASA / an aminosalicylate that helps with inflammation
PO and rectal forms, can be used together
rectal is more effective than PO
induction = 6-8 weeks then MD

Question 16

what are the aminosalicylates used in IBD

Answer 16

mesalamine
sulfasalazine
balsalazide

Question 17

what are the integrin receptor antagonists used in UC and/or CD? which is for which?

Answer 17

verdolizumab can be used in UC and CD
natalizumab is only for CD

Question 18

what are the thiopurines used in IBD? where do they fall in the tx process?

Answer 18

AZA and mercaptopurine
for mod-severe UC or CD