Biological Response-Modifiers and Antirheumatic Drugs Flashcards
What are biological response modifying drugs (BRMs)
They alter the body’s response to diseases such as cancer and autoimmune, inflammatory, infectious disease
What are the 2 classes of BRMs
Hematopoietic drugs
Immunomodulating drugs (IMDs)
What are the 4 subclasses of IMDs
Interferons (IFNs)
Monoclonal antibodies (MABs)
Interleukin(IL) receptor agonists and antagonists
Miscellaneous drugs
What are immunomodulating drugs
They alter a patients immune response to malignant tumour cells
What part of cancer therapy are IMDs
Fourth part
What other diseases are IMDs used for
Autoimmune
Inflammatory
Infectious
What is the MOA of BRMs
Enhancement of hematopoietic functions
Enhancement or regulation of the host’s immune system defenses against the tumor
Inhibition of metastases, prevention of cell division, or inhibition of cell maturation
What are the two components of the immune system and briefly describe them
Humoral immunity (B-cell functions)
Cell-mediated immunity (T-cell functions)
Where do B cells originate from
Bone marrow
What do B cells do?
They create the antibodies
What are Monoclonal antibodies
Identical cells derived from a single cell
What are the five major types of naturally occurring immunoglobulins
A, D, E, G, and M
Where do T cells originate and mature
Originate from bone marrow but mature in thymus
What are the 3 types of T cells
Cytotoxic T cells
T-helper cells
T-suppressor cells
What is the ratio of T-helper cells to T-suppressor cells in a healthy immune system
T-helper cells are twice as many as T-suppressor cells
Name 2 hematopoietic drugs and what type they are
Darbepoetin alfa is an erythropoietic drugs
Filgrastim is a colony-stimulating factor
What is the MOA of hematopoietic drugs
Decreases the duration of chemotherapy-induced anemia, neutropenia, thrombocytopenia
Enable higher doses of chemo to be given
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 and virus or fungus infected cells
What does filgrastim do?
Stimulates precursor cells for granulocytes
When is filgrastim administered?
Before the patient develops an infection
Which form is filgrastim administered?
SQ injections for 7-14 days
T/F: Do not start filgrastim until 18 hrs after chemo is completed
False: Do not start until 24 hours after chemo is completed
How is filgastrim stored and what should you do before use?
Refrigerated
Take out minimum 30 minutes before use
When should you discontinue
When the absolute neutrophil count (ANC) reaches 1 x 10^9/ L
What is Nadir
When blood counts are at their lowest
How long does Nadir last
As long as 28 days
What are the indications for hematopoietic drugs
Patients who have experienced destruction of bone marrow cells as a result of cytotoxic chemo
Decreasing the duration of low neutrophil counts, thus reducing the incidence and duration of infections
What are the adverse effects of hematopoietic drugs
Fever
Muscle aches
Bone pain
Flushing
What are interferons
Proteins with 3 basic properties
Antiviral
Antitumor
IMD
What are the 3 groups of interferon drugs
Alfa
Beta
Gamma
What is the MOA of interferons
Enable cells to produce enzymes that protect human cells from viral attacks
Prevent cancer cells from dividing and replicating
Increase the activity of other immune system cells (NK, macrophages, etc.)
What effects do interferons have on the immune system
Restore immune systems function if it’s impaired
Augment the immune systems ability to function as the body’s defense
Inhibit the IS from working (autoimmune disorders)
What are the indications of interferons
Viral infections
Cancer
Autoimmune disorders
What are the adverse effects of interferons
Flulike symptoms
Anorexia
Dizziness
Vomiting
Diarrhea
What is a dose limiting adverse effect of interferons
Fatigue
Name 4 interferon drugs and their indications
IFN alfa-2b (Hep B and C, cancer, etc)
PegIFN alfa-2a (chronic Hep C)
IFN beta-1a (MS)
IFN beta -1b (MS)
What are the indications for Monoclonal antibodies
Treatment of cancer, rheumatoid arthritis, MS and organ transplantation
What is the MOA of MABs
Target cancer cells and have minimal effect on healthy cells
What are the contraindications of MABs
Active TB and other infections because of its immunosuppressive qualities
MABs are anti TNF properties. What is TNF
Tumor Necrosis Factor is a cytokine involved in systemic inflammation
It is produced mainly by activated macrophages
What are TNF inhibitors
Drugs that help stop inflammation
What are they also known as?
TNF blockers or anti-TNF drugs
Name 4 MAB drugs
Adalimumab
Infliximab
Rituximab
Natiluzumab
Name an Interleukin(IL) drug
Aldesleukin
What is the MOA of interleukins (IL)
It binds to receptors in the T cells, which stimulates the T cells to multiply.
Lymphokine-activated killer (LAK) cells
LAK cells recognize and destroy only cancer cells
What is capillary leak syndrome?
Capillaries lose ability to retain vital colloids.
Capillaries become leaky and substances migrate into surrounding tissues
What are adverse effects of IL
Fluid retention as a result of capillary leak syndrome
Respiratory distress
HF
MI
Dysrhythmias
Is capillary leak syndrome reversible?
Yes, after IL therapy is discontinued
What are the contraindications of aldesleukin
Organ transplants
What does aldesleukin treat?
Metastatic renal cell carcinoma and metastatic melanoma
What is the difference between osteoarthritis and RA
RA is autoimmune related
Osteoarthritis is not an auto-immune related condition
Disease-modifying antirheumatic drugs (DMARDs)
Inhibit the movement of various cells into an inflamed, damaged area, such as a joint
Name 2 nonbiological disease-modifying antirheumatic drugs
Methotrexate
Leflunomide
What is the first line therapy for RA
Methotrexate
What are the doses for methotrexate and what is the onset of action?
7.5mg to 20 mg per week
It is always per week
3-6 weeks
What is taken concurrently with methotrexate to lessen adverse effects
Folic acid supplement
Biological Disease-modifying antirheumatic drugs
Adalimumab
Etanercept
Infliximab
Abatacept
What is etanercept
Used to treat RA and moderate to severe chronic plaque psoriasis
Onset is 1 to 2 weeks
Contraindicated in presence of active infections
What is abatacept
Used to treat RA
Caution if the patient has a history of recurrent infections or COPD
May decrease response to dead or live vaccines
Patients must be up to date on immunizations before starting therapy
Watching for febrile neutropenia; it needs ________________________
urgent treatment and monitoring
