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Anti-inflammatory agents Flashcards

1
Q

What are the four drug classes of anti-inflammatory agents?

A

DMARD biologic, bio similars and kinase inhibitors

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2
Q

What is the indication and effect of DMARD’s?

A

They are immuno suppressant for chronic inflammatory conditions, and they take weeks to months to take affect

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3
Q

What are the most common DMARD’s?

A

Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide

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4
Q

Are DMARD’s biologic or non-biologic and bio similar or non-bio similar and kinase inhibitors

A

They are non-biologic non-bio similar non-kinase inhibitors

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5
Q

What biologic agents use recumbent DNA techniques

A

Biologic DMARD’s

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6
Q

What are examples of biologic DMARD’s?

A

infliximab, etanercept, adalimumab, golimumab

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7
Q

How are biologic DMARD’s given?

A

Parentally

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8
Q

How fast do biologic DMARD’s work compared to DMARD

A

More rapidly within two weeks up to six weeks

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9
Q

What is the nomenclature of Cept

A

Fusion of a receptor to the FC part of human immunoglobin one IgG1

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10
Q

What does the nomenclature of mab mean

A

It indicates a monoclonal antibody

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11
Q

What does the nomenclature of ximab mean

A

It indicates a chimeric mAb

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12
Q

What is the nomenclature of zumab

A

It indicates a humanized mAb

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13
Q

What are biosimilar’s?

A

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.

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14
Q

Why are bio similar cheaper than biologic?

A

It has a shorter timeline for development, which results in a lower cost to the patient

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15
Q

What are kinase inhibitors?

A

They are targeted synthetic DMARD that inhibit cytoplasmic protein tyrosine kinases

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16
Q

How are kinase inhibitors administered?

A

Orally

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17
Q

What is the only kinase inhibitor available in the US?

A

Tofactinib

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18
Q

What are example examples of inflammatory cytokines?

A

Interleukins 12, tumor necrosis, factor alpha, and interferon Alpha

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19
Q

True or false conventional DMARD’s bring about symptom relief fairly rapidly within days to a few weeks

A

False, it typically takes several months

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20
Q

What are the indications for the DMARD methotrexate

A

Rheumatoid arthritis ankylosing spondylitis Felty syndrome

21
Q

How does methotrexate work?

A

It inhibits purine metabolism, anti-cell activation, and may also inhibit interleukin one beta

22
Q

How is methotrexate dose and what should you monitor?

A

It is just once a week orally I am or SC and it is really excreted so you should monitor GFR

23
Q

When is methotrexate contraindicated?

A

In pregnancy and breast-feeding

24
Q

What are the adverse effects of methotrexate?

A

G.I. upset hepatotoxicity, thrombocytopenia alopecia infection, lymphoma, and pneumonitis

25
What dog did you avoid giving methotrexate with?
Other folate depleting drugs like Trimethaprim sulfamethoxazole
26
What should patients have while treating with methotrexate?
They must have up-to-date vaccines and do not give them live virus vaccines
27
What should you avoid while taking methotrexate?
You should avoid drinking alcohol and contact with people receiving the life polio vaccine
28
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
29
What supplement should patients treating with methotrexate take?
Folic acid 1 mg a day to prevent hematologic effects
30
What is entanerecpt used for?
Rheumatoid arthritis, juvenile, idiopathic, arthritis, psoriatic, arthritis, psoriasis, and ankylosing spondylitis
31
How often is entanerecpt dosed
Once every one to two weeks sub Q
32
What are the side effects of entanerecpt
G.I. rash infection, injection, site reaction and lymphoma and pediatric patients
33
What is the onset of action of entanerecpt
One to two weeks and it is excreted slowly with a half-life of 102 hours
34
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
35
What is required prior to therapy with entanerecpt
TB tests CBC to check for infection and a hepatitis B screening
36
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
37
What is a major barrier for patients that need entanerecpt
It cost more than $5000 for a single dose
38
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
39
What is required prior to infliximab therapy
A TB screening up-to-date vaccines check for infections and test for HBV
40
What are you at an increased risk for while dosing with infliximab
Lymphoma, especially in the pediatric population
41
What are the pros to dosing within infliximab versus entanerecpt
it is $4800 for an eight week dose
42
What’s the most common kinase inhibitor?
Tofactinib
43
What is Tofactinib indicated in?
Moderate to severe rheumatoid arthritis that had an intolerant or inadequate response to methotrexate
44
What are the common adverse reactions to Tofactinib
URI UTI headache, diarrhea elevation in LFTs cholesterol and serum creatinine
45
How is Tofactinib given?
Orally twice a day
46
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
47
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
48
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.
49

Pharm Test 3 (12 decks)

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