Chapter 73: Inflammatory Bowel Disease

Question 1

What is IBD?

Answer 1

A group of inflammatory conditions of the colon and small intestine

Question 2

What are the major types of IBD?

Answer 2

1. Ulcerative colitis
2. Crohn’s disease

Question 3

Classic symptom of IBD

Answer 3

bloody diarrhea

Question 4

Which class of drugs can cause IBD flares

Answer 4

NSAIDs

Question 5

What is the difference between IBS and IBD

Answer 5

IBS does not cause inflammation

Question 6

Ulcerative colitis is characterized by mucosal inflammation confined to the

Answer 6

rectum and colon with superficial ulcerations

Question 7

When UC is limited to the descending colon and rectum, it is called ___ and can be treated with ____

Answer 7

distal disease
topical (rectal) treatment

Question 8

Inflammation limited to the rectum is called

Answer 8

proctitis

Question 9

Fistulas/strictures are common in (crohn’s disease/ulcerative colitis)

Answer 9

CD

Question 10

Where is Crohn’s Disease located

Answer 10

Entire GI tract

Question 11

Crohn’s Disease depth is

Answer 11

Transmural

Question 12

CD pattern vs UC pattern

Answer 12

CD is non-continuous

UC is continuous

Question 13

What is the usual diagnosis method for IBD?

Answer 13

Colonoscopy with tissue biopsy

Question 14

What is the best eating habit for patients with IBD?

Answer 14

Eating smaller, more frequent meals that are low in fat and dairy PLUS drinking a lot of water

Question 15

Which medications cn help with symptom management of diarrhea?

Answer 15

• Loperamide
• Dicyclomine

Question 16

What is the role of vitamine supplements in IBD?

Answer 16

prevent defeciencies related to malabsorption

Question 17

How can probiotics help patients with IBD?

Answer 17

Reduce abdominal pain, bloating, urgency, C/D

Question 18

What is commonly used to treat acute exacerbations in both UC and CD

Answer 18

short courses of oral or IV steroids

Question 19

What is used for maintenance therapy in UC (distal or mild extensive disease)

Answer 19

aminosalicylates

Question 20

What is preferred for mild CD that is limited to the ileum and proximal colon

Answer 20

Budesonide for less than or = 3 months

After this course, d/c treatment or change to thiopurine or MTX

Question 21

What can be used for moderate-severe CD for maintenance of remission

Answer 21

1. Anti-TNF agents
2. Thiopurine
3. MTX

Question 22

What can be used for refractory treatment or steroid dependent CD

Answer 22

Vedolizumab or natalizumab

Question 23

What can be used for mild UC for maintenance of remission

Answer 23

Mesalamine (5-ASA) rectal and/or oral preferred

Question 24

What can be used for moderate-severe UC for maintenance of remission

Answer 24

Anti-TNF agents (Humira, Remicade, Simponi)
Thiopurine
Cyclosporine
Stelara
Xeljanz

Question 25

What can be used for refractory treatment or steroid dependent UC

Answer 25

Vedolizumab

Question 26

Budesonide brand name

Answer 26

Entocort EC (for CD only) Uceris (for UC only)

Question 27

If steroids are used longer than ___ weeks, they must be tapered

Answer 27

2 weeks

Question 28

If long-term use of steroids is required, must

Answer 28

* assess bone density, * optimize Ca & Vit D intake * consider bisphosphonate

Question 29

Which drug can be used for both induction and maintenance of UC and CD

Answer 29

Budesonide

Question 30

Rectal steroids (hydrocortisone and budesonide rectal foam) are indicated for __ only

Answer 30

UC

Question 31

When using budesonide, must avoid strong and moderate ____ of which CYP enzyme, including ____

Answer 31

inhibitors ## Footnote 3A4 grapefruit juice and grapefruit products

Question 32

What are the short term side effects associated with PO steroids?

Answer 32

* increase appetite * weight gain * emotional instability * insomnia

Question 33

Which formulations does mesalamine come in

Answer 33

oral and rectal

Question 34

Induction with mesalamine for UC oral therapy is used for ___ weeks and rectal therapy for ___ weeks

Answer 34

6-8 oral 3-6 rectal

Question 35

Mesalamine rectal suppository should be retained in the rectum for at least ___ hours

Answer 35

1-3

Question 36

Mesalamine enema should be retained in the rectum for how long

Answer 36

Overnight

Question 37

Mesalamine CI

Answer 37

hypersensitivity to salicylates or aminosalicylates

Question 38

For distal disease/proctitis in UC, which formulation of mesalamine is more effective

Answer 38

Rectal

Question 39

Mesalamine ER tablet (Asacol) and ER capsule (Delzicol) patient counseling

Answer 39

can leave a ghost tablet in the stool

Question 40

Sulfasalazine CI

Answer 40

salicylate and sulfa allergy

Question 41

Balsalazide can cause

Answer 41

staining of the teeth/tongue

Question 42

Patients with which genetic deficiency are at increased risk of myelosuppression when using azathioprine

Answer 42

TPMT

Question 43

Methotrexate can be used for induction & maintenance of remission in mod-severe

Answer 43

CD (in pts who cannot tolerate azathioprine)

Question 44

How often is MTX dosed in CD & what route of admin?

Answer 44

once weekly by IM or SC route

Question 45

Which immunosuppressive drug is recommended for severe UC

Answer 45

Cyclosporine

Question 46

Natalizumab is only approved for

Answer 46

CD

Question 47

What is Natalizumab formulation?

Answer 47

Injection

Question 48

How often is natalizumab given

Answer 48

every 4 weeks

Question 49

Natalizumab should be d/c if no response by ___ weeks

Answer 49

12

Question 50

Vedolizumab is approved for

Answer 50

UC and CD

Question 51

Vedolizumab should be d/c if no response by ___ weeks

Answer 51

14

Question 52

Natalizumab boxed warning

Answer 52

PML ## Footnote Progressive multifocal leukoencephalopathy

Question 53

Natalizumab is only available through

Answer 53

REMS TOUCH program

Question 54

Natalizumab brand name

Answer 54

Tysabri

Question 55

Vedolizumab brand name

Answer 55

Entyvio

Question 56

What is the warning associated with Vedolizumab?

Answer 56

infusion reaction infection