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Derm Pharm 2020 > 2 - TNF Inhibitors > Flashcards

2 - TNF Inhibitors Flashcards

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Dermatology Board Prep flashcards
1
Q

Increased lesion and serum TNF-alpha levels correlate with severity of psoriasis

A

True

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2
Q

TNF-alpha is a Th1 (T-helper 1 cell) cytokine that stimulates keratinocyte proliferation which then releases additional pro inflammatory cytokines

A

True

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3
Q

TNF-alpha upregulates intracellular adhesion molecules on the surface of endothelial cells

A

True

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4
Q

TNF-alpha is chemotactic for neutrophils

A

True

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5
Q

Decreased liver function (such as in patients with liver disease) does not affect the efficacy of etanercept

A

True

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6
Q

Etanercept can be used in patients with active hepatitis C infection

A

True (no adverse effects in these patients)

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7
Q

Etanercept is a fully human dimeric fusion protein RECEPTOR that binds to both soluble and membrane bound TNF-alpha as well as TNF-beta

A

True

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8
Q

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are Pregnancy Category B

A

True

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9
Q

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are relatively contraindicated in patients with family history of demyelinating diseases i.e. Multiple sclerosis

A

True

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10
Q

The TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is absolutely contraindicated in the setting of active or chronic infections

A

True

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11
Q

Etanercept affects the mortality of patients with moderate to severe hepatitis

A

True (small clinical trial showed increased mortality)

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12
Q

The TNF-alpha inhibitors have been associated with reactivation of Hep B fulminant hepatitis and caution and antiviral therapy is advised even without active disease

A

True

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13
Q

2% of Etanercept patients will develop non-neutralising autoantibodies (not anti-drug antibodies)

A

True (and so these autoantibodies are not associated with ineffective treatment or adverse events)

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14
Q

The most common adverse event associated with Etanercept is injection site reaction

A

True (delayed hypersensitivity type reaction)

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15
Q

Anakinra (an IL-1 antagonist) used in conjunction with the TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) is associated with an increased risk of serious infections

A

True

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16
Q

Live-vaccines are absolutely contraindicated in patients on Etanercept (and other biological agents)

A

True (any vaccine is acceptable EXCEPT live-vaccines)

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17
Q

Etanercept pre filled syringes stored in the refrigerator should be allowed to return to room temperature 15 minutes before injecting in order to reduce injection-related pain

A

True

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18
Q

Infliximab is a CHIMERIC IgG monoclonal antibody specific to TNF-alpha

A

True

19
Q

The neutralising anti-drug antibodies in Infliximab treated patients may reduce efficacy of Infliximab in a minority of patients

A

True

20
Q

Infliximab neutralises soluble TNF-alpha and blocks membrane bound TNF-alpha

A

True

21
Q

Etanercept prevents TNF-alpha from binding to any cell surface receptors

A

True

22
Q

Infliximab should not be given to any patient with a hypersensitivity to murine (mouse) proteins

A

True (derived from mouse and human sources)

23
Q

Infliximab >5mg/kg is absolutely contraindicated in patients with congestive cardiac failure

A

True (absolute contraindication for >5mg/kg - significant mortality and hospitalisation, OK for lower dose)

24
Q

Infliximab may be prescribed in HIV patients

A

True (HIV patients with low viral loads and normal CD4 counts have tolerated Infliximab)

25
Q

20% of Infliximab patients experience infusion reactions

A

True

26
Q

Anti-drug antibodies to Infliximab is associated with an increased clearance rate of Infliximab and reduced efficacy

A

True

27
Q

Anti-drug antibodies to Infliximab is associated with an increased incidence of infusion reactions

A

True

28
Q

Higher antibody titres of anti-drug antibodies to Infliximab corresponds to severity of infusion reactions or serious infectious complications

A

False

29
Q

Increasing the dose per kg or shortening the interval between doses combats the formation of anti-drug antibodies to Infliximab

A

True (other methods include premedicating with oral corticosteroids and concomitant immunomodulatory therapy I.e. Methotrexate)

30
Q

Infliximab has been associated with hepatotoxicity

A

True (active liver failure, autoimmune hepatitis, jaundice, cholestasis)

31
Q

Adalimumab is a fully human IgG recombinant monoclonal antibody to TNF-alpha

A

True

32
Q

All 3 TNF-alpha inhibitors (Etanercept, Infliximab, Adalimumab) are metabolised via proteolysis and excreted into the bile and urine

A

True

33
Q

The most common adverse event for Adalimumab is injection site reaction

A

True

34
Q

The rate of neutralising (anti-drug) antibody production for Adalimumab was 5%, with no correlation with adverse event or disease activity

A

True

35
Q

Methotrexate can reduce the clearance of Adalimumab after multiple dosing, but this does not reduce Adalimumab’s efficacy

A

True

36
Q

There is an increased risk of active TB infection with the TNF-alpha inhibitors

A

True (monoclonal antibodies Infliximab and Adalimumab associated with higher rates than Etanercept)

37
Q

Once TB infection has been treated, TNF-alpha inhibitors can be started

A

True

38
Q

Invasive fungal infections are associated with TNF-alpha inhibitors treatment

A

True

39
Q

TNF-alpha inhibitors are contraindicated in chronic carriers of Hepatitis B (Hep B surface antigen positive)

A

True (there is risk of reactivation of Hepatitis B and clinicians are cautioned before using these drugs in patients with history of Hep B)

40
Q

Patients with congestive cardiac failure should use TNF-alpha inhibitors with caution

A

True

41
Q

Positive ANA and anti-dsDNA induction has been associated with the TNF-alpha inhibitors, although the incidence of drug-induced lupus/SLE/lupus-like syndrome remains low

A

True

42
Q

TNF-alpha inhibitors may rarely cause haematologic toxicity (leukopenia, neutropenia, thrombocytopenia, pancytopenia)

A

True

43
Q

The risk of lymphoma and skin cancer is unclear in patients on TNF-alpha inhibitors

A

True

44
Q

Patients with underlying conditions that predispose to infection i.e. Diabetes should be monitored closely whilst on TNF-alpha inhibitors

A

True (it is reasonable to withdraw therapy in patients with active infections)

Derm Pharm 2020 (47 decks)

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