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Year 2 MIS Core Drugs > Antimetabolites and Monoclonal Antibodies > Flashcards

Antimetabolites and Monoclonal Antibodies Flashcards

1
Q

In a patient who is having a flare up and requires symptom relief from RA requires a bridging therapy in RA, what are the 2 groups of drugs patients can be prescribed?

1 - NSAIDs and biologicals (anti-TNF-a)
2 - NSAIDs and Glucocorticoids
3 - NSAIDs and DMARDs
4 - Glucocorticoids and DMARDs

A

2 - NSAIDs and Glucocorticoids

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2
Q

In a patient who is having a flare up and requires symptom relief from RA requires a bridging therapy in RA, they can be prescribed NSAIDs and Glucocorticoids. What are the 4 core glucocorticoids that we need to be aware of?

1 - Cortisone, Beclometasone, Prednisolone, Hydrocortisone
2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone
3 - Methylprednisolone, Cortisone, Prednisolone, Hydrocortisone
4 - Methylprednisolone, dexamethasone, Prednisolone, Hydrocortisone

A

2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone

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3
Q

What is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD)

1 - Methotrexate
2 - Adalimumab
3 - Tocilizumab
4 - Rituximab

A

1 - Methotrexate

- 1st line gold standard core drug for RA

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4
Q

Methotrexate is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD). Which activated cells is Methotrexate able to induce apoptosis in?

1 - CD4 and B cells
2 - CD4 and CD8 T cells
3 - CD8 and B cells
4 - CD4 and neutrophils

A

2 - CD4 and CD8 T cells

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5
Q

Methotrexate is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD). What micronutrient can be taken alongside Methotrexate to reduce the side effects?

1 - folic acid
2 - iron
3 - vitamin B12
4 - vitamin A

A

1 - folic acid

  • important for DNA and cell proliferation
  • DMARDs cause bien marrow suppression such as neutropenia
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6
Q

Methotrexate is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD). What effect does Methotrexate have on cell proliferation?

1 - increases cell proliferation
2 - no effect
3 - inhibits cell proliferation

A

3 - inhibits cell proliferation

  • impacts cells that proliferate a lot like RBCs and WBCs
  • BUT can cause neutropenia as a consequence
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7
Q

Methotrexate is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD). Methotrexate is able to increase the levels of adenosine. Why is this important?

1 - adenosine inhibits CD4 and CD8 T cells
2 - adenosine reduces CD4 and CD8 activation
3 - adenosine reduces leukocyte recruitment and thus inflammation
4 - adenosine induces vasodilation

A

3 - adenosine reduces leukocyte recruitment and thus inflammation

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8
Q

Methotrexate is the core antimetabolite drug that we need to be aware of that is a disease modifying anti-rheumatic drug (DMARD). How long must Methotrexate be taken before improvements in patients symptoms can be seen?

1 - 1-3 days
2 - 2-3 weeks
3 - 8-12 weeks
4 - 3-6 months

A

3 - 8-12 weeks

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9
Q

What is a biological therapy?

A
  • drugs that target the bodies immune system

- derived from bodies own genes to inhibit proteins (TNF-a, IL-6 etc..)

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10
Q

What is a monoclonal antibody (mab)?

A
  • mono = one
  • clonal = clone/replicate something
  • antibodies engineered to replicate a biological antibody and elicit similar effects
  • can bind receptors on cells to stop infection or bind the pathogen or protein directly and stop it from acting on cells
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11
Q

The end of a drug with mab indicates that the drug is a monoclonal antibody. What does the end of a drug name with ‘ximab’ mean?

1 - monoclonal antibody (mAb)
2 - chimeric (part human and park animal) mAb
3 - humanized mAb
4 - fully human mAb

A

2 - chimeric (part human and park animal) mAb

- remember ce biotic is from animals

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12
Q

The end of a drug with mab indicates that the drug is a monoclonal antibody. What does the end of a drug name with ‘zumab’ mean?

1 - monoclonal antibody (mAb)
2 - chimeric (part human and park animal) mAb
3 - humanized mAb
4 - fully human mAb

A

3 - humanized mAb

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13
Q

The end of a drug with mab indicates that the drug is a monoclonal antibody. What does the end of a drug name with ‘umab’ mean?

1 - monoclonal antibody (mAb)
2 - chimeric (part human and park animal) mAb
3 - humanized mAb
4 - fully human mAb

A

4 - fully human mAb

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14
Q

In the immune system which 2 activated cells predominantly secrete TNF-a?

1 - T cells and B cells
2 - T cells and neutrophils
3 - macrophages and T cells
4 - macrophages and B cells

A

3 - macrophages and T cells

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15
Q

A biological DMARDs can be used to treat RA. Before biological DMARDs can be prescribed, what must the patient have already tried?

1 - NSAIDs and 1 DMARD
2 - NSAIDs and 1 glucocortisone
3 - >2 DMARDs (1 must be methotrexate)
4 - >4 DMARDs (1 must be methotrexate)

A

3 - >2 DMARDs (1 must be methotrexate)

- patients must also have a high RA disease score based on DAS 28

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16
Q

Which biological DMARDs that is a core drug is ant-TNF-a?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - abatacept

A

1 - Adalimumab

- administered as a subcutaneous injection

17
Q

Adalimumab is a biological DMARDs that binds and inhibits TNF-a. What is the key side effect from this drug?

1 - increased risk of cardiovascular event
2 - increased risk of renal disease
3 - increased risk of infection
4 - increased risk of cancer

A

3 - increased risk of infection

- TNF-a is part of the immune system so reducing it increases the risk of infection

18
Q

Adalimumab is a biological DMARDs that binds and inhibits TNF-a. Prior to administering Adalimumab, what 3 conditions should patients be screened for as this drug can accentuate these conditions?

1 - TB, heart failure, T1DM
2 - TB, heart failure, CKD
3 - TB, heart failure, multiple sclerosis
4 - CKD, heart failure, multiple sclerosis

A

3 - TB, heart failure, multiple sclerosis

  • been shown to damage myocardium
  • increases risk of infection so TB
19
Q

When prescribing a biological DMARDs, what other drug should be avoided?

1 - NSAIDs
2 - convention DMARDs
3 - glucocorticoids
4 - other biological DMARDs

A

4 - other biological DMARDs

- would dampen the immune response too much

20
Q

Which biological DMARDs that is a core drug is ant-B cell?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - abatacept

A

3 - Rituximab

- partially humanised CD20 drug

21
Q

Rituximab, a partially humanised CD20 drug is the biological DMARDs that is ant-B cell. What is the mechanism of action of this drug?

1 - binds to CD20 receptors causing opsonisation of B cell
2 - binds to CD20 receptors and induces apoptosis of B cell
3 - binds to CD20 receptors and inhibits B cell activity
4 - binds to CD20 receptors and stops antigen B cell activation

A

1 - binds to CD20 receptors causing opsonisation of B cell

- undergoes phagocytosis, complement system is activated and Antibody-dependent cell mediated cytotoxicity

22
Q

Which biological DMARDs that is a core drug is ant-IL-6S?

1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept

A

2 - Tocilizumab

  • IL-6 relates to the protein
  • S relates to soluble forms of the IL-6 receptor
23
Q

Tocilizumab is a humanised IL-6S receptor biological DMARDs that is able to inhibit IL-6. What is the mechanism of action of this drug?

1 - binds directly to IL-6 and induces proteolysis
2 - binds directly to IL-6 and inhibits its activity
3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind
4 - binds directly to IL-6 receptors on cells and inhibits its activity

A

3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind

24
Q

Tocilizumab is a humanised IL-6 soluble receptor biological DMARDs that is able to inhibit IL-6 by binding directly to soluble IL-6 receptor ensuring IL-6 cannot bind to cells. How is this drug generally administered?

1 - subcutaneously
2 - subcutaneously and intravenously
3 - orally and subcutaneously
4 - orally and intravenously

A

2 - subcutaneously and intravenously

25
Q

What is meant by combination therapy in RA?

1 - combining NSAIDs with DMARDs
2 - combining a biological with DMARDs
3 - combining NSAIDs with biological
4 - combining glucocorticoid with DMARDs

A

2 - combining a biological with DMARDs (commonly methotrexate)

26
Q

Combination therapy in RA is when a biological is copmbined with a DMARDs, which is generally methotrexate. What affect can this have on immunogenicity (ability of a foreign substance to initiate an immune response)?

A
  • immunogenicity is bodies ability to initiate an immune response in response to an antigen
  • combined therapy reduces immunogenicity
  • reduces the bodies ability to attach the biologicals
  • however, can also increase the risk of infection

Year 2 MIS Core Drugs (6 decks)

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