2026 NAPLEX chapter 73: inflammatory bowel disease

what is IBD

group of inflammatory conditions of the colon and small intestine

what are the 2 major types of IBD

- ulcerative colitis

- Crohn's disease

classic sx of IBD

bloody diarrhea

IBD flare trigger drug

NSAIDs

IBD vs IBS

inflammatory bowel disease vs irritable bowel syndrome-

both have similar sx (abdominal pain, bloating, gas) but IBS does not cause inflammation and is not as serious

(ulcerative colitis/crohns disease) is characterized by mucosal inflammation confined to the rectum and colon with superficial ulcerations

ulcerative colitis

when UC is limited to the descending colon it is called _______ and can be treated with _______

distal disease; topical (rectal) treatment

Inflammation limited to the rectum is called ...

proctitis

(ulcerative colitis/crohns disease) is characterized by deep, transmural inflammation that can affect any part of the GI tract

crohn's disease

CD vs UC comparison:

location

- UC: colon (esp rectum)

- CD: entire GI tract

CD vs UC comparison:

pattern

- UC: continuous

- CD: non-continuous (cobblestone appearance)

CD vs UC comparison:

depth

- UC: superficial

- CD: transmural

How to diagnose IBD

colonoscopy with tissue biopsy

IBD lifestyle measures

- eat smaller, more frequent meals that are low in fat/dairy

- drink plenty of water

IBD supportive care

- antidiarrheals or antispasmodics (eg dicyclomine)

- vitamin supplements to help prevent deficiencies related to malabsorption

- probiotics can reduce sx

short courses of oral or IV ___ is commonly used to treat acute exacerbation in both UC and CD and will usually be tapered off.

oral or IV steroids

T/F: treatment options that are used for induction can be continued for maintenance remission for both UC and CD

true (with the exception of steroids)

what are the thiopurines

azathioprine, mercaptopurine

treatment of mild CD

oral budesonide for ≤3 months, then d/c or change to a thiopurine or methotrexate

treatment of moderate-severe CD

preferred:

- anti-TNF agent ± methotrexate or a thiopurine

- IL-receptor antagonist

- integrin receptor antagonist -> Vedolizumab

alternatives/refractory tx:

- janus kinase inhibitor

treatment of mild UC

mesalamine (5-ASA)

distal disease: rectal preferred

extensive disease: rectal ± oral

treatment of moderate-severe UC

preferred:

- anti-TNF agent ± a thiopurine

- IL receptor antagonist

- integrin receptor antagonist

- oral sphingosine-1-phosphate receptor modulators

alternatives/refractory tx:

- janus kinase inhibitor

Entocort EC, Uceris

budesonide

Entocort EC is used for (UC/CD) only

CD

Uceris is used for (UC/CD) only

UC

short-term side effects of oral steroids

- increased appetite/weight gain

- emotional instability

- insomnia

long-term side effects of oral steroids

- adrenal suppression/Cushing's

- impaired wound healing

- hypertension

- osteoporosis, and more

can use alternate day therapy with oral steroids to ______

decrease adrenal suppression

if using oral steroids longer than ______, must taper

2 weeks

budesonide has ______ systemic exposure as compared to other oral steroids due to extensive ______

decreased; first-pass metabolism

T/F: Budesonide can be crushed, chewed or opened

F

Capsules can only be opened and sprinkled on applesauce

Long-term use of steroids, assess...

bone density

optimize calcium and vitamin D

consider bisphosphonates

rectal steroids are indicated for (UC/CD) only

UC

maintenance use of rectal hydrocortisone is limited to ______ as an alternative to ______

mild-moderate distal UC; aminosalicylates

budesonide is a major substrate of CYP____; avoid CYP inhibitors and this drink: _____

3A4; grapefruit

aminosalicylates are indicated for treatment of (UC/CD)

UC

mechanism of aminosalicylates for UC

topical anti-inflammatory effect in the GI tract

________ is the primary aminosalicylate used in the US for UC treatment.

___ is less commonly used due to many side effects

mesalamine;

sulfasalazine

Sulfasalazine contraindications (2)

Salicylate or sulfa allergy

mesalamine suppository should be retained in rectum for at least _____

1-3 hours

mesalamine enema should be retained in the rectum for how long

overnight

contraindications to mesalamine

hypersensitivity to salicylates or aminosalicylates

warnings with mesalamine

hypersensitivity reactions (more likely with sulfasalazine)

rectal mesalamine is more effective than :

-oral mesalamine

-rectal steroids for _________

distal disease/proctitis in UC

Delzicol (mesalamine ER caps) counseling

can leave ghost tablet in stool

_______ can cause staining of the teeth/tongue if the capsules are opened and sprinkled on applesauce

Balsalazide

Although not FDA-approved, they are guideline recommended: thiopurines are recommended as an option for....?

induction and maintenance of remission in IBD

warning with thiopurines

pts with genetic deficiency of thiopurine methyltransferase (TPMT) are at increased risk for myelosuppression

monitoring with thiopurines

CBC

consider _______ testing before starting thiopurines

TPMT genetic testing

azathioprine is metabolized to ______

mercaptopurine

Mehtotrexate: dosing frequency + administration route + indication

once weekly by IM or SC injection

for refractory CD induction/maintenance (guideline recommended, not FDA approved)

Anti-TNF drugs are ____ used for severe UC often with thiopurine

monoclonal antibodies (infliximab, adalimumab)

what are the integrin receptor antagonists (2)

- natalizumab (Tysabri)

- vedolizumab (Entyvio)

integrin receptor antagonists are indicated for _________

induction and maintenance of remission in pts with moderate to severe IBD

Entyvio

vedolizumab (integrin receptor antagonist)

natalizumab dosing frequency + route

q4 weeks by injection

natalizumab boxed warning

progressive multifocal leukoencephalopathy (PML)- only available thru REMS TOUCH prescribing program

vedolizumab should be discontinued if no benefit by week ____

14

vedolizumab warnings (3)

- infusion reactions

- infections

- all immunizations must be up to date before starting