IBD IBD Pharmacotherapy

Question 1

What is the mechanism of action of mesalamine (5-ASA) in treating ulcerative colitis?

Accepted Answer

Local anti-inflammatory effect via inhibition of arachidonic acid metabolites and NF-κB in colonic mucosa

Answer

Blocking TNF-α receptor binding

Answer

Inhibiting JAK1/JAK3 kinases

Answer

Suppressing T-cell activation via calcineurin inhibition

Question 2

Which anti-TNF biologic is available as both IV infusion and subcutaneous formulation for IBD treatment?

Accepted Answer

Infliximab

Answer

Certolizumab pegol

Answer

Adalimumab

Answer

Golimumab

Question 3

Thiopurine medications (azathioprine, 6-mercaptopurine) work primarily by which mechanism in IBD?

Accepted Answer

Inhibiting de novo purine synthesis, leading to T and B lymphocyte suppression

Answer

Blocking TNF-α synthesis

Answer

Blocking IL-12/IL-23 signaling

Answer

Inhibiting dihydrofolate reductase

Question 4

Before initiating thiopurine therapy, testing for which enzyme deficiency is recommended to prevent severe toxicity?

Accepted Answer

Thiopurine methyltransferase (TPMT) or NUDT15

Answer

Glucose-6-phosphate dehydrogenase (G6PD)

Answer

Dihydropyrimidine dehydrogenase (DPD)

Answer

Uridine diphosphate glucuronosyltransferase (UGT)

Question 5

Vedolizumab (Entyvio) is considered 'gut-selective' because it specifically blocks which interaction?

Accepted Answer

α4β7 integrin on lymphocytes from binding MAdCAM-1 on gut endothelium

Answer

TNF-α binding to its receptor on intestinal epithelial cells

Answer

IL-6 receptor signaling in the colon

Answer

JAK1 signaling in mesenteric lymph nodes

Question 6

Which corticosteroid formulation for IBD is designed to minimize systemic side effects through extensive first-pass hepatic metabolism?

Accepted Answer

Budesonide

Answer

Prednisone

Answer

Methylprednisolone IV

Answer

Hydrocortisone enema