IBD

Question 1

Major types of IBD

Answer 1

Crohn’s disease

Ulcerative colitis

Question 2

Classic symptom of IBD

Answer 2

bloody diarrhea

Question 3

Other symptoms of IBD

Answer 3

rectal urgency
abdominal pain
weight loss
night sweats
n/v 
constipation

Question 4

triggers of IBD flares

Answer 4

infections
use of NSAIDs
certain foods (beans, lentils, broccoli, etc)

Question 5

IBD can be mistaken for what other disease

Answer 5

Irritable bowel syndrome (IBS)
similar symptoms
IBS does not cause inflammation

Question 6

Characteristics of UC

Answer 6

mucosal inflammation of colon and/or rectum

superficial ulcerations

distal disease can be treated with topical treatments (per rectum)

Question 7

Classification of UC

Answer 7

moderate: > 4 stools/day with minimal signs of toxicity
severe: > 6 stools with signs of toxicity (fever, tachycardia, anemia, etc.)

Question 8

Characteristics of CD’s

Answer 8

deep, transmural inflammation
can affect any part of the GI tract
most common the ileum and colon
can cause strictures and fistulas

Question 9

Smoking is a risk factor for both CD and UC (t/f)

Answer 9

False

smoking is protective in UC
Nicotine patches have been used as adjunct therapy in some cases

Question 10

Goal of IBD drug therapy

Answer 10

cause induction of remission

Maintain remission

Question 11

Options for induction of remission in UC:

Answer 11

Steroids +/- 5-ASA or thiopurine
Anti-TNF +/- thiopurine
IV cyclosporine

Question 12

Options for induction of remission in CD:

Answer 12

steroids +/- thiopurine or MTX
Anti-TNF +/- thiopurine
IL receptor antag

Question 13

Preferred maintenance meds for mild CD of the ileum/right colon

Answer 13

oral budesonide

Question 14

Preferred maintenance meds for mod-severe CD

Answer 14

Anti-TNF (Humira, Remicade, Cimzia)
Azathioprine, mercaptopurine
MTX
IL receptor antagonist (Stelara)

*Used in monotherapy on combo

Question 15

Meds used for refractory CD

Answer 15

Integrin receptor antagonist
Natalizumab
Vedolizumab

Question 16

Preferred maintenance meds for mild UC

Answer 16

Mesalamine (5-ASA) rectal/oral

Question 17

Preferred maintenance meds for mod-severe UC

Answer 17

Anti-TNF agents (Humira, Remicade, Simponi)
Azathioprine, mercaptopurine
Cyclosporine 
*mono or combo*
**no MTX or IL antag**

Question 18

Meds used for refractory UC

Answer 18

Vedolizumab (integrin antag)

Question 19

Humira

Answer 19

adalimumab

Question 20

Remicade

Answer 20

Infliximab

Question 21

Cimzia

Answer 21

Certolizumab

CD only

Question 22

Simponi

Answer 22

Golimumab

UC only

Question 23

Entocort EC

Answer 23

Budesonide ER 3 mg caps
for CD only
6 mg daily x 3 mons, then taper
undergoes incr 1st pass metabolism; less systemic exposure than other steroids

Question 24

Uceris

Answer 24

Budesonide 9 mg ER tab
for UC only
for induction of UC
9 mg QAM for up to 8 weeks

Question 25

Steroids use longer than ___ weeks must be tapered

Answer 25

2 weeks | avoid cortisol withdrawal symptoms

Question 26

Available rectal steroids

Answer 26

Hydrocortisone (Cortifoam, Cortenema) Budesonide rectal foam (Uceris) only indicated for UC, not been proven effective for maintenance of remission (only in mild, distal UC)

Question 27

Budesonide metabolism

Answer 27

CYP3A4 substrate | avoid mod/strong inhibitors (includ grapefruit juice)

Question 28

Aminosalicylates are used for which type of IBD?

Answer 28

UC provides local anti-inflammatory effect in GI tract

Question 29

Available aminosalicylates [4]

Answer 29

mesalamine ER sulfasalazine (Azulifidine, ER) Balsalazinde (Giazo, Colazal) Olsalazine (Dipentum)

Question 30

Which aminosalicylate is available rectally?

Answer 30

Mesalamine suppository (Canasa) for induction enema (Rowasa) induction and maintenance

Question 31

Oral mesalamine brand names [5]

Answer 31

``` Apriso Delzicol Pentasa Asacol HD Lialda ```

Question 32

aminosalicylates hypersensitivity is more likely to occur with which drug:

Answer 32

sulfasalazine

Question 33

Rectal and oral mesalamine can be used together (t/f)

Answer 33

TRUE | rectal is more effective for distal/ proctitis in UC

Question 34

Thiopurines are FDA approved for IBD (t/f)

Answer 34

False, not FDA-approved guideline recommended though for induction and maintenance of IBD) Azathiprine (Azasan, Imuran) Mercaptopurine (Purixan)

Question 35

Warnings/side effects of thiopurines

Answer 35

leukopenia thrombocytopenia anemia myelosupression N/v/d, rash, incr LFTs

Question 36

Methotrexate is FDA approved for both CD and UC (t/f)

Answer 36

false approved for neither used in mod-severe CD for pts that cannot tolerate azathioprine given IM of SC weekly

Question 37

Integrin receptor antagonist MOA

Answer 37

monoclonal antibodies that bind to integrin molecules and prevent migration of inflammatory cells into the GI tissue used for refractory IBD pts and pts who are steroid-dependent

Question 38

Tysabri info

Answer 38

``` integrin receptor antagonist Natalizumab approved for CD's and MS IV infusion q 4 weeks BBW: Progressive multifocal leukoencephalopathy (PML) viral OI, REMS prgram SEs: infusion reaction, HA, fatigue do not use with other immunosuppressants d/c if no benefit by week 12 ```

Question 39

Entyvio info

Answer 39

``` integrin receptor antagonist Vedolizumab for CDs and UC IV given 0, 2, 6 weeks, then q 8 w similar warnings to Tysabri d/c if no benefit by week 14 ```