bcacp - GI, GU Questions With Complete Solutions

Of the enviromental factors, which one exacerbates Crohn's but improves ulcerative colitis correct answer: smoking This disease is limited to rectum and terminal ilieum, can result in toxic megacolon, and puts pt at risk for colorectal cancer correct answer: Ulcerative colitis This disease can be located from mouth to anus, can involve perianal area, has mucosal ulcers that extend to submucosal area, is associated with malabsorption and fistulas/strictures correct answer: Crohn's disease This drug is best for colonic disease involvement, is cleaved by colonic bacteria into two active components, and can cause GI disturbance, headache, arthralgia and rarely bone marrow suppression correct answer: sulfasalazine (5-aminosalicylate, sulfafyridine). avoid in sulfa allergy Folate malabsorption Hemolytic anemia Hepatotoxic First line CD/UC, selection of product predicated on disease location, rare instances of nephrotoxicity and one of them is associated with secretory diarrhea correct answer: Non sulfa 5-Aminosalicylates olsalazine = secretory diarrhea Use what sparingly because of risk of toxic megacolon correct answer: antidiarrheals. (immodium, hyoscyamine, probantheline, dicyclocmine) These have no role in maintenance but up to 50% of pts can become dependent. One product is indicated in terminal ileum or ascending colon disease. correct answer: Corticosteroids Budesonide (terminal ileum, ascending colon) Aminosalicylate products used for colonic involvement correct answer: Asacol HD, Pentasa, Lialda, Apriso, Dipentum, Balsalazide Aminosalicylate products for rectum involvement correct answer: Canasa suppository Rowasa enema is indicated for what type of IBD correct answer: rectum and terminal colon Used due to steroid sparing effect. Can be used for maintenance due to long onset of action. Need to determine thiopurine methyltransferase activity prior to prescribing. Can cause pancreatitis, bone marrow suppression, hepatotoxicity. correct answer: 6-MP, Azathioprine. Used for Crohn's maintenance, has long onset of action (mos to one year), can be steroid sparing, and can cause bone marrow suppression, pulmonary toxicity, hepatotoxicity, diarrhea, rash. correct answer: MTX - 15-25mg weekly IM Chimeric antibody against TNF. Useful for fistulizing CD, and moderate to severe UC/CD. 50% develop antinuclear antibodies. Side effects are infection, HF exacerbation, BBW- cancers such as hepatosplenic T-Cell lymphoma correct answer: Infliximab Dose of Infliximab if used in heart failure correct answer: