IBD

Question 1

Crohn’s Disease
-Where can it occur? most common
-Whats the pattern?
-Inflammation can extend deep (transmural) –> Name 4 characteristics

Answer 1

Any part of GI tract (80% w/small bowel involvement) –> most common is terminal ileum and colon

Discontinuous. Skip lesions + cobblestone appearance

Fissures, fistulas, abscesses, strictures

Question 2

UC :
Where is it limited to?
Pattern?
It’s superficial (Mucosal and submucosal layers) –> 1 feature?

Answer 2

Rectum and colon

continuous pattern

crypt abscesses

Question 3

Crohn’s Distinguishing Sx’s Vs UC Distinguishing Features

4 vs 2

Answer 3

WEIGHT LOSS, perianal fissures, fistula , ulcers

Hematochezia (Blood in stool), Tenesmus

Question 4

Crohn’s Severity (CDAI)

Mild to Mod (CDAI 150-220) Features?

Mod to Severe (220-450) Features?

Severe to Fulminant (>450) Features?

Answer 4

Ambulatory, No signs of dehydration, No signs of systemic activity,No abdominal tenderness or mass, no obstruction

Failure to respond to treatment for
mild-mod disease, Fever, abdominal pain/tenderness, vomiting, weight loss
Anemia, Intestinal Obstruction

Persistent symptoms despite
outpatient therapy, Abdominal pain, rebound tenderness
High temperature, persistent
vomiting, Possible obstruction, abscess

Question 5

TX Guidelines Induction for CD

Mild/Moderate–> Low Risk Disease Burden what meds do u consider(3)

And from there if responding?

What about if steroid dependent?

Mod/Severe –> Mod/High Disease risk Burden What meds do u consider?

Answer 5

Sulfasalazine (colonic or ileocolonic)
Oral corticosteroids
Budesonide (Terminal ileum and right/ascending colon)

Continue until remission. taper steroids over 6-8 wks (not longer than 3 months)

Immunomod +/- Biologic .. maybe JAK inhib

Iv, PO corticosteroids +/- immunomod
Biologics +/- immunomod
JAK Inhib??

Question 6

TX guidelines Maintenance CD

Mild/Moderate–> Low Risk Disease Burden what meds do u consider

Mod/Severe –> Mod/High Disease risk Burden What meds do u consider?

Answer 6

Nothing (mild asx)
Immunomodulator
Biologis +/- Immunomod
JAK inhib?

Biologics +/-Immunomod
JAK inhib?

Question 7

Fistulizing CD
-Before tx initiated what do u do?
-Monotherapy with ?
Whats the preferred ANTI TNF?
ANtibiotics such as?

Answer 7

drain abscess

ANTI TNF or thiopurines or combo therapy

Infliximab

Metro, cipro,levo

Question 8

UC : Disease location
-usually limited to ?
-Proctitis?
-Proctosigmoiditis?
-Distal or left sided?
-Extensive pancolitis?
Terminal Ileitis?

Answer 8

rectum and colon

confined to rectum

rectum and sigmoid colon

distal to splenic flexure, descending colon

proximal to the splenic flexure (involves majroity of the colon)

Backwash ileitis

Question 9

UC Asessment of Disease Severity
Higher score means?
What about an endoscopic score of greater than or equal to 2?

Answer 9

more severe disease

more severe regardless of final score

Question 10

TX Induction of UC
Mild/Mod –> Distal (lower part of rectum or colon)

Mild/Mod –> Extensive

Answer 10

Topical 5ASA for proctitis
Topical + oral 5-ASA (left-sided)
Topical Corticosteroids
(not responding or intolerant to 5-ASA)
+Budesonide MMX (if no response to 5-ASA)
oral systemic corticosteroids (if no response to above)

Oral +/- Topical 5ASA
+Budesonide MMX (if no response to 5ASA)
Oral systemic corticosteroids (if no response to above)

Question 11

TX INDUCTION OF UC

NOT HOSPITAZLIED (6)

VS

HOSPITAZLIED (2)

Answer 11

Oral 5-ASA (moderate only), Budesonide MMX, Oral systemic corticosteroids, Biologic +/- thiopurine or MTX,
JAK Inhibitors, S1P MODULATORS

IV corticosteroids (7-10 days)
ADD IV CYLCOSPORINE or IFX (if no response after 3-5 days) + Thiopurine

Question 12

TX MAINTENCE OF UC

MILD/MOD : DISTAL VS EXTENSIVE

MODERATE/SEVERE

Answer 12

DISTAL : TOPICAL +/- ORAL 5ASA
EXTENSIVE : ORAL +/- TOPICAL 5ASA

THIOPURINES (STEROID INDUCED REMISSION) , BIOLOGIC +/- THIOPURINE OR MTX, JAK INHIBS, S1P MODULATORS

Question 13

Aminosalicylates :
Indicated for?
Examples?
What kind of formulations?

Answer 13

Induction and maint UC and CD (with colonic involevment)
-Sulfasalazine, mesalamine, olsalazine, balsalazide

-oral and rectal

Question 14

Aminosalicylates : Site of action
Where do the orals work?
Suppositories?
Foams?
Enemas?

Answer 14

everywhere

rectum only (Least high)

reaching up to 40 cm, sigmoid reached

highest reach into descending colon

Question 15

Kim : Dosing and ae’s for these drugs on printed sheet

Answer 15

print out

Question 16

Corticosteroids
Indications?
formulations?

AE’s?

Answer 16

ACute inflamm only, not used for maintenance

IV PO and rectal

Impaired glucose, dyslipidemia, HTN, osteoporosis, edema, infection, acne, myopathy, psychosis

Question 17

Immunomodulators :
Indication ?
Failing ____
Refractory to or dependent on ___
May be used as monotherapy or concomitantly with ?
Examples?
Must be used for __ before benefit seen

Answer 17

maintenance therapy for IBD
aminosalicylate therapy
corticosteroids
other IBD tx ‘s

azathioprine, 6MP, MTX
extended period of time

Question 18

Biologics : ANTI TNF
Indication?
Examples?
print out for ae’s

Answer 18

Induction and maintenance of IBD
inflix, adalim, golim,certoliz

Question 19

Biologics: ANti Integrin Therapy

Indications?
Examples?

Which drug is used primarily in CD? State its place in therapy
Which one for CD and UC? State its place in therapy

Answer 19

Induction and maintenance of IBD

Vedolizumab and natalizumab

Nataliz -> CD mod to severe disease

Vedoliz : CD/UC mod to severe diseases

Question 20

Biologics : Anti IL12/23 Therapy
Indictaion ?
Example?

For each drug, state which disease they involved in and which state of the disease

Answer 20

Idnuction and maint of IBD

Ustekinumab, Risankizumab, mirikizumab

Ustek -> CD and UC mod to severe
Risank: CD mod to severe
Mirik: UC mod to severe active disease

Question 21

JAK Inhibitors
Indication ? Must have?
Examples? 2

Which JAK does each target ?

WHat are their places in therapy?

Answer 21

Induction and Maintenance of IBD
-must have inadequate response or intolerance to anti TNF therapies

tofacitinib (UC), upadacitinib

Tofa is JAK 1 and 3
UPA is JAK1

TOFA : UC mod to seevre disease (no response to ANTI TNF)

UPADAC: CD and UC mod to seevre (no response to ANTI TNF)

Question 22

JACK Inhibs AE’s?
Warnings and ADR’s?

Answer 22

Print out

Question 23

Small Molcules : S1P modulators

Indication?
Exampels?

Answer 23

Mod to severe active UC
Ozanimod , Etrasimod