Inflammatory Bowel Disease treatment

Question 1

In Crohn’s disease, what nutritional deficiencies are expected in jejunoileitis?

Answer 1

Anemia

Hypoalbuminemia

Hypocalcemia

Hypomagnesemia

Coaguolopathy

Hyperoxaluria with nephrolithiasis

Question 2

Typical presentation of patient with Colitis in Crohn’s disease

Answer 2

Low grade fever Malaise diarrhea Crappy abdominal pain Sometimes hematochezia

Question 3

These agents are effective at inducing and maintaining remission in Ulcerative Colitis, with limited role in inducing remission in CD but no clear role in maintenance in CD

Answer 3

5-ASA agents

Question 4

Hypersensitivity reaction in sulfasalazine include? 8 manifestations

Answer 4

1. Rash 2. Fever 3. Hepatitis 4. Agranulocytosis 5. Pancreatitis 6. Worsening of colitis 7. Hypersensitivity pneumonitis 8. Reversible sperm abnormalities

Question 5

Which of the oral 5-ASA preparations exclusively deliver in the colon?

Answer 5

Sulfasalazine Balsalazide

Question 6

Patients taking sulfasalazine are in danger of which nutritional deficiency?

Answer 6

Sulfasalazine can also impair folate absorption and should be given folic supplement

Question 7

What are the common side effects of 5-ASA?

Answer 7

Headache Nausea Hair loss Abdominal pain

Question 8

This is a new glucocorticoid for UC which is released entirely in the colon and has minimal to no glucocorticoid side effects.

Answer 8

Budesonide 9 mg/d for 8 weeks and no taper is required.

Question 9

True or. false. topical 5-ASA is more effective than topical steroid therapy in the treatment of distal UC.

Answer 9

True.

Question 10

True or False. Glucocorticoids are important in maintenance therapy of both UC and CD.

Answer 10

False.

Question 11

Which antibiotic/s is/are effective in active inflammatory, fistulizing and perianal CD?

Answer 11

Metronidazole and Ciprofloxacin. However ciprofloxacin is associated with tendinitis and tendon rupture.

Question 12

Which is the active end product of azathioprine and 6-mercaptopurine?

Answer 12

Thioinosinic acid (inhibitor of purine ribonucleotide synthesis and cell proliferation

Question 13

Side effects of 6-MP and Azathioprine

Answer 13

Pancreatitis (completely reversible upon cessation of meds) Nausea, fever, rash, and hepatitis Bone marrow suppression (dose related)

Question 14

What does methotrexate inhibit?

Answer 14

Dihydrofolate reductase which results in impaired DNA synthesis

Question 15

Potential toxicities of Methotrexate

Answer 15

Leukopenia hepatic fibrosis Hypersensitivity Pneumonitis

Question 16

Pharmacological effects of Cyclosporine

Answer 16

Blocks the production of IL-2 by helper T cells Indirectly inhibits B cell function by blocking helper T cells CSA binds to cyclophilin which inhibits CALCINEURIN (involved in activation of T cells)

Question 17

Side effects of CSA

Answer 17

Renal toxicity Hypertension Gingival hyperplasia Hyper triceps is Paresthesias Tremors Headaches Electrolyte abnormalities

Question 18

____________ is a macrolide antibiotic which is 100 times as potent as CSA but not dependent on bile or mucosal integrity for absorption

Answer 18

Tacrolimus.

Question 19

First biological therapy approved for moderate to severely active CD and UC, IgG1 antibody against TNF-alpha

Answer 19

Infliximab

Question 20

Which drug has similar mechanism of action to infliximab but with less immunogenicity?

Answer 20

Adalimumab

Question 21

Which medication is a pegylated form of an anti-TNF Fab portion of an antibody administered SC once monthly?

Answer 21

Certolizumab pegol (effective for induction of clinical response in patients with active inflammatory CD)

Question 22

What are the side effects of anti-TNF therapies?

Answer 22

Development of antibodies Non-Hodgkin’s lymphoma Hepatosplenic T-cell lymphoma Skin lesions (psoriasiform lesions) Infections (reactivation of latent TB)

Question 23

Examples of anti-integrins

Answer 23

NVU (Nat Ved Us) Natalizumab Vedolizumab Ustekinumab

Question 24

Anti-integrin not widely used for CD due to the risk of Progressive Multifocal Leukoencephalopathy

Answer 24

Natalizumab (recombinant humanized IgG4 antibody against alpha-integrin