Anti-inflammatory agents Flashcards
What are the four drug classes of anti-inflammatory agents?
DMARD biologic, bio similars and kinase inhibitors
What is the indication and effect of DMARD’s?
They are immuno suppressant for chronic inflammatory conditions, and they take weeks to months to take affect
What are the most common DMARD’s?
Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide
Are DMARD’s biologic or non-biologic and bio similar or non-bio similar and kinase inhibitors
They are non-biologic non-bio similar non-kinase inhibitors
What biologic agents use recumbent DNA techniques
Biologic DMARD’s
What are examples of biologic DMARD’s?
infliximab, etanercept, adalimumab, golimumab
How are biologic DMARD’s given?
Parentally
How fast do biologic DMARD’s work compared to DMARD
More rapidly within two weeks up to six weeks
What is the nomenclature of Cept
Fusion of a receptor to the FC part of human immunoglobin one IgG1
What does the nomenclature of mab mean
It indicates a monoclonal antibody
What does the nomenclature of ximab mean
It indicates a chimeric mAb
What is the nomenclature of zumab
It indicates a humanized mAb
What are biosimilar’s?
They are reverse engineered copies of FDA approved biologic and they have a highly similar but not identical product to biologic, but are similar and quality, safety and efficacy. They are not better and they are not worse.
Why are bio similar cheaper than biologic?
It has a shorter timeline for development, which results in a lower cost to the patient
What are kinase inhibitors?
They are targeted synthetic DMARD that inhibit cytoplasmic protein tyrosine kinases
How are kinase inhibitors administered?
Orally
What is the only kinase inhibitor available in the US?
Tofactinib
What are example examples of inflammatory cytokines?
Interleukins 12, tumor necrosis, factor alpha, and interferon Alpha
True or false conventional DMARD’s bring about symptom relief fairly rapidly within days to a few weeks
False, it typically takes several months
What are the indications for the DMARD methotrexate
Rheumatoid arthritis ankylosing spondylitis Felty syndrome
How does methotrexate work?
It inhibits purine metabolism, anti-cell activation, and may also inhibit interleukin one beta
How is methotrexate dose and what should you monitor?
It is just once a week orally I am or SC and it is really excreted so you should monitor GFR
When is methotrexate contraindicated?
In pregnancy and breast-feeding
What are the adverse effects of methotrexate?
G.I. upset hepatotoxicity, thrombocytopenia alopecia infection, lymphoma, and pneumonitis
What dog did you avoid giving methotrexate with?
Other folate depleting drugs like Trimethaprim sulfamethoxazole
What should patients have while treating with methotrexate?
They must have up-to-date vaccines and do not give them live virus vaccines
What should you avoid while taking methotrexate?
You should avoid drinking alcohol and contact with people receiving the life polio vaccine
How is methotrexate dose?
7.5 mg a week and is increased every four weeks as tolerated to control symptoms and signs of inflammation. The maximum dose is 25 mg a week every other week dosing can we try on patients on long-term therapy that are stable and have achieved their optimal response
What supplement should patients treating with methotrexate take?
Folic acid 1 mg a day to prevent hematologic effects
What is entanerecpt used for?
Rheumatoid arthritis, juvenile, idiopathic, arthritis, psoriatic, arthritis, psoriasis, and ankylosing spondylitis
How often is entanerecpt dosed
Once every one to two weeks sub Q
What are the side effects of entanerecpt
G.I. rash infection, injection, site reaction and lymphoma and pediatric patients
What is the onset of action of entanerecpt
One to two weeks and it is excreted slowly with a half-life of 102 hours
What is entanerecpt contraindicated in?
It is contraindicated in sepsis, and it has major drug drug interactions with other immunosuppressant agents, and it does cross the placenta and his present breastmilk
What is required prior to therapy with entanerecpt
TB tests CBC to check for infection and a hepatitis B screening
What signs and symptoms should you monitor while taking entanerecpt
You should monitor for signs and symptoms of malignancy like splenomegaly, hepatomegaly, abdominal pain, persistent, fever, night sweats, and weight loss
What is a major barrier for patients that need entanerecpt
It cost more than $5000 for a single dose
What is the bios similar infliximab used for, and how is it given?
It is a TNF inhibitor and it is given every eight weeks for Crohn’s disease and moderate to severe assertive colitis, moderate to severe rheumatoid arthritis, plaque, psoriasis, and psoriatic arthritis
What is required prior to infliximab therapy
A TB screening up-to-date vaccines check for infections and test for HBV
What are you at an increased risk for while dosing with infliximab
Lymphoma, especially in the pediatric population
What are the pros to dosing within infliximab versus entanerecpt
it is $4800 for an eight week dose
What’s the most common kinase inhibitor?
Tofactinib
What is Tofactinib indicated in?
Moderate to severe rheumatoid arthritis that had an intolerant or inadequate response to methotrexate
What are the common adverse reactions to Tofactinib
URI UTI headache, diarrhea elevation in LFTs cholesterol and serum creatinine
How is Tofactinib given?
Orally twice a day
What are two things you can do as a prescriber to help with the cost of drug
Drug manufacturer, co-pay, saving cards and prescription assistance programs
After NSAIDs, what class of drugs is typically the first to be prescribed for people with a chronic inflammatory condition like rheumatoid arthritis
A conventional DMARD like methotrexate
Why are biologic and bios similar’s only administered parentally
They are large molecule complex drugs, similar to insulin. They can be destroyed by the gut before they absorbed into the circulation.
