biologics

Question 1

hydrocortisone glucocorticoid/mineralocorticoid activity

duration

Answer 1

high glucocorticoid, some mineralocorticoid

short-acting

Question 2

dexamethasone glucocorticoid/mineralocorticoid activity

duration

Answer 2

some gluco, no mineralo

long acting

Question 3

fludrocortisone glucocorticoid/mineralocorticoid activity

duration

Answer 3

no gluco, very high mineralo

long-acting

Question 4

prednisone/methylprednisolone gluco/mineral

duration

Answer 4

moderate, moderate

intermediate-acting

Question 5

glucocorticoid AEs

Answer 5

poorly tolerated

hyperglycemia
leukocytosis
HPA axis insufficiency
neuropsych effects
osteopenia
myopathy
fluid retention
gastritis

Question 6

conventional synthetic DMARD examples & uses

Answer 6

methotrexate, leflunomide, sulfasalazine, hydroxychloroquine

RA

Question 7

methotrexate uses

Answer 7

RA - first line, once weekly

IBD

Question 8

conventional synthetic DMARDS AE

Answer 8

ALL - folic acid deficiency, bone marrow suppression, infection, hepatitis, teratogenic

methotrexate - stomatitis **folic acid supplementation reduces toxicity

lefluonomide - alopecia ** loooong half life

sulfasalazine - rash, SJS **avoid in pt w sulfa allergy

Question 9

hydroxychloroquine use

Answer 9

used in RA for pt that are pregnant

Question 10

hydroxychloroquine AE

Answer 10

ocular toxicitieies, increased skin pigmentation, QT PROLONGATION

Question 11

JAK inhibitor AEs

Answer 11

infection, malignancy, THROMBOSIS, HLD

Question 12

jak inhibitors examples

Answer 12

tofacitinib
baracitinib
upadacitinib

Question 13

biologic meds characteristics

Answer 13

produced by living cell cultures
large, complex, heavy molecules
complex structures
potentially immunogenic
unstable and sensitive to external conditions

Question 14

-mab medications

Answer 14

monoclonal antibodies

Question 15

-cept medications

Answer 15

soluble receptor antagonist

etanercept

Question 16

biologics rule of thumb

Answer 16

update immunizations and screen before tx
avoid live vaccines
injectables (not oral!)
do not combine biologics

injection site rxn
IV infusion rxn
antidrug antibody formation

Question 17

TNF-a inhibitors

Answer 17

etanercept
infliximab
adalimumab
golimumab
certolizumab pegol

Question 18

infliximab admin

Answer 18

give w methotrexate in RA

give w azathioprine or 6-mercantopurine in IBD

Question 19

golimumab admin

Answer 19

give w methotrexate in RA

Question 20

certolizumab pegol admin

Answer 20

give w polyethylene glycol to prolong half life and reduce immunogenicity

Question 21

TNF-a inhibitor AEs

Answer 21

HEART FAILURE!!!

malignancy, infection, anti-drug antibody formation (immunogenicity)

Question 22

CD20 monoclonal antibodies AEs

Answer 22

infusion/injection site rxn - premedicate w antihistamine/APAP/glucocorticoid

malignancy
infection (leukoencephalopathy)

Question 23

fumaric acids indications

Answer 23

MS

Question 24

fumaric acids AE

Answer 24

gi upset/flushing

infections, pymphopenia

Question 25

S1PR modulators use

Answer 25

MS

Question 26

S1PR AEs

Answer 26

``` QT prolongation bradyarrhythmia HTN macular edema infection ``` CI in pt w hx of severe cardiac problem in past 6 mos

Question 27

S1PR modulators examples

Answer 27

fingolimod - higher incidence of QTprolong/brady - admin in clinc siponimod ozanimod

Question 28

induction immunosuppressants

Answer 28

glucocorticoids basiliximab antithymocyte immune globulin alemtuzumab

Question 29

maintenance immunosuppression

Answer 29

calcineurin inhibitor, antiproliferative, glucocorticoid tacro > cyclosporine mycophenolate > azathioprine prednisone

Question 30

cyclosporine/tacro AEs

Answer 30

nephrotox, tremor, HTN, HLD, hyperglc, gingival hyperplasia, hirsutism tacro - hyperuricemia titrated, many interax

Question 31

mycophenolate/azathioprine AE

Answer 31

bone marrow suppression myco - diarrhea azathioprine - hepatotox - varied metabolism TMPT

Question 32

RA mgmt

Answer 32

methotrexate contraindication to methotrexate - leflunomide, sulfasalazine short term glucocorticoids when initiating/changing csDMARDs try another DMAD, then use bDMARD or tsDMARD

Question 33

types of MS

Answer 33

relapse-remitting - clearly defined relapses w full recovery or residual deficit upon recovery secondary progressive - RRMS w steady deterioration of function primary progressive - occasional plateaus w steady decline

Question 34

MS therapy efficacy

Answer 34

infusion therapy oral therapy injection therapy

Question 35

relapse remitting tx

Answer 35

any meds poor prognosis - natalizumab, ocrelizumab, alemtuzumab

Question 36

secondary progressive MS tx

Answer 36

siponimod or any DMT

Question 37

PPMS tx

Answer 37

oreclizumab