A client with Crohn disease is scheduled to start infliximab… | MyMerci
Crisis InterventionPSI
Question
A client with Crohn disease is scheduled to start infliximab. Which test must be completed before the first infusion?
1Latent TB screening (TST or IGRA) plus HBV serology, because TNF-alpha inhibitors can reactivate latent TB and hepatitis B✓ Correct answer
2Echocardiogram
3Bone density scan
4CT chest
Explanation
Correct (2): Anti-TNF biologics (infliximab, adalimumab, etanercept, certolizumab, golimumab) carry a boxed warning for serious infections including reactivation of latent TB and hepatitis B. Screen with TST/IGRA + HBV serology before first dose. Treat latent TB before initiation. (1,3,4) Unrelated to standard pre-biologic workup.
In-depth explanation
Memory Tip Anti-TNF = "Tube-Necrosis-Factor blocker" before starting: TB + Hep B + JC virus precautions. Infusion reactions also monitored.
Clinical scenario
Scenario 35-year-old male with refractory Crohn disease scheduled for infliximab 5 mg/kg IV. Pre-infusion checklist.
Key concepts
TNF-alpha inhibitor — Biologic class — infliximab, adalimumab, etanercept; boxed warning for infections.
Latent TB screening — TST (≥5 mm positive) or IGRA before starting anti-TNF therapy.
Infliximab infusion reaction — Acute (during/within 24h) or delayed (1-14 days); slow infusion with premedication if reactive.