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pharm > Biological modifying drugs and DMARDS > Flashcards

Biological modifying drugs and DMARDS Flashcards

1
Q

What do modifying drugs/biological response do?

A

Alter the body’s response to diseases such as cancer, autoimmune, inflammatory and infectious diseases

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2
Q

Categories of modifying drugs

A

Hematopoietic drugs and immunomodulating drugs

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3
Q

Types of Immunomodulating drugs

A

Interferons(IFNs)
Monoclonal antibodies (MABs)
Interleukin (IL) receptor agonists and antagonists
others

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4
Q

Immunomodulating drugs

A

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

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5
Q

What are the fourth parts of cancer therapy

A

Surgery, chemotherapy, radiation and immunomodulating drugs

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6
Q

What diseases are immunomodulating drugs for

A

Autoimmune diseases, inflammatory diseases and infectious diseases

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7
Q

Subclasses of modifying drugs

A

Hematopoietic drugs, IFNs, MARBs, interleukin receptor agonists/antagonists, disease modifying antirheumatic and others

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8
Q

MOA of modifying drugs

A

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

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9
Q

What does the immune system do

A

Recognize and destroy foregin particles and cells in the blood or other blood or any other tissue

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10
Q

Humoral immunity mediated by?

A

Mediated by the b-cell functions (antibodies)

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11
Q

Cell mediated immunity mediated by?

A

Mediated by T-cell functions

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12
Q

What do tumour antigens do to tumor cells

A

They mark the tumor cells as abnormal cells so the antibodies can attack them

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13
Q

How do the antibodies attack the tumor cells?

A

the B(B cells) lymphocytes from the humoral immune system and the T (T cells) lymphocytes from the cell mediated immune system

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14
Q

Where do B lymphocytes originate

A

the bone marrow

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15
Q

What do B cells do?

A
  • 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
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16
Q

Monoclonal antibodies (MABs)

A

Are immunoglobulins derived from a dingle cell

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17
Q

Five major types of naturally occuring immunoglobulins (types of antibodies)

A

A,D,E,G and M

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18
Q

Where do T lymphocytes originate

A

Also originate from bone marrow but mature in the thymus gland

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19
Q

Three types of T Cells

A

Cytotoxic T Cells
T-Helper cells
T-suppressor cells

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20
Q

What does a cytotoxic T cells do?

A

Kill their targets by causing cell lysis or rupture

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21
Q

What does T helpers do?

A

Direct the actions of many other components of the immune system to the antigens

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22
Q

What do T suppressors do?

A

Limit or control the immune response

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23
Q

What does an overactive T suppressor cells mean for cancer cases

A

may be the cause of cancer cases as it permits tumour growth beyond immune system control

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24
Q

Therapeutic effects of biological response-modifying frugs

A

Enhance hematopoietic function, enhance/regulate the immune response including cytotoxic or cytostatic activity against cancer cells, inhibits metastases, division and cell maturation

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25
Q

What do hematopoietic drugs do

A

Promote synthesis of blood components in the bone marrow such as erythrocytes and red blood cells.
Created by DNA technology

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26
Q

What are Hematopoietic drugs used for

A
  • 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
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27
Q

Erythropoietic drugs description and drugs

A

Stimulate the production of red blood cells
Darbepoetin alfa

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28
Q

Colony stimulating factors Description and drug

A

Stimulates the bone marrow to produce WBC, RBC and Platelets.
Filgrastim

29
Q

Filgrastim and when to administer it

A

Stimulates precursor cells for WBC (granulocytes) and is administer before patient develops an infections

30
Q

Route of Filgrastim

A

Given as SQ injections 7-14 days

30
Q

Indications of Filgrastim

A
  • 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
31
Q

What is Nadir

A

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

32
Q

Indications for Hematopoietic

A
  • 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
32
Q

Pegfilgrastim

A

Same as filgrastim but long acting and reduces the amount of injections

33
Q

Hematopoietic adverse effects

A

Mild
more common: fever, muscle aches, bone pain and flushing

34
Q

Interferons 3 basic properties

A

Antiviral, antitumor and immunomodulating

35
Q

three different groups of interferons

A

Alfa, beta and Gamma interferons(IFN) and each with its own antigenic and biological activates

36
Q

Interferons MOA

A
  • 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
37
Q

Interferons effects on the immune system

A
  • 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
38
Q

Indications

A
  • Viral infections (alfa interferons are anti viral)
  • Cancer (Alfa interferons are also anti tumor)
  • Autoimmune disorders (beta interferons are immunomodulating/ suppressive)
39
Q

Adverse effects of interferons

A

Flulike effects: fever, chills, headaches, myalgia
Dose limiting adverse effect is fatigue
Other effects include: anorexia, dizziness, nausea, vomiting, diarrhea

40
Q

IFN alfa products are…

A

produced from human leukocytes including
- IFN alfa 2B (wide use)
- Peginterferon alfa 2a (chronic hepatitis C)

41
Q

Interferons B products are for… (who not to give it to)

A

Relapsing remitting MS. Do not give to those with allergy to human albumin

42
Q

Monoclonal Antibodies indications

A

For treatment of cancer, rheumatoid arthritis, MS and organ transplant

43
Q

Monoclonal antibodies MOA for cancer

A

Target an abnormal gene in the cancer cells and destroy it having minimal effect on healthy cells

44
Q

Monoclonal antibodies Contraindications

A

Active TB and other infections because they have immunosuppressant qualities (as they may breakdown immunity cells) and drug allergies

45
Q

What is TNF

A

(Tumor necrosis factor) is a cytokine(proteins) that stimulates an immune response by activating macrophages or cell

46
Q

TNF inhibitors

A

are drugs that inhibit inflammation and help treat diseases like rheumatoid arthritis and juveniles arteritis. Monoclonals have Anti TNF properties.

47
Q

Monoclonal antibody drugs and what they are used to treat

A

Adalimumab RA(Rheumatoid arthritis)
Infliximab RA and crohn’s
Rituximab NHL (non hodgkin’s lymphoma)
Natiluzumab (MS)

48
Q

Rituximab

A

Associated with allergic response and should be predicated with diphenhydramine and acetaminophen to avoid the effects

49
Q

Interleukins

A

Are classified lymphokines and have an action of antitumour

50
Q

Interleukin(IL) receptor agonists

A

aldesleukin

51
Q

Antitumor action of interleukins

A

IL-2 is produced by activating T cells in response to macrophages processing antigens and secreted IL1

52
Q

IL-2 derivative aldesleukin

A

Stimulates or restores the immune system

53
Q

Aldesleukin MOA

A

Binds to receptor sites on the T cells which stimulate the T cells to multiply

54
Q

Lymphokine-activated killer cells

A

: recognize and destroy only cancer cells and ignore normal cells

55
Q

Capillary leak syndorme

A

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)

56
Q

How to reverse capillary leak syndrome

A

After interleukin therapy is discontinued it can be reverse

57
Q

Aldesleukin indication and contraindicated and route

A
  • For treatment of metastatic renal cell carcinoma and metastatic melanoma
  • contraindicated in those with organ transplant
  • for injection
58
Q

Rheumatoid Arthritis

A

An autoimmune disorder causing inflammation ad tissue damage joints

59
Q

Rheumatoid arthritis treatment

A

NSAID and disease-modifying antirheumatic drugs (DMARDs)

60
Q

Osteoarthritis

A

Age related degeneration of joint tissues causing pain and reduced function

61
Q

Antirheumatic drugs

A
  • 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
62
Q

Nonbiological Antirheumatic drugs ex

A

Methotrexate
Leflunomide

63
Q

Methotrexate

A
  • 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
64
Q

Biologicals disease modifying antirheumatic drugs ex.

A

adalimumab, abatacept, etanercept, infliximab

65
Q

Etanercept

A
  • 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
66
Q

abatacept

A
  • 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
67
Q
A

pharm (21 decks)

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