Inflammatory Bowel Disease

Proctitis refers to inflammation of the following: A. Esophagus B. Small intestine C. Liver D. Rectum E. Gall bladder

Proctitis is inflammation of the rectum. It can be caused by IBD, sexually transmitted diseases or radiation of certain cancers. Patients often complain of feeling like they need to have a bowel movement constantly. Treatment is directed at the underlying cause. Refer to the section(s) beginning on p. 945 of 2021 RxPrep Course Book.

Which steroids are available as rectal foam products for IBD? A. Prednisone and budesonide B. Hydrocortisone and methylprednisolone C. Budesonide and hydrocortisone D. Budesonide and dexamethasone E. Hydrocortisone and prednisone

C. Budesonide and hydrocortisone Budesonide and hydrocortisone are available as rectal foam products. Refer to the section(s) beginning on p. 948 of 2021 RxPrep Course Book.

The term Inflammatory Bowel Disease (IBD) refers primarily to which of the following condition/s? (Select ALL that apply.) A. Stomatitis B. Ulcerative colitis C. Irritable bowel syndrome D. Crohn's disease E. Inflammation of the gut lining caused by H. pylori disease

B. Ulcerative colitis D. Crohn's disease Inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The two major types of IBD are ulcerative colitis (UC) and Crohn's disease (CD). Refer to the section(s) beginning on p. 945 of 2021 RxPrep Course Book.

What is the generic name of Entyvio? A. Natalizumab B. Vedolizumab C. Azathioprine D. Golimumab E. Certolizumab

B. Vedolizumab Vedolizumab (Entyvio) is approved for UC and Crohn's disease. Refer to the section(s) beginning on p. 951 of 2021 RxPrep Course Book.

Which of the following is correct regarding budesonide for the treatment of Crohn's disease? A. Budesonide has a decreased risk of side effects compared to other steroids (e.g., prednisone). B. Budesonide works better than prednisone in treating the disease symptoms. C. Budesonide should be used indefinitely and should not be discontinued. D. Budesonide does not interact with other medications. E. The brand name is Uceris.

A. Budesonide has a decreased risk of side effects compared to other steroids (e.g., prednisone). Budesonide is an oral steroid that is less absorbed systemically than prednisone. It is not more effective than prednisone but has fewer severe side effects because of the limited absorption. Budesonide has a few brand names; Uceris is for ulcerative colitis only. Budesonide is a CYP 3A4 substrate so drug interactions are a concern. Ideally, steroids should be used for 8-12 weeks for an acute flare then tapered off to avoid long-term side effects. Refer to the section(s) beginning on p. 948 of 2021 RxPrep Course Book.

Which of the following are short-term adverse effects of prednisone? A. Insomnia and mood changes B. Cushing's syndrome and growth retardation C. Cataracts and poor wound healing D. Fat deposits in the face and adrenal suppression E. Osteoporosis and immunosuppression

A. Insomnia and mood changes A patient started on these doses of steroids short-term may experience elevated blood pressure, changes in mood, insomnia and elevated blood glucose, among other adverse effects. The remaining choices are long-term adverse effects of corticosteroids. Refer to the section(s) beginning on p. 948 of 2021 RxPrep Course Book.

Which of the following is a first-line treatment option for a patient newly diagnosed with distal mild ulcerative colitis? A. Mesalamine suppository B. Oral methotrexate C. Infliximab injection D. Oral azathioprine E. Oral sulfasalazine

A. Mesalamine suppository Aminosalicylates are the recommended first-line treatment for ulcerative colitis. In distal disease, rectal options are preferred. Refer to the section(s) beginning on p. 949 of 2021 RxPrep Course Book.

Which of the following describes the mechanism of action of infliximab? A. Monoclonal antibody that binds to TNF B. Monoclonal antibody that binds to integrin C. Monoclonal antibody that depletes CD20 B cells D. Monoclonal antibody that inhibits T cell activation E. Monoclonal antibody against interleukin-1

A. Monoclonal antibody that binds to TNF Infliximab is an anti-TNF monoclonal antibody approved for several autoimmune conditions, including inflammatory bowel disease. Refer to the section(s) beginning on p. 950 of 2021 RxPrep Course Book.

Which drug used for the treatment of inflammatory bowel disease has a high risk for myelosuppression in patients with a genetic deficiency of thiopurine methyltransferase (TMPT)? A. Infliximab B. Azathioprine C. Mercaptopurine D. Mesalamine E. Sulfasalazine

B. Azathioprine Azathioprine can cause significant hematologic toxicities in patients with TMPT deficiency. Refer to the section(s) beginning on p. 950 of 2021 RxPrep Course Book.

Labs: Na (mEq/L) = 142 (135 - 145) K (mEq/L) = 4.8 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 26 (24 - 30) BUN (mg/dL) = 28 (7 - 20) SCr (mg/dL) = 1.3 (0.6 - 1.3) Glucose (mg/dL) = 79 (100 - 125) Ca (mg/dL) = 9.2 (8.5 - 10.5) Mg (mEq/L) = 1.9 (1.3 - 2.1) PO4 (mg/dL) = 4.2 (2.3 - 4.7) WBC (cells/mm3) = 9.3 (4 - 11 x 10^3) Hgb (g/dL) = 12.9 (12 - 16) Hct (%) = 39.2 (36 - 46) Plt (cells/mm3) = 399 (150 - 450 x 10^3) AST (IU/L) = 15 (10 - 40) ALT (IU/L) = 12 (10 - 40) Albumin (g/dL) = 4.5 (3.5 - 5) ESR (mm/hr) = 12 (/< 20 male, /< 30 female) Tests: CT of the abdomen: Discontinuous pattern of inflammation in the ascending/transverse colon and ileum. Rectum appears unaffected. Numerous strictures and bleeding are noted throughout the GI tract. Plan: Admit for consultation with GI service. Based on the information above, what is MJ's most likely diagnosis? A. Ulcerative colitis B. Crohn's disease C. C. difficile associated diarrhea D. Irritable bowel syndrome E. Infectious diarrhea

B. Crohn's disease MJ most likely has Crohn's disease based on the presence of numerous strictures, discontinuous pattern of inflammation, and location throughout the GI tract. He colon and ileum are affected and the rectum is spared. Crohn's disease is usually transmural, whereas UC generally affects the colon and rectum and is more superficial. Refer to the section(s) beginning on p. 946 of 2021 RxPrep Course Book.

Which medication can be used once weekly to treat Crohn's disease? A. Tacrolimus B. Methotrexate C. Tysabri D. Cyclosporine E. Tofacitinib

B. Methotrexate Methotrexate can be given once weekly by IM or SC injection to treat Crohn's disease. Cyclosporine and tofacitinib are only indicated for severe UC. Tysabri is dosed every 4 weeks. Refer to the section(s) beginning on p. 950 of 2021 RxPrep Course Book.

Choose the correct statement for sulfasalazine. A. Sulfasalazine can be safely administered to patients with a sulfa allergy. B. Sulfasalazine is contraindicated in patients with a sulfa allergy. C. Sulfasalazine is also used to treat osteoarthritis. D. Sulfasalazine is a thiopurine (similar to azathioprine). E. Sulfasalazine has a lower risk of hypersensitivity reactions than mesalamine.

B. Sulfasalazine is contraindicated in patients with a sulfa allergy. Sulfasalazine is contraindicated when there is a salicylate or sulfa allergy. It is an aminosalicylate in the same class as mesalamine but it has a higher risk for adverse effects. Sulfasalazine can also be used to treat rheumatoid arthritis. Refer to the section(s) beginning on p. 949 of 2021 RxPrep Course Book.

Which of the following medications are aminosalicylates? (Select ALL that apply.) A. Mercaptopurine B. Tofacitinib C. Balsalazide D. Mesalamine E. Olsalazine

C. Balsalazide D. Mesalamine E. Olsalazine Mesalamine, sulfasalazine, balsalazide and olsalazine are all aminosalicylates used in the treatment of ulcerative colitis. Refer to the section(s) beginning on p. 949 of 2021 RxPrep Course Book.

Which of the following lifestyle measures would be useful for a patient with inflammatory bowel disease? (Select ALL that apply.) A. Avoid vitamin supplements B. Eat plenty of beans, cabbage and broccoli C. Eat smaller, more frequent meals D. Choose lactose-free dairy products E. Drink plenty of water

C. Eat smaller, more frequent meals D. Choose lactose-free dairy products E. Drink plenty of water Food triggers in IBD are highly patient-specific. Fatty foods and gas-producing foods (such as beans, cabbage and broccoli) are often triggers. Patient with IBD can develop vitamin deficiencies due to malabsorption so vitamin supplements may be needed. Probiotics can also be useful to reduce abdominal symptoms in some patients. Refer to the section(s) beginning on p. 946 of 2021 RxPrep Course Book.

Allergies: sulfa (rash) Past Medical History: none Medications: Seasonique, loperamide (started one week ago), Bentyl (started one week ago) Physical Exam/Vitals: Height: 5'2" Weight: 102 pounds BP: 115/65 mmHg HR: 106 BPM RR: 14 BPM Temp: 99.2(o)F Pain: 5/10 General appearance: thin, young female HEENT: dry mucous membranes CV: tachycardia, regular rhythm Lungs: clear Abdomen: diffusely tender to palpation Extremities: dry skin MJ needs to be treated for new-onset, acute IBD. Which of the following is an appropriate recommendation? A. Certolizumab SC B. Natalizumab IV C. Loperamide PO D. Prednisone PO E. Methotrexate PO

D. Prednisone PO Exacerbations of inflammatory bowel disease are treated with short courses of steroids (for Crohn's disease) or aminosalicylates +/- steroids (for ulcerative colitis). Refer to the section(s) beginning on p. 946 of 2021 RxPrep Course Book.

What is meant by the term "distal" ulcerative colitis? A. Near the lower esophageal sphincter B. Near the ileum C. Adjacent to the stomach D. Near the rectum E. Near the duodenum

Distal ulcerative colitis refers to disease occurring near the rectum (can include the most distal part of the colon, called the sigmoid colon, or the most distal portion of the descending colon). Refer to the section(s) beginning on p. 945 of 2021 RxPrep Course Book.

Chief Complaint: "I am going to the bathroom 10 times a day". History of Present Illness: MJ is a 32-year-old female who presents to the ER describing a 2-week history of increasing abdominal pain and frequency of bowel movements. It started with 4-5 bowel movements per day and escalated to 6-8 bowel movements per day. There is sometimes blood in the stool. MJ saw her primary care physician 1 week ago and was told it could be irritable bowel syndrome. MJ has only been drinking Gatorade and eating saltine crackers for fear that the diarrhea and pain will get worse. She has lost weight, but doesn't weigh herself regularly, so she doesn't know how much. MJ has not traveled out of the country and has eaten the same foods as her husband (and he is not ill). After 72 hours of therapy in the hospital, MJ is feeling better and has fewer loose stools and less pain. Which of the following is the best medication to discharge MJ on? A. Uceris rectal foam B. Sulfasalazine PO C. Uceris tablets PO D. Canasa suppositories E. Entocort EC capsules PO

E. Entocort EC capsules PO MJ has Crohn's disease of the ascending/transverse colon and ileum. Entocort EC (oral budesonide) is specifically indicated for Crohn's disease in that location and is the preferred treatment. She does not have distal disease, so topical products will not be effective. Uceris tablets are indicated only for UC. Refer to the section(s) beginning on p. 948 of 2021 RxPrep Course Book.