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Chapter 19. Inflammatory Bowel Disease

Student Questions

Which mesalamine formulation would be most appropriate for a patient with mild active ulcerative colitis (UC) who has proctitis?

A. Intravenous solution

B. Delayed-release capsule

C. Enema

D. Suppository

Answer: D

Option A: Incorrect. Mesalamine is not available in a parental formulation.

Option B: Incorrect. This formulation would be best for ileal disease.

Option C: Incorrect. This formulation would be best for left-sided disease.

Option D: Correct. Suppositories deliver maximal concentrations of mesalamine to the rectal area.

Which medication is most likely to exacerbate symptoms in patients with UC?

A. Acetaminophen

B. Naproxen

C. Nicotine patch

D. VSL#3

Answer: B

Option A: Incorrect. This would be preferred for pain in patients with IBD.

Option B: Correct. NSAIDs can induce and exacerbate IBD symptoms.

Option C: Incorrect. Nicotine patches have some demonstrated efficacy in treating UC symptoms.

Option D: Incorrect. Probiotics such as VSL#3 can be used to treat pouchitis in patients with UC.

Prior to initiating therapy with azathioprine, patients should be evaluated for activity of which enzyme?

A. Thiopurine methyltransferase

B. Cytochrome p450 1A2

C. Dihydrofolate reductase

D. Alanine aminotransferase

Answer: A

Option A: Correct. This enzyme is responsible for azathioprine activity, and activity must be evaluated prior to initiating therapy.

Option B: Incorrect. CYP1A2 is not responsible for azathioprine metabolism.

Option C: Incorrect. DHFR is responsible for methotrexate metabolism.

Option D: Incorrect. This enzyme is used to evaluate liver dysfunction.

Loperamide should be avoided in patients with active UC due to its ability to induce which one of the following complications?

A. Toxic megacolon

B. Intestinal stricture

C. Fistula formation

D. Aphthous ulcers

Answer: A

Option A: Correct. Drugs that slow GI motility may precipitate toxic megacolon.

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