IBD

Question 1

Two Main Types

Answer 1

• Ulcerative colitis: mainly distal disease, (proctitis if only in rectum), superficial ulcerations
• Crohn’s Disease: Deep, transmural (throughout bowel) disease, chronic diarrhea, strictures/fistulas
• *IBS DOESN’T cause inflammation like IBD dose**

Question 2

Diagnosis/Differences in Two Types

Answer 2

• Mainly diagnosed by colonoscopy with tissue biopsy
• UC: mainly colon (especially rectum), superficial depth, continuous pattern
• CD: entire GI tract, transmural depth, non-continuous pattern (“cobblestone”)

Question 3

Lifestyle Suggestions for IBD

Answer 3

• Smaller, more frequent meals
• Avoid triggering foods (low fat/dairy)
• Drink plenty of water
• Antidiarrheals and antispasmodics (dicyclomine) can help with sxs management
• May need vitamin supplementation due to malabsorption
• Probiotics can help reduce pain/bloating/diarrhea in some patients

Question 4

Induction Options for CD

Answer 4

• Steroids +/- thiopurine or MTX
• Anti-TNF +/- thiopurine
• Interleukin Receptor Antagonist

Question 5

Induction Options for UC

Answer 5

• Steroids (oral or rectal) +/- 5-ASA or thiopurine
• Anti-TNF +/- thiopurine
• IV cyclosporine
• Tofacitinib (Xeljanz)

Question 6

Mild CD Treatment

Answer 6

• Oral budesonide

- Entocort EC

Question 7

Mild UC Treatment

Answer 7

• Mesalamine (5-ASA) - also used for maintenance in mild disease
• Rectal and/or oral preferred
• If using steroid: oral budesonide (Uceris) preferred, rectal options also indicated for UC only

Question 8

Anti-TNFs for CD

Answer 8

• Adalimumab
• Infliximab
• Certolizumab

Question 9

Anti-TNFs for UC

Answer 9

• Adalimumab
• Infliximab
• Golimumab

Question 10

Budesonide

Answer 10

• Uceris - UC only
• Entocort EC - CD only
• *Avoid with grapefruit, CYP3A4i**

Question 11

Mesalamine Brands

Answer 11

• Asacol - ER tablets (ghost tablet)
• Rowasa - enema
• Canasa - suppository

Question 12

Mesalamine Information

Answer 12

• Aminosalicylate (5-ASA)
• Preferred for use in UC (including proctitis), rectal formulations are more effective
• Retain supp. for 3-4 hours, enemas overnight
• CI: Allergic to salicylates or aminosalicylates
• Allergic rxns less common (more with sulfasalazine)

Question 13

Sulfasalazine

Answer 13

• Aminosalicylate (5-ASA)
• Less efficacious and more toxic than mesalamine
• CI: sulfa and salicylate allergies

Question 14

Azathiopurine

Answer 14

• Thiopurine
• Used for CD or UC
• Risk for myelosuppression
• Test for TMPT (don’t use if deficient)
• Metabolized to mercaptopurine (don’t use in combination)

Question 15

MTX

Answer 15

• Used for mod-severe CD ONLY
• Used when unable to tolerate azathioprine
• Dosed once weekly

Question 16

IV Cyclosporine

Answer 16

• Used for severe UC ONLY

- Oral option is also available, but usually given by continuous infusion IV

Question 17

Stelara

Answer 17

• Ustekinumab
• Interleukin receptor antagonist
• Used for moderate to severe UC or CD

Question 18

Tysabri

Answer 18

• Natalizumab
• Integrin Receptor Antagonists
• Used for CD ONLY
• Dosed Q4weeks
• D/C if no response by 12 weeks

Question 19

Entyvio

Answer 19

• Vedolizumab
• Integrin Receptor Antagonists
• Used for UC or CD
• Discontinue if no response by 14 weeks

Question 20

Integrin Receptor Antagonists Information

Answer 20

• Only used for pts REFRACTORY to other tx
• Monoclonal antibodies
• Box warning: PML (progressive multifocal leukoencephalopathy), REMS drug
• NO live vaccines
• Risk of severe allergic rxns (anaphylaxis)