3 - Autoimmune Drugs Flashcards
What are the 2 factors necessary for development of an autoimmune disease?
- Inherited genes (MHC)
- Environmental trigger
What are autoantibodies active against?
Self-antigens and not foreign antigens
How do autoantibodies initiate disease?
- Alter/inhibit receptor function
- Myasthenia gravis
- Stimulate receptors that would normally be stimulated by a hormone
- Hyperthyroidism
What is the treatment of autoimmune disease aimed at?
- **Reducing inflammation (steroids) **
- Antagonists (blockers) to cytokines
- Immunosuppressive drugs used to inhibit T cell responses
When does damage to bone occur in rhematoid arthritis?
During first several years
What is the pharmacologic model for autoimmune disease management?
Treatment of RA
- Reduce joint inflammation and swelling
- Relieve pain and stiffness
- Encourage normal function
What are the corner stones of treatments for RA?
Aspirin and NSAIDS
What is used in treatment of RA in patients with inadequate response to aspirin and NSAIDS?
sulfasalazine (Azulfidine)
What is the adverse risk for taking celebrex (Celecoxib)?
- Cardiovascular risks
- Monitor BP when used with antihypertensives = decreases effectiveness of BP meds
What is celebrex contraindicated in?
- Aspirin/NSAIDs allergic patients
- Those allergic to sulfonamides
What are DMARDS?
Disease-Modifying Anti-Rheumatic Drugs
What is used for pts that dont respond to COX-2 inhibitors?
DMARDS
What is the drug of choice for severe RA or psoriatic arthritis (unresponsive to NSAIDS)?
methotrexate (Rheumatrex, Trexall)
What are the 2 indications for use of methotrexate?
- High dose - chemotherapy
- Low dose - immune modulator for autoimmune diseases
What’s the most common adverse effect of methotrexate?
- Mucosal ulcerations, nausea
What immune modulator inhibits pyrimidine synthesis, resulting in anti-proliferative and anti-inflammatory effects?
leflunomide (Arava)
What are the pro-inflammatory cytokines involved in the pathogenesis of RA?
- IL-1b
- TNF-alpha
What kind of drug is etanercept (Enbrel)?
TNF-alpha blocker
What drug is a TNF-alpha blocker that, when used long term is associated with developing antibodies against the drug?
infliximab (Remicade)
What kind of drug is adalimumab (Humira)?
TNF-alpha blocker
What drug is an interleukin-1 receptor antagonist? And what does it do?
anakinra (Kineret) - slows degradation of cartilage and bone loss
What are the common preps of antimalarials?
- chloroquine (Aralen)
- hydroxychloroquine (Plaquenil)
Which type of drugs will cause blue-black intraoral pigmentation with severe side effects or toxicity?
Anti-malarials (and gold compounds)
(chloroquine or hydroxychloroquine)
Name a chelating agent that slows the progression of bone destruction and RA?
penicillamine
What are the problems with gold compounds to treat auto-immune diseases?
- Preps are expensive to buy and administer
- High incidence of toxicity - requires intensive monitoring
How can you identify the gold compounds?
contain the “aur” in the name
What are the main immunosuppressive drugs?
- Used in cases of refractory RA
- azathioprine (Imuran)
- cyclophosphamide (Cytoxan)
- cyclosporine (Sandimmune)
What drug is an immunosuppressant that is used in dentistry with prednisone for severe erosive lichen planus, major aphtous stomatitis, erythema mutliforme, and pemphigoid?
azathioprine (Imuran)
What immunosuppressant is used primarily to prevent rejection of organ transplants?
cyclosprine (Sandimmune)
What drug is known to cause gingival hyperplasia?
Cyclosporine
What are the pathophysiologies of Sjorgren’s Syndrome?
- Primary - not associated with any other disease
- Secondary - associated with other connective tissue diesease (RA, SLE, scleroderma)
What are the diagnostic blood tests given to test for Sjorgren’s?
- ANA (Anti-nuclear antibody)
- RF
- SSA (or Ro) and SSB (or La)
- ESR (Erythrocyte sedimentation rate)
- IGs
What test measures tear production?
- Schirmer Test
- Rose Bengal and Lissamine Green - for dry spots
In a pt with sjogren’s, with severe oral and ocular dryness, how much of their glandular cells remain intact?
50%
What destroys eye muscles in exopthalmos in Grave’s Disease?
Immunoglobins
