A nurse is evaluating a client who has ulcerative colitis and is receiving infliximab, a monoclonal antibody. What are some of the outcomes that indicate the effectiveness of the therapy?

Infliximab is a monoclonal antibody that is used to treat ulcerative colitis and other inflammatory conditions by blocking the action of tumor necrosis factor-alpha (TNF-α), a cytokine that causes inflammation and tissue damage in the gut¹. It can be given intravenously every 8 weeks as a maintenance therapy for moderate to severe ulcerative colitis¹. However, it can also have some potential benefits and risks that the nurse should monitor.

The correct answer to your question is:

D. All of the above

This is because infliximab can improve the clinical outcomes of ulcerative colitis in several ways, such as:

A. Decreased frequency and severity of diarrhea, abdominal pain, and rectal bleeding:

These are the main symptoms of ulcerative colitis that affect the quality of life of patients. Infliximab can reduce these symptoms by healing the inflammation and ulcers in the colon and rectum. Several studies have shown that infliximab can induce and maintain clinical remission, response, and mucosal healing in patients with moderate to severe ulcerative colitis who are refractory to conventional therapies²³⁴.

B. Increased appetite, weight gain, energy level, and quality of life:

These are the secondary outcomes of ulcerative colitis that reflect the nutritional status and well-being of patients. Infliximab can improve these outcomes by reducing the systemic effects of inflammation, such as malabsorption, anemia, fatigue, and fever. Several studies have shown that infliximab can improve the health-related quality of life, nutritional status, and functional status of patients with moderate to severe ulcerative colitis²³⁴.

C. Normalized stool culture, blood count, electrolytes, and liver function tests:

These are the laboratory tests that indicate the severity and complications of ulcerative colitis. Infliximab can normalize these tests by reducing the bacterial translocation, blood loss, dehydration, and liver involvement that may occur in ulcerative colitis. Several studies have shown that infliximab can improve the stool culture, hemoglobin, albumin, C-reactive protein, and liver enzymes of patients with moderate to severe ulcerative colitis²³⁴.

A. It inhibits the synthesis of inflammatory mediators and suppresses the activation and proliferation of immune cells.

Prednisone is a synthetic glucocorticoid that mimics the natural hormone cortisol, which is produced by the adrenal cortex. Cortisol has potent anti-inflammatory and immunosuppressive effects by inhibiting the synthesis of inflammatory mediators such as prostaglandins, leukotrienes, histamine, cytokines, and adhesion molecules, and by suppressing the activation and proliferation of lymphocytes, macrophages, eosinophils, and mast cells. These effects reduce the immune-mediated damage to the self-tissues in autoimmune diseases such as rheumatoid arthritis.

The other options are wrong because:

B. It blocks the activation of T cells by inhibiting the enzyme calcineurin, which is required for the transcription of interleukin-2.

This option is wrong because it describes the mechanism of action of calcineurin inhibitors, not glucocorticoids. Calcineurin inhibitors are a type of immunosuppressant that target T cells specifically, while glucocorticoids have a broader effect on various immune cells and inflammatory mediators.

C. It interferes with the synthesis of nucleic acids, which are essential for the replication and function of immune cells.

This option is wrong because it describes the mechanism of action of antimetabolites, not glucocorticoids. Antimetabolites are a type of immunosuppressant that interfere with the synthesis of nucleic acids, which are the building blocks of DNA and RNA. This affects the replication and function of immune cells, as well as other rapidly dividing cells such as cancer cells.

D. It binds to specific antigens or receptors on the surface of immune cells and either neutralizes them or induces their destruction.

This option is wrong because it describes the mechanism of action of monoclonal antibodies, not glucocorticoids. Monoclonal antibodies are a type of immunosuppressant that bind to specific antigens or receptors on the surface of immune cells and either neutralize them or induce their destruction. This can prevent the activation or function of immune cells that are involved in transplant rejection or autoimmune diseases.