Question

Test: A Guide for the Management of Crohn’s Disease
1) Which of the following factors increases the risk of developing Crohn’s disease (CD) in Caucasians?
Smoking
Smoking cessation
Breastfeeding
High vitamin D levels
2) Which of the following pathologic features indicate CD more than ulcerative colitis?
Fistulas
Rectal bleeding
Continuous disease distribution
Abdominal tenderness
3) Which of the following is true regarding the pathophysiology of CD?
Crohn’s disease is normally confined to the colon and rectum
Crohn’s disease commonly has a “cobblestone” appearance in which the diseased bowel is separated by segments of healthy bowel
Crohn’s disease is often mild and not progressive in nature
Unlike ulcerative colitis, Crohn’s disease is not associated with extraintestinal complications
4) Which of the following classes of medications are used primarily to treat CD flares but should not be used long-term?
Immunomodulators
Anti-TNF agents
5-aminosalicylates
Corticosteroids
5) Which of the following agents has a slow onset of action and is ineffective for induction in active, symptomatic CD?
Mesalamine
Azathioprine
Infliximab
Adalimumab
6) A patient who may receive azathioprine therapy should have which of the following tests completed prior to initiating therapy?
PML test
PPD
TPMT
TGN
7) A patient who develops pancreatitis from a CD medication is most likely taking which of the following?
Methotrexate
Mesalamine
Sulfasalazine
Ustekinumab
8) Which anti-TNF agent is a chimeric mouse-human IgG1 monoclonal antibody that is given intravenously to treat CD?
Infliximab
Adalimumab
Certolizumab
Golimumab
9) Patients should be counseled to do which of the following prior to starting anti-TNF therapy?
Receive the live, attenuated influenza vaccine
Be treated for tuberculosis
Receive the pneumococcal pneumonia vaccine
Receive treatment for viral hepatitis
10) Which of the following roles can pharmacy technicians play in the care of patients with CD?
Recommending patients as surgical candidates
Helping to determine when patients are not adherent to their treatment regimens
Recommending alternative medication therapies when first-line treatments fail
Assisting with determining an appropriate dietary regimen

Answer 1

1) Smoking — smoking increases risk of Crohn’s disease in Caucasians.

2) Fistulas — transmural inflammation leading to fistula formation is characteristic of Crohn’s.

3) Crohn’s commonly has a “cobblestone” appearance with diseased bowel separated by segments of healthy bowel (skip lesions).

4) Corticosteroids — used for induction/flares but should not be used long‑term because of adverse effects.

5) Azathioprine — slow onset (weeks–months) and not effective for induction of active symptomatic disease.

6) TPMT — test thiopurine methyltransferase activity/genotype before starting azathioprine.

7) Mesalamine — 5‑ASA agents (including mesalamine) are known causes of drug‑induced pancreatitis.

8) Infliximab — a chimeric mouse–human IgG1 monoclonal given IV.

9) Be treated for tuberculosis — patients should be screened and treated for latent TB before starting anti‑TNF therapy.

10) Helping to determine when patients are not adherent to their treatment regimens — pharmacy technicians can assist with adherence monitoring and related tasks.