A nurse is reviewing new prescriptions for a client who has a history of severe irritable bowel disease and is experiencing a flare-up. Which of the following medications should the nurse recognize as contraindicated for this client?

Brief Introduction: Irritable bowel disease involves chronic inflammation of the gastrointestinal tract, often presenting with hematochezia, abdominal cramping, and urgent defecation. Management requires monitoring for toxic megacolon and maintaining hydration levels above 1500 mL daily. Rationale: A. Sulfasalazine is a 5-aminosalicylate that reduces mucosal inflammation by inhibiting prostaglandin synthesis. It is a first-line treatment for maintaining remission in ulcerative colitis. Nurses must monitor for agranulocytosis and ensure adequate fluid intake to prevent crystalluria. B. Alosetron is contraindicated during active flares of inflammatory bowel disease due to the high risk of ischemic colitis. This selective 5-HT3 antagonist can cause severe constipation and bowel obstruction, which exacerbates underlying structural damage in these clients. C. Prednisone is a corticosteroid used to induce rapid remission during acute exacerbations of inflammatory bowel disease. It suppresses the immune response and reduces systemic cytokine production. Prolonged use requires monitoring for hyperglycemia and adrenal insufficiency. D. Infliximab is a tumor necrosis factor inhibitor used for refractory cases of Crohn’s disease or ulcerative colitis. It helps close enterocutaneous fistulas and maintain mucosal healing. Clients must undergo tuberculosis screening prior to initiating this biological therapy.