Automimmune Diseases

Question 1

Name 4 conventional dmards

Answer 1

Disease modifying antirheumatic drugs
• sulphasalazine
• chloroquine (antimalarial)
• methotrexate (immunosuppressant)
• leflunomide

Question 2

Sulphalazine moa?

Answer 2

• Broken down in gut into 2 component molecules, 5-aminosalicylate (5-asa) and sulfapyridine.
. 5-asa free radical scavenger
• modulate B cell response and angiogenesis

Question 3

Name 3 adverse effects sulphasalazine

Answer 3

• Lupus flare-up
• rarely blood disorders
• rarely oligospermia

Question 4

Chloroquine moa in treatment rheumatoid arthritis?

Answer 4

• Decrease il-1 production by macrophages
• modulate cytokine secretion
• modulate lysosomal enzymes
Also decrease lymphoproliferative responses and t cell cytotoxic response.

Question 5

Methotrexate moa?

Answer 5

Competitive inhibitor dihydrofolate reductase (purine synthesis)
Induce adenosine release
Anti.inflamatory, cytotoxic and immunosuppressant from folic acid antagonism

Question 6

Name 3 adverse effects methotrexate

Answer 6

• Blood dyscrasias ( marrow suppression)
• liver toxicity, cirrhosis
• nausea (overcome by take at night,), diarrhoea, rashes, alopecia, mouth ulcers, stomatitis

Question 7

Name 4 TNF Alpha inhibitors

Answer 7

• Infliximab
• etenercept
• adalimumab
• golimumab

Question 8

Indication TNF alpha antagonists in rheumatoid arthritis ?

Answer 8

Highly active ra in those that have failed to respond to at least 2 standard dmard due to safety issues

Question 9

Rituxamab moa?

Answer 9

• Monoclonal antibody
• eliminate memory B cells making rf, decreasing immune complexes.
• eliminate B cell presenting antigen to T cells

Question 10

Rituximab indications? (4)

Answer 10

• Inflammatory ra moderate to severe, after dmards not adequate response.
• SLE
• juvenile dermatomyositis
• vasculitis

Question 11

Name 3 adverse effects rituximab

Answer 11

Monoclonal antibody.
• re-emergence Tb
• progressive multifocal leukoencephalopathy PML infections
• avoid with live vaccines -infection.

Question 12

Which drug must be avoided in scleroderma?

Answer 12

Corticosteroids

Question 13

Name 5 drugs used in lupus management and what each used for.

Answer 13

• NSAID :all manifestations
• antimalarrials: all except major organ
• azathioprine (immunosuppressant): all except constitutional
• cylclosphosphamide: major organ
• dapsone (sulphone antibiotic): cutaneous
• immunoglobulins: major organ
• Danazol (androgenic): major organ