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Derm Pharm 2020 > 3 - IV Immunoglobulin Therapy (IVIg) > Flashcards

3 - IV Immunoglobulin Therapy (IVIg) Flashcards

1
Q

IVIg is derived from a purified human plasma pool of more than 1000 healthy blood donors

A

True

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2
Q

IVIg contains IgG in supraphysiologic levels, including traces of other immunoglobulins

A

True

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3
Q

IVIg exerts a variety of immunomodulating activities and is an effective alternative approach for the treatment of many autoimmune immune-mediated inflammatory dermatoses

A

True

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4
Q

Based on currently available data, the most optimal responses to IVIg appears to be patients with:

(1) Kawasaki’s disease
(2) dermatomyositis
(3) autoimmune blistering diseases - Pemphigus vulgaris, cicatricial pemphigoid, epidermolysis bullous acquisita, pemphigoid gestationis
(4) TEN

A

True

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5
Q

IVIg can produce favourable clinical outcome, used either as monotherapy or in combination with other immunomodulating agents such as systemic corticosteroids and immunosuppressive agents and allowing for dose reductions of these concomitant therapy and their adverse effects

A

True

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6
Q

IVIg therapy is appropriate for autoimmune diseases which are progressive, uncontrolled, or rapidly debilitating despite conventional immunosuppressive therapy

A

True

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7
Q

IVIg therapy is appropriate for autoimmune diseases where there is significant adverse effects from conventional immunosuppressive therapy that are potentially life-threatening, or adverse effects that cause significant morbidity/inability to carry out activities of daily living

A

True

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8
Q

IVIg therapy is appropriate for autoimmune diseases where there are relative or absolute contraindications to the use of high-dose, long-term systemic corticosteroid therapy or immunosuppressive agents

A

True

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9
Q

IVIg can be used during pregnancy

A

True

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10
Q

IVIg can induce long-term remission of various dermatoses

A

True

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11
Q

IVIg can allow for the reduction or discontinuation of concomitant immunosuppressive treatments

A

True

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12
Q

Peak serum concentrations of IVIg occur immediately after IV injection

A

True

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13
Q

Peak serum concentrations of IVIg are dose related

A

True

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14
Q

Within 24 hours of an IVIg injection, 30% of the dose may be removed by catabolism and distribution

A

True

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15
Q

IVIg distributes mainly in the intravascular space (60%) than the extravascular space (40%)

A

True

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16
Q

IVIg crosses the placenta

A

True

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17
Q

IVIg may be excreted into milk

A

True

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18
Q

The serum half life of IVIg is 3-5 weeks

A

True

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19
Q

IVIg causes reduction/suppression of pathogenic autoantibody production due to IgG binding to the corresponding cell surface receptors on B lymphocytes

A

True (B lymphocytes usually produce antibodies, and IgG binding on its surface receptors causes downregulation of pathogenic autoantibody production)

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20
Q

IVIg causes neutralisation of complement-mediated effects by binding to complement components such as C3 and C5 convertases and so blocking complement activation at an early stage

A

True

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21
Q

The anti-idiotypic antibodies in IVIg preparations bind to and neutralise circulating pathogenic autoantibodies

A

True (after IVIg infusions, a marked reduction or even disappearance of these pathogenic autoantibodies could be demonstrated)

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22
Q

IVIg binds to receptors on macrophages, subsequently saturate, alter, and downregulate these receptors leading to inhibition of the pathogenic autoantibody-mediated cellular activation

A

True

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23
Q

IVIg preparations contain amounts of soluble CD4, CD8, and MHC-I and MHC-II molecules which inhibit autoreactive T-lymphocytes

A

True

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24
Q

IVIg restores the Th1/Th2 cytokine balance by supplying neutralising antibodies against the pathogenic autoantibodies

A

True

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25
Q

IVIg may affect the migration of immunocompetent cells from blood to target tissue

A

True

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26
Q

IVIg preparations contain anti-Fas-receptor antibodies which block molecular Fas ligand-Fas receptor interactions and consequently that of keratinocyte apoptosis

A

True (this mechanism explains the role of IVIg in the treatment of TEN)

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27
Q

Adjunctive use of IVIg has led to reduced dose requirements for systemic corticosteroids due to the increased glucocorticoid receptor sensitivity as well as because IVIg and corticosteroids cam synergistically suppress lymphocyte activation

A

True

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28
Q

The benefit of IVIg in graft versus host disease is questionable, but may still reduce the infection risk for these patients

29
Q

Headache is an IVIg infusion-related adverse effect

30
Q

IVIg infusion-related adverse effects are generally mild

31
Q

IVIg infusion-related adverse effects often occur 30-60 mins after the onset of the infusion

32
Q

IVIg infusion-related adverse effects can be managed by slowing down the infusion rate or temporarily discontinuing the infusion

33
Q

IVIg infusion-related adverse effects may sometimes require pre-treatment with analgesics

34
Q

IVIg infusion-related adverse effects may sometimes require pre-treatment with NSAIDS

35
Q

IVIg infusion-related adverse effects may sometimes require pre-treatment with antihistamines

36
Q

IVIg infusion-related adverse effects may sometimes require pre-treatment with low-dose IV corticosteroids

37
Q

Myalgia is an IVIg infusion-related adverse effect

38
Q

Fever/chills is an IVIg infusion-related adverse effect

39
Q

Flushing is an IVIg infusion-related adverse effect

40
Q

Nausea/vomiting is an IVIg infusion-related adverse effect

41
Q

Low back pain is an IVIg infusion-related adverse effect

42
Q

Wheezing is an IVIg infusion-related adverse effect

43
Q

Chest pain is an IVIg infusion-related adverse effect

44
Q

Blood pressure changes is an IVIg infusion-related adverse effect

45
Q

Tachycardia is an IVIg infusion-related adverse effect

46
Q

Anaphylactic reactions is associated with IgA deficiency in the presence of anti-IgA antibodies

A

True (immunoglobulin levels are measured before IVIg therapy to exclude IgA deficiency, and if IgA is absent or titre is low, then anti-IgA titres should be assessed on the IVIg product to be infused to minimise risk of anaphylaxis)

47
Q

Dermatitis, erythema multiforme and purpura are other hypersensitivity reactions associated with IVIg

48
Q

There is risk of fluid overload with IVIg infusions, particularly sucrose-containing preparations (increases intravascular volume)

A

True (patients with significant cardiac or kidney disease need careful and continuous monitoring to prevent fluid overload)

49
Q

Rarely acute renal failure due to osmotic nephrosis may occur in patients receiving sucrose-containing IVIg preparations (increases intravascular volume)

50
Q

Haematologic disorders such as neutropenia and haemolysis have been noted in individuals with autoantibodies against blood group antigens of the ABO and Rhesus system

51
Q

Aseptic meningitis has been noted in neurological patents receiving IVIg

52
Q

IVIg has been associated with thromboembolic events, including myocardial infarction and stroke in older patients

53
Q

IVIg-induced thromboembolic events are due to the osmolality of some IVIg products causing increased serum viscosity leading to secondary thrombogenesis

54
Q

The risk of IVIg-induced thromboembolic events is increased in patients receiving higher doses or rapid infusion rates

A

True (due to increased serum viscosity)

55
Q

The risk of IVIg-induced thromboembolic events may be minimised by lowering the IgG dose or slowing the infusion rate

A

True (due to increased serum viscosity)

56
Q

IVIg preparations carry the potential risk of transferring blood-borne diseases as IVIg is derived from pooled human plasma

57
Q

Congestive cardiac failure is a relative contraindication to IVIg due to increased risk of fluid overload

58
Q

Renal failure is a relative contraindication to IVIg due to increased risk of fluid overload

59
Q

Rheumatoid arthritis is a relative contraindication to IVIg due to increased risk of acute renal failure and fluid overload

A

True (screen for Rheumatoid factor before starting IVIg therapy)

60
Q

Cryoglobulinaemia is a relative contraindication to IVIg due to increased risk of acute renal failure and fluid overload

A

True (screen for cryoglobulins before starting IVIg therapy)

61
Q

IgA deficiency is a relative contraindication to IVIg due to increased risk of anaphylaxis

A

True (measure immunoglobulin levels before starting IVIg therapy)

62
Q

Before starting IVIg therapy, perform FBC, liver and renal function tests

A

True (to assess liver disease and renal disease as these are risks for fluid overload)

63
Q

Before starting IVIg therapy, immunoglobulin levels are measured to exclude IgA deficiency

A

True (IgA deficiency is a risk for anaphylaxis)

64
Q

In the absence of IgA or in the presence of low IgA before starting IVIg therapy, anti-IgA titres should be assessed on the IVIg product to be infused to minimise the risk of anaphylaxis

A

True (IgA deficiency is a risk for anaphylaxis)

65
Q

Before starting IVIg therapy, consider screening for hepatitis B/C and HIV

A

True (for medicolegal reasons as patient is receiving a blood product with potential risk of blood-borne diseases)

66
Q

Before starting IVIg therapy, screen for rheumatoid factor

A

True (patients with rheumatoid arthritis are at increased risk of acute renal failure and fluid overload)

67
Q

Before starting IVIg therapy, screen for cryoglobulins

A

True (patients with cryoglobulinaemia are at increased risk of acute renal failure and fluid overload)

68
Q

In patients with reduced cardiac and renal function, IVIg must be carefully administered to prevent fluid overload

69
Q

During IVIg infusions, blood pressure and heart rate should be monitored to assess for signs of fluid overload

Derm Pharm 2020 (47 decks)

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