Antimetabolites and Monoclonal Antibodies Flashcards
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
2 - NSAIDs and Glucocorticoids
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
2 - Methylprednisolone, Beclometasone, Prednisolone, Hydrocortisone
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
1 - Methotrexate
- 1st line gold standard core drug for RA
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
2 - CD4 and CD8 T cells
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
1 - folic acid
- important for DNA and cell proliferation
- DMARDs cause bien marrow suppression such as neutropenia
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
3 - inhibits cell proliferation
- impacts cells that proliferate a lot like RBCs and WBCs
- BUT can cause neutropenia as a consequence
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
3 - adenosine reduces leukocyte recruitment and thus inflammation
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
3 - 8-12 weeks
What is a biological therapy?
- drugs that target the bodies immune system
- derived from bodies own genes to inhibit proteins (TNF-a, IL-6 etc..)
What is a monoclonal antibody (mab)?
- 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
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
2 - chimeric (part human and park animal) mAb
- remember ce biotic is from animals
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
3 - humanized mAb
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
4 - fully human mAb
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
3 - macrophages and T cells
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)
3 - >2 DMARDs (1 must be methotrexate)
- patients must also have a high RA disease score based on DAS 28
Which biological DMARDs that is a core drug is ant-TNF-a?
1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - abatacept
1 - Adalimumab
- administered as a subcutaneous injection
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
3 - increased risk of infection
- TNF-a is part of the immune system so reducing it increases the risk of infection
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
3 - TB, heart failure, multiple sclerosis
- been shown to damage myocardium
- increases risk of infection so TB
When prescribing a biological DMARDs, what other drug should be avoided?
1 - NSAIDs
2 - convention DMARDs
3 - glucocorticoids
4 - other biological DMARDs
4 - other biological DMARDs
- would dampen the immune response too much
Which biological DMARDs that is a core drug is ant-B cell?
1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - abatacept
3 - Rituximab
- partially humanised CD20 drug
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
1 - binds to CD20 receptors causing opsonisation of B cell
- undergoes phagocytosis, complement system is activated and Antibody-dependent cell mediated cytotoxicity
Which biological DMARDs that is a core drug is ant-IL-6S?
1 - Adalimumab
2 - Tocilizumab
3 - Rituximab
4 - Abatacept
2 - Tocilizumab
- IL-6 relates to the protein
- S relates to soluble forms of the IL-6 receptor
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
3 - binds directly to soluble and cell based IL-6 receptor ensuring IL-6 cannot bind
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
2 - subcutaneously and intravenously
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
2 - combining a biological with DMARDs (commonly methotrexate)
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)?
- 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
