Inflammatory Bowel Disease

Question 1

What are the 2 types of IBD?

Answer 1

Ulcerative colitis

Crohn’s disease

Question 2

What can trigger IBD flares

Answer 2

Infections
NSAID use
Certain foods (typically fatty and gas-producing)

Question 3

Which causes inflammation, IBS or IBD?

Answer 3

IBD (Inflammatory bowel disease vs irritable bowel syndrome)

Question 4

What is ulcerative colitis (UC)?

Answer 4

Included in IBD

Inflammation confined to rectum and colon with superficial ulcerations

Question 5

What is it called when UC is limited to the descending colon and rectum?

Answer 5

Distal disease

Question 6

What is it called when UC is limited to the rectum?

Answer 6

Proctitis

Question 7

What is crohn’s disease (CD)?

Answer 7

IBD with deep, trasmural (through bowel wall) inflammation that can affect ANY part of the GI tract

Question 8

Clinical features of CD vs UC

Location, depth, pattern, smoking

Answer 8

CD: Entire GI tract, transmural, non-continuous through GI tract, smoking is risk factor
UC: colon, superficial, continuous, smoking is protective

Question 9

How is IBD diagnosed?

Answer 9

colonoscopy with tissue biopsy

Question 10

What lifestyle measures can be used to help prevent IBD triggers?

Answer 10

Small, frequent meals

Low in fat and dairy

Question 11

What OTC medications and natural products can help with IBD symptoms?

Answer 11

Antidiarrheals or antispasmodic drugs
Vitamin supplements (B12, vitamin D, calcium, iron)
Probiotics may help in some patients

Question 12

What medications are used for induction of remission for CD

Answer 12

Steroids +/- thiopurine or MTX
Anti-TNF +/- thiopurine
Ustekinumab (Stelara)

Question 13

What medications are used for induction of remission for UC

Answer 13

5-ASA +/- steroids
Anti-TNS agents
Ustekinumab (Stelara)
Tofacitinib (Xeljanz)
Vedolizumab
IV cyclosporine

Question 14

What medications are used for maintenance of remission for CD?

Answer 14

Mild: oral budesonide then thiopurine or methotrexate
Moderate: anti-TNF agents, Thiopurine, MTX, Ustekinumab (Stelara)
Refractory or steroid dependent: Integrin receptor antagonists

Question 15

What medications are used for maintenance of remission for UC

Answer 15

Mild: Mesalamine rectal or oral
Moderate: Anti-TNF agents, Thiopurine, cyclosporine, Ustekinumab (Stelara), Tofacitinib (Xeljanz)
Refractory or steroid dependent: Vedolizumab

Question 16

What anti-TNF agents are used in CD and UC

Answer 16

Both: Adalimumab (Humira) and Inflizimab (remicade)
CD: Certolizumab (Cimzia)
UC: Golimumab (Simponi)

Question 17

Oral steroids used in IBD

Answer 17

Perdnisone (Deltasone) and Budesnoide (Entocort, Uceris)

Question 18

Rectal steroids used in UC

Answer 18

Hydrocortiosne and budesonide

Only used for UC, NOT CD

Question 19

What medications are aminosalicylates? Are they used in CD or UC?

Answer 19

Mesalamine, sulfasalazine, balsalazide, olsalazine

Indicated for use in UC

Question 20

Aminosalicylate CI and warnings

Answer 20

CI: salicylate sensitivity/allergy
Warnings: hypersensitivity reaction (more common with sulfasalazine)

Question 21

What thiopurine medications are used in IBD

Answer 21

Azathioprine and mercaptopurine

Question 22

Azathiopurine warnings

Answer 22

Genetic deficiency of thiopurine methyltransferase (TPMT) are at increased risk for myelosuppression

Question 23

What medications are integrin receptor antagonists? What are they indicated fro?

Answer 23

Natalizumab (Tysabri) - CD

Vendolizumab (Entyvio) - CD and UC

Question 24

Natalizumab (Tysabri) BBW

Answer 24

Progressive multifocal leukoencephalopathy (PML); only available through REMS program

Question 25

Key counseling point ofr Mesalamine

Answer 25

Select ER products can cause ghost tablets