Inflammatory bowel disease: drug therapy MCQs With Answer

Introduction

Inflammatory bowel disease (IBD), comprising ulcerative colitis and Crohn’s disease, requires a nuanced understanding of pharmacotherapy for effective management. This quiz set is designed for M.Pharm students studying Pharmacotherapeutics I (MPP 102T) and focuses on drug mechanisms, clinical indications, adverse effects, monitoring, and therapeutic strategies used in IBD. Questions emphasize both classical agents (aminosalicylates, corticosteroids, immunomodulators, antibiotics) and modern biologics and small molecules (anti-TNF agents, anti-integrin drugs, anti-IL therapies, JAK inhibitors). Use these MCQs to test knowledge critical for clinical decision-making, safe prescribing, and designing patient-specific treatment plans, including monitoring and risk mitigation.

Q1. Which statement best describes the pharmacologic action of sulfasalazine in ulcerative colitis?

• Sulfasalazine is a systemic corticosteroid that reduces inflammation by glucocorticoid receptor activation
• Sulfasalazine is a prodrug that is cleaved by colonic bacteria to release 5-ASA (mesalazine) and sulfapyridine
• Sulfasalazine is a monoclonal antibody against TNF-alpha
• Sulfasalazine is a calcineurin inhibitor that blocks T-cell activation

Correct Answer: Sulfasalazine is a prodrug that is cleaved by colonic bacteria to release 5-ASA (mesalazine) and sulfapyridine

Q2. For induction of remission in mild-to-moderate distal ulcerative colitis, which agent is considered first-line therapy?

• Oral azathioprine
• Topical or oral mesalazine (5-ASA)
• Intravenous infliximab
• Oral methotrexate

Correct Answer: Topical or oral mesalazine (5-ASA)

Q3. Which adverse effect monitoring test is recommended before starting azathioprine therapy?

• Serum creatinine and eGFR
• Thyroid function tests (TFTs)
• Thiopurine methyltransferase (TPMT) activity or genotype
• Lipid profile

Correct Answer: Thiopurine methyltransferase (TPMT) activity or genotype

Q4. Which biologic agent is a chimeric anti-TNF monoclonal antibody commonly used for moderate-to-severe Crohn’s disease and ulcerative colitis?

• Vedolizumab
• Infliximab
• Ustekinumab
• Tofacitinib

Correct Answer: Infliximab

Q5. What is the mechanism of action of vedolizumab in IBD therapy?

• Blockade of TNF-alpha, neutralizing proinflammatory cytokine
• Inhibition of JAK-STAT signaling pathway
• Antagonism of α4β7 integrin to prevent gut-specific lymphocyte trafficking
• Inhibition of dihydrofolate reductase to suppress lymphocyte proliferation

Correct Answer: Antagonism of α4β7 integrin to prevent gut-specific lymphocyte trafficking

Q6. Which oral small-molecule drug is a Janus kinase (JAK) inhibitor approved for moderate-to-severe ulcerative colitis?

• Certolizumab pegol
• Tofacitinib
• Cyclosporine
• Sulfasalazine

Correct Answer: Tofacitinib

Q7. Regarding systemic corticosteroids in IBD management, which statement is most accurate?

• Corticosteroids are recommended for long-term maintenance of remission
• Corticosteroids are primarily used for induction of remission in moderate-to-severe flares but are not for maintenance
• Corticosteroids have no role in induction therapy
• Corticosteroids are preferred over biologics for steroid-refractory disease

Correct Answer: Corticosteroids are primarily used for induction of remission in moderate-to-severe flares but are not for maintenance

Q8. Which immunomodulator is preferred as a steroid-sparing agent for maintenance in Crohn’s disease when azathioprine is not tolerated?

• Methotrexate (parenteral low-dose weekly)
• High-dose oral prednisone daily
• Oral mesalazine daily
• Oral ciprofloxacin indefinitely

Correct Answer: Methotrexate (parenteral low-dose weekly)

Q9. Which antibiotic is commonly used for perianal Crohn’s disease and postoperative prophylaxis in selected cases?

• Metronidazole
• Vancomycin
• Amoxicillin-clavulanate
• Linezolid

Correct Answer: Metronidazole

Q10. Ustekinumab exerts its therapeutic effect in IBD by targeting which cytokines?

• Interleukin-17 (IL-17)
• Interleukin-12 and Interleukin-23 (IL-12/23)
• Tumor necrosis factor-alpha (TNF-α)
• Interferon-gamma (IFN-γ)

Correct Answer: Interleukin-12 and Interleukin-23 (IL-12/23)

Q11. Which anti-integrin agent has been associated with a notable risk of progressive multifocal leukoencephalopathy (PML), limiting its use in IBD?

• Vedolizumab (gut-selective anti-α4β7)
• Natalizumab (anti-α4 integrin)
• Infliximab (anti-TNF)
• Ustekinumab (anti-IL-12/23)

Correct Answer: Natalizumab (anti-α4 integrin)

Q12. Which vaccination recommendation is correct for a patient about to start anti-TNF therapy?

• Administer live attenuated vaccines after anti-TNF initiation
• No need for vaccine review before starting therapy
• Prefer to update necessary live vaccines before initiating anti-TNF therapy
• Live vaccines are safe during combined anti-TNF and thiopurine therapy

Correct Answer: Prefer to update necessary live vaccines before initiating anti-TNF therapy

Q13. Therapeutic drug monitoring (TDM) in anti-TNF therapy is most useful for which purpose?

• Assessing renal clearance of biologics
• Measuring serum drug trough concentrations and anti-drug antibodies to guide dose adjustments
• Evaluating hepatic metabolism via CYP enzymes
• Replacing the need for clinical assessment of disease activity

Correct Answer: Measuring serum drug trough concentrations and anti-drug antibodies to guide dose adjustments

Q14. Long-term systemic corticosteroid therapy in IBD is associated with which major adverse effect?

• Osteoporosis and increased fracture risk
• Permanent kidney failure
• Immediate anaphylaxis in most patients
• Severe hyperkalemia as the most frequent toxicity

Correct Answer: Osteoporosis and increased fracture risk

Q15. Azathioprine’s immunosuppressive activity is primarily due to which mechanism?

• Inhibition of TNF-alpha signaling
• Purine analogue that interferes with DNA and RNA synthesis in proliferating lymphocytes
• Selective blockade of IL-6 receptors
• Direct inhibition of cyclooxygenase enzymes

Correct Answer: Purine analogue that interferes with DNA and RNA synthesis in proliferating lymphocytes

Q16. Which adverse effect is specifically associated with sulfasalazine therapy and often reversible upon discontinuation?

• Permanent male infertility due to azoospermia
• Reversible oligospermia (reduced sperm count) in men
• Severe irreversible hepatic necrosis in all patients
• Development of insulin-dependent diabetes

Correct Answer: Reversible oligospermia (reduced sperm count) in men

Q17. Combination therapy with anti-TNF agents and thiopurines increases the risk of which serious complication?

• Venous thromboembolism markedly above baseline
• Lymphoma (including hepatosplenic T-cell lymphoma in young males)
• Acute pancreatitis in all patients
• Severe hypoglycemia

Correct Answer: Lymphoma (including hepatosplenic T-cell lymphoma in young males)

Q18. In severe, steroid-refractory ulcerative colitis requiring urgent salvage therapy, which agent is commonly used as an alternative to surgery?

• Oral mesalazine monotherapy
• Intravenous cyclosporine or infliximab
• Long-term metronidazole alone
• Oral azathioprine as immediate rescue therapy

Correct Answer: Intravenous cyclosporine or infliximab

Q19. Tofacitinib plasma concentrations are affected by inhibitors of which enzyme system, requiring dose adjustment or caution?

• Monoamine oxidase (MAO)
• CYP3A4 (and to a lesser extent CYP2C19)
• Aldehyde dehydrogenase
• Renal organic anion transporters only

Correct Answer: CYP3A4 (and to a lesser extent CYP2C19)

Q20. Which IBD medication is absolutely contraindicated in pregnancy due to teratogenicity and should be stopped prior to conception?

• Methotrexate
• Mesalazine (5-ASA)
• Infliximab
• Azathioprine

Correct Answer: Methotrexate

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