IBD

Question 1

What are 1st line treatments for CD?

Answer 1

Mild: Budesonide (Enterocort EC) for ≤3 months –> thiopurine/MTX
Moderate-Severe: Anti-TNF agent +/- MTX/thiopurine, IL rec antagonist; alt. Integrin receptor antagonist, Jak inhibitor

Question 2

What are 1st line treatments for UC?

Answer 2

Mild: Mesalamine (rectal preferred for distal; PO+/- rectal for extensive)
Moderate-severe: Anti-TNF +/- thiopurine, IL rec antagonist, Integrin receptor antagonist
Alt: Jak inhibitor, Oral sphingosin 1phosphate receptor modulator

Question 3

When are recal steroids used?

Answer 3

UC only

Question 4

What are CIs/warnings with mesalamine ER?

Answer 4

CI: HSR to (amino)salycilates
Warnings: HSR (myocarditis, pericarditis, nephritis, hemotologic abnormalities, organ damage)- More likely with sulfasalazine

Question 5

Which forms of Mesalamine can leave a ghost tablet in the stool?

Answer 5

Asacol
Delzicol

Question 6

How is the mesalamine suppository vs. enema administered?

Answer 6

Suppository (Canasa): retain for 1-3h
Enema (Rowasa): retain over night

Question 7

Mesalamine ER

Answer 7

Pentasa (ER cap)
Asacol HD (ER tab)
Rowasa (enema)
Canasa (suppository)

Question 8

What are BBWs/SEs with azathioprine and mercaptoprine (thiopurines)?

Answer 8

BBW: Immunosuppression warnings (azathioprine)
Warnings: Hematologic toxicity; TPMT deficiency increases risk for myelosuppression
SE: N/V/D, rash, elevated LFTs

Question 9

What agents are Integrin inhibitors used for mod-severe IBD?

Answer 9

natalizumab (Tysarbi)
vedolizumab (Entivyo)

Question 10

What are BBWs with natalizumab (Tysarbi)?

Answer 10

1. Progressive multifocal leukoencephalopathy (PML)
2. Only avalible thru REMS TOUCH program

Question 11

How is natalizumab (Tysarbi) administered/dosed?

Answer 11

IV every 4 weeks; D/C if no response in 12 weeks due to PML risk

Question 12

What are warnings with vedolizumab (Entyvio)?

Answer 12

1. Infusion reactions
2. Infections, PML (lower risk than natalizumab)
3. D/C if no benefit by 14 weeks
4. hepatic injury