Gastrointestinal Conditions: Inflammatory Bowel Disease

Question 1

Ulcerative Colitis classifications

Answer 1

Moderate disease = > 4 stools per day
severe disease = > 6 bloody stools per day
Fulminant disease = > 10 stools per day, risk to progress to toxic mega colon

Question 2

Crohn’s disease for mild disease txm

Answer 2

oral budesonide for < 3 months then d/c or change to thiopurine/methotrexate

Question 3

Crohn’s moderate-severe disease txm

Answer 3

Anti-TNF agents = Humiram Remicade, Cimzia
Thiopurine
Methotrexate
Stelara

Question 4

Crohn’s refractory disease txm

Answer 4

Entyvio
Tysabri

Question 5

Ulcerative colitis mild disease txm

Answer 5

mesalamine rectal or oral

Question 6

Ulcerative colitis moderate/severe disease txm

Answer 6

Anti-TNF agents: Humira, Remicade, Simponi
thiopurine
Cyclosporine
Stelera

Question 7

Ulcerative Colitis refractory disease txm

Answer 7

Entyvio
Xeljanz

Question 8

Steroids for txm notes

Answer 8

avoid long term use
if longer than 2 weeks, then taper to avoid withdrawal
if using long term, assess bone mineral density

Question 9

Rectal steroids are indicated only for….

Answer 9

ulcerative colitis

Question 10

Aminosalicylates used for UC txm?

Answer 10

Mesalamine
Sulfasalazine = Azulfidine
Balsalazide = Colozal
Olsalazine = Dipentum

Question 11

Mesalamine Contraindications

Answer 11

Hypersensitivity to salicylates or aminosalicylates

Question 12

Mesalamine warings

Answer 12

acute intolerance syndrome
hypersensitivity reactions
photosensitivity
inc risk of blood dyscrasias

Question 13

Mesalamine side effects

Answer 13

abdominal pain
nausea
headache
flatulence
belching

Question 14

Sulfasalazine contraindications

Answer 14

salicylate allergy
sulfa allergy

Question 15

Balsalazide (Colazal) info

Answer 15

CI: salicylate allergy
warning: Gastric retention
SE: Headache, N/V/D
notes: can stain teeth/tongue

Question 16

Thiopurines are recommended as option in guidelines for…

Answer 16

indication and maintenance of remission in combo with other drugs

not FDA approved for IBD

Question 17

Azathioprine (Azasan) boxed warnings

Answer 17

chronic immunosuppression
inc risk of malignancy in pts with IBD

Question 18

Azathioprine (Azasan) warnings

Answer 18

Hematologic toxicities
inc risk for myleosuppression in TPMT deficiency pts

Question 19

Azathiopurine (Azasan) monitoring and notes

Answer 19

monitor = CBC, weekly 1st month
dont use with mercaptopurine

Question 20

Methotrexate in IBD?

Answer 20

not FDA indication

used for induction and maintenance of remission in moderate-severe CD pts who cant tolerate azathioprine

used once weekly

Question 21

Which interleukin receptor antagonist binds to and interferes with IL-12 and IL-23

Answer 21

Ustekinumab (Stelara)

Question 22

Which IL receptor does Skyrizi (Risankizumab) bind to

Answer 22

IL-23

Question 23

Integrin receptor antagonists are used for….

Answer 23

induction and maintenance of remission in pts with IBD who have responded inadequately or cannot tolerate conventional therapies, or steroid dependent patient

Question 24

Integrin receptor antagonists

Answer 24

Natalizumab = Tysabri
Vedolizumab = Entyvio

Question 25

Natalizumab (Tysabri) boxed warnings

Answer 25

PML only available trough REMS program

Question 26

Natalizumab (Tysabri) side effects

Answer 26

infusion reactions headache fatigue nausea rash

Question 27

When should Natalizuamab (Tysabri) be discontinued?

Answer 27

if no response after 12 weeks then d/c

Question 28

When should Vedolizumab (Entyvio) be discontinued?

Answer 28

if no response after 14 weeks then d/c