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Pharmacology 2 > 3 - Autoimmune Drugs > Flashcards

3 - Autoimmune Drugs Flashcards

1
Q

What are the 2 factors necessary for development of an autoimmune disease?

A
  • Inherited genes (MHC)
  • Environmental trigger
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2
Q

What are autoantibodies active against?

A

Self-antigens and not foreign antigens

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3
Q

How do autoantibodies initiate disease?

A
  • Alter/inhibit receptor function
    • Myasthenia gravis
  • Stimulate receptors that would normally be stimulated by a hormone
    • Hyperthyroidism
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4
Q

What is the treatment of autoimmune disease aimed at?

A
  • **Reducing inflammation (steroids) **
  • Antagonists (blockers) to cytokines
  • Immunosuppressive drugs used to inhibit T cell responses
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5
Q

When does damage to bone occur in rhematoid arthritis?

A

During first several years

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6
Q

What is the pharmacologic model for autoimmune disease management?

A

Treatment of RA

  • Reduce joint inflammation and swelling
  • Relieve pain and stiffness
  • Encourage normal function
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7
Q

What are the corner stones of treatments for RA?

A

Aspirin and NSAIDS

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8
Q

What is used in treatment of RA in patients with inadequate response to aspirin and NSAIDS?

A

sulfasalazine (Azulfidine)

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9
Q

What is the adverse risk for taking celebrex (Celecoxib)?

A
  • Cardiovascular risks
    • Monitor BP when used with antihypertensives = decreases effectiveness of BP meds
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10
Q

What is celebrex contraindicated in?

A
  • Aspirin/NSAIDs allergic patients
  • Those allergic to sulfonamides
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11
Q

What are DMARDS?

A

Disease-Modifying Anti-Rheumatic Drugs

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12
Q

What is used for pts that dont respond to COX-2 inhibitors?

A

DMARDS

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13
Q

What is the drug of choice for severe RA or psoriatic arthritis (unresponsive to NSAIDS)?

A

methotrexate (Rheumatrex, Trexall)

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14
Q

What are the 2 indications for use of methotrexate?

A
  1. High dose - chemotherapy
  2. Low dose - immune modulator for autoimmune diseases
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15
Q

What’s the most common adverse effect of methotrexate?

A
  • Mucosal ulcerations, nausea
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16
Q

What immune modulator inhibits pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects?

A

leflunomide (Arava)

17
Q

What are the pro-inflammatory cytokines involved in the pathogenesis of RA?

A
  • IL-1b
  • TNF-alpha
18
Q

What kind of drug is etanercept (Enbrel)?

A

TNF-alpha blocker

19
Q

What drug is a TNF-alpha blocker that, when used long term is associated with developing antibodies against the drug?

A

infliximab (Remicade)

20
Q

What kind of drug is adalimumab (Humira)?

A

TNF-alpha blocker

21
Q

What drug is an interleukin-1 receptor antagonist? And what does it do?

A

anakinra (Kineret) - slows degradation of cartilage and bone loss

22
Q

What are the common preps of antimalarials?

A
  • chloroquine (Aralen)
  • hydroxychloroquine (Plaquenil)
23
Q

Which type of drugs will cause blue-black intraoral pigmentation with severe side effects or toxicity?

A

Anti-malarials (and gold compounds)

(chloroquine or hydroxychloroquine)

24
Q

Name a chelating agent that slows the progression of bone destruction and RA?

A

penicillamine

25
Q

What are the problems with gold compounds to treat auto-immune diseases?

A
  • Preps are expensive to buy and administer
  • High incidence of toxicity - requires intensive monitoring
26
Q

How can you identify the gold compounds?

A

contain the “aur” in the name

27
Q

What are the main immunosuppressive drugs?

A
  • Used in cases of refractory RA
  • azathioprine (Imuran)
  • cyclophosphamide (Cytoxan)
  • cyclosporine (Sandimmune)
28
Q

What drug is an immunosuppressant that is used in dentistry with prednisone for severe erosive lichen planus, major aphtous stomatitis, erythema mutliforme, and pemphigoid?

A

azathioprine (Imuran)

29
Q

What immunosuppressant is used primarily to prevent rejection of organ transplants?

A

cyclosprine (Sandimmune)

30
Q

What drug is known to cause gingival hyperplasia?

A

Cyclosporine

31
Q

What are the pathophysiologies of Sjorgren’s Syndrome?

A
  • Primary - not associated with any other disease
  • Secondary - associated with other connective tissue diesease (RA, SLE, scleroderma)
32
Q

What are the diagnostic blood tests given to test for Sjorgren’s?

A
  • ANA (Anti-nuclear antibody)
  • RF
  • SSA (or Ro) and SSB (or La)
  • ESR (Erythrocyte sedimentation rate)
  • IGs
33
Q

What test measures tear production?

A
  • Schirmer Test
  • Rose Bengal and Lissamine Green - for dry spots
34
Q

In a pt with sjogren’s, with severe oral and ocular dryness, how much of their glandular cells remain intact?

A

50%

35
Q

What destroys eye muscles in exopthalmos in Grave’s Disease?

A

Immunoglobins

Pharmacology 2 (21 decks)

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