Biological modifying drugs and DMARDS Flashcards
What do modifying drugs/biological response do?
Alter the body’s response to diseases such as cancer, autoimmune, inflammatory and infectious diseases
Categories of modifying drugs
Hematopoietic drugs and immunomodulating drugs
Types of Immunomodulating drugs
Interferons(IFNs)
Monoclonal antibodies (MABs)
Interleukin (IL) receptor agonists and antagonists
others
Immunomodulating drugs
therapeutically alter a patients immune response to malignant tumour cells by modifying the bodies own immune response so that it can destroy various viruses and cancerous cells
What are the fourth parts of cancer therapy
Surgery, chemotherapy, radiation and immunomodulating drugs
What diseases are immunomodulating drugs for
Autoimmune diseases, inflammatory diseases and infectious diseases
Subclasses of modifying drugs
Hematopoietic drugs, IFNs, MARBs, interleukin receptor agonists/antagonists, disease modifying antirheumatic and others
MOA of modifying drugs
Enhancement of hematopoietic(function of bone marrow) function
Enhancement of regulation of the host’s immune system defences against the tumor
Inhibition of metastases prevention of cell division or inhibition of cell maturation
What does the immune system do
Recognize and destroy foregin particles and cells in the blood or other blood or any other tissue
Humoral immunity mediated by?
Mediated by the b-cell functions (antibodies)
Cell mediated immunity mediated by?
Mediated by T-cell functions
What do tumour antigens do to tumor cells
They mark the tumor cells as abnormal cells so the antibodies can attack them
How do the antibodies attack the tumor cells?
the B(B cells) lymphocytes from the humoral immune system and the T (T cells) lymphocytes from the cell mediated immune system
Where do B lymphocytes originate
the bone marrow
What do B cells do?
- The b cells turn into plasma cells which then produce antibodies that will kill the antigen (antibody-antigen complex)
- Develops into when encounter a new antigen memory cells
Monoclonal antibodies (MABs)
Are immunoglobulins derived from a dingle cell
Five major types of naturally occuring immunoglobulins (types of antibodies)
A,D,E,G and M
Where do T lymphocytes originate
Also originate from bone marrow but mature in the thymus gland
Three types of T Cells
Cytotoxic T Cells
T-Helper cells
T-suppressor cells
What does a cytotoxic T cells do?
Kill their targets by causing cell lysis or rupture
What does T helpers do?
Direct the actions of many other components of the immune system to the antigens
What do T suppressors do?
Limit or control the immune response
What does an overactive T suppressor cells mean for cancer cases
may be the cause of cancer cases as it permits tumour growth beyond immune system control
Therapeutic effects of biological response-modifying frugs
Enhance hematopoietic function, enhance/regulate the immune response including cytotoxic or cytostatic activity against cancer cells, inhibits metastases, division and cell maturation
What do hematopoietic drugs do
Promote synthesis of blood components in the bone marrow such as erythrocytes and red blood cells.
Created by DNA technology
What are Hematopoietic drugs used for
- To decrease the duration of chemotherapy induced anemia, neutropenia and thrombocytopenia
- Enable higher doses of chemo because chem would kill all blood cells and this allows for the rejuvenation of the good cells
- Decrease bone marrow recovery time after bone marrow transplantation or irradiation
- Stimulate other cells in the immune system to destroy or inhibit the growth of cancer cells as well as virus or fungal infected cells
Erythropoietic drugs description and drugs
Stimulate the production of red blood cells
Darbepoetin alfa
Colony stimulating factors Description and drug
Stimulates the bone marrow to produce WBC, RBC and Platelets.
Filgrastim
Filgrastim and when to administer it
Stimulates precursor cells for WBC (granulocytes) and is administer before patient develops an infections
Route of Filgrastim
Given as SQ injections 7-14 days
Indications of Filgrastim
- Do not start until 24hrs after chemo is finished
- Keep refrigerated, take out minimum 30 min to warm up before use
- Discontinue after ANC (Absolute neutrophil count) has reached 1x10^9/L
What is Nadir
Is when the blood count (mainly ANC and platelet counts) are at its lowest. Can be 7-10 days post chemo and last as long as 28 days
Indications for Hematopoietic
- For pt who experienced destruction of bone marrow due to cytotoxic chemo
- Decrease how long one has low neutrophil counts, reducing the incidence of infection
- Enhances the functioning of the mature cells in the immune system increasing the ability to kill antigens (cancer cells)
- Enhances RBC and platelet count in pt with bone marrow suppression
- Allows for higher doses of chemotherapy
Pegfilgrastim
Same as filgrastim but long acting and reduces the amount of injections
Hematopoietic adverse effects
Mild
more common: fever, muscle aches, bone pain and flushing
Interferons 3 basic properties
Antiviral, antitumor and immunomodulating
three different groups of interferons
Alfa, beta and Gamma interferons(IFN) and each with its own antigenic and biological activates
Interferons MOA
- Are manufactured to be identical to the IFN cytokines that are naturally present in the body.
- They protect human cells from virus attack, prevent cancer cells from dividing and replicating and increase the activity of other immune system cells
Interferons effects on the immune system
- Restore the immune system’s function if impaired
- Improve the immune system’s ability to defend the body
- Inhibit the immune system from working for autoimmune diseases
Indications
- Viral infections (alfa interferons are anti viral)
- Cancer (Alfa interferons are also anti tumor)
- Autoimmune disorders (beta interferons are immunomodulating/ suppressive)
Adverse effects of interferons
Flulike effects: fever, chills, headaches, myalgia
Dose limiting adverse effect is fatigue
Other effects include: anorexia, dizziness, nausea, vomiting, diarrhea
IFN alfa products are…
produced from human leukocytes including
- IFN alfa 2B (wide use)
- Peginterferon alfa 2a (chronic hepatitis C)
Interferons B products are for… (who not to give it to)
Relapsing remitting MS. Do not give to those with allergy to human albumin
Monoclonal Antibodies indications
For treatment of cancer, rheumatoid arthritis, MS and organ transplant
Monoclonal antibodies MOA for cancer
Target an abnormal gene in the cancer cells and destroy it having minimal effect on healthy cells
Monoclonal antibodies Contraindications
Active TB and other infections because they have immunosuppressant qualities (as they may breakdown immunity cells) and drug allergies
What is TNF
(Tumor necrosis factor) is a cytokine(proteins) that stimulates an immune response by activating macrophages or cell
TNF inhibitors
are drugs that inhibit inflammation and help treat diseases like rheumatoid arthritis and juveniles arteritis. Monoclonals have Anti TNF properties.
Monoclonal antibody drugs and what they are used to treat
Adalimumab RA(Rheumatoid arthritis)
Infliximab RA and crohn’s
Rituximab NHL (non hodgkin’s lymphoma)
Natiluzumab (MS)
Rituximab
Associated with allergic response and should be predicated with diphenhydramine and acetaminophen to avoid the effects
Interleukins
Are classified lymphokines and have an action of antitumour
Interleukin(IL) receptor agonists
aldesleukin
Antitumor action of interleukins
IL-2 is produced by activating T cells in response to macrophages processing antigens and secreted IL1
IL-2 derivative aldesleukin
Stimulates or restores the immune system
Aldesleukin MOA
Binds to receptor sites on the T cells which stimulate the T cells to multiply
Lymphokine-activated killer cells
: recognize and destroy only cancer cells and ignore normal cells
Capillary leak syndorme
Is a result of toxicity of aldesleukin therapy. Capillaries lose the ability to retain molecules in the blood and these substances then leak into surrounding tissue leading to massive fluid retention. (respiratory distress, HF, MI, and dysrhythmias)
How to reverse capillary leak syndrome
After interleukin therapy is discontinued it can be reverse
Aldesleukin indication and contraindicated and route
- For treatment of metastatic renal cell carcinoma and metastatic melanoma
- contraindicated in those with organ transplant
- for injection
Rheumatoid Arthritis
An autoimmune disorder causing inflammation ad tissue damage joints
Rheumatoid arthritis treatment
NSAID and disease-modifying antirheumatic drugs (DMARDs)
Osteoarthritis
Age related degeneration of joint tissues causing pain and reduced function
Antirheumatic drugs
- Produces anti-inflammatory, antiarthritic and immunomodulating effects
- inhibits the movement of various cells into the inflamed and damaged area to prevent inflammation
- Slow inset compared to NSAIDs
Nonbiological Antirheumatic drugs ex
Methotrexate
Leflunomide
Methotrexate
- DMARDs
- First line of therapy and given per weekly
- Bone marrow suppression is most common adverse effect as well as stomatitis. To prevent this folic acid supplement are needed.
- lower doses compared to when used for cancer
- Onset 3-6 weeks, half life 3-10 hrs
Biologicals disease modifying antirheumatic drugs ex.
adalimumab, abatacept, etanercept, infliximab
Etanercept
- Use to treat RA and plaque psoriasis but patients must be screened latex allergy as it may contain latex
- Onset 1-2 wks
- Contraindication: active infection as it may worsen or reactivate it
abatacept
- Used to treat RA
- Cation if history of recurrent infections or COPD
- Patient must be up to date on immunization before therapy
- May increase infection if live vaccines and may decrease response to vaccines
