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year 3 exam 1 > biologics clinical > Flashcards

biologics clinical Flashcards

1
Q

MOA of methotrexate

A

dihydrofolate reductase inhibitor, alters pyrimidine and purine biosynthesis

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2
Q

C/I with methotrexate

A
  • infection - severe renal impairment - hepatic impairment - bone marrow suppression - immunodeficiency - pregnancy/breastfeeding - older patients
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3
Q

use of methotrexate in clinic

A
  • low dose for immunosuppression - once a week - should only be prescribed in 2.5mg - alert card! - can be co prescribed with folic acid 5mg - Missed doses can be taken within 2 days with once weekly preparations
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4
Q

monitoring requirements for methotrexate

A
  • baseline: FBC, LFT, urea, electrolytes, renal function- monitoring: LFT, renal function, FBC 1-2 weeks until stable then every 2-3 months
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5
Q

cautions with methotrexate

A
  • surgery - renal impairment - diarrhoea - ascites - peptic ulcer - not had chicken pox
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6
Q

methotrexate side effects

A
  • bone marrow suppression - GI toxicity - liver toxicity - pulmonary toxicity - skin reactions
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7
Q

MOA of leflunomide

A

affects de novo pyrimidine biosynthesis - particularly in activated lymphocytes due to increased demand

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8
Q

C/I in leflunomide

A
  • hepatic impairment - severe immunodeficiency - severe infection - severe hyponatraemia - moderate renal impairment - pregnancy/breastfeeding
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9
Q

leflunomide use in clinic

A

100mg OD for 3 days then decrease to 10-20mg OD- Loading dose can cause side effects - Effect starts 4-6 weeks after taking and an improve 4-6 months after starting - Long half-life - 1-4 weeks - Monitoring after discontinuation is required

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10
Q

wash out procedure for leflunomide

A

□ Stop treatment □ Give cholestyramine 8mg TDS or activated charcoal 50g QDS Treat for 11 days

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11
Q

monitoring requirements for leflunomide

A

□ LFTs, FBCs, BP Every 2 weeks for the first 6 months and then every 8 weeks

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12
Q

cautions with leflunomide

A
  • Administration with hemotoxic or hepatotoxic drugs - History of TB - Bone marrow suppression - leucopenia, anaemia, thrombocytopaenia
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13
Q

side effects of leflunomide

A
  • hepatic impairment - bone marrow suppression - leucopenia - anaemia - thrombocytopaenia - hypertension - GI irritation - alopecia - skin reactions - dizziness
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14
Q

MOA of ciclosporin

A

calcineurin inhibitor

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15
Q

C/I for ciclosporin

A

abnormal renal function malignancy uncontrolled hypertension uncontrolled infection

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16
Q

cautions with ciclosporin

A
  • Elderly (reduced renal and hepatic) - Gout - Hepatic impairment (main mechanism of metabolism)
17
Q

use of leflunomide in clinic

A
  • IBD, transplants, psoriasis, atopic dermatitis and RA - Oral solution should be mixed with orange/apple juice immediately before administration- BD - branded
18
Q

monitoring requirements for ciclosporin

A

○ Renal function ○ Hepatic function ○ BP ○ Lipids ○ Electrolytes - potassium/magnesium Uric acid

19
Q

side effects of leflunomide

A
  • fatigue, convulsions, muscle cramps, hyperlipidaemia/glycaemia/tension/kalaemia, hypomagnesaemia
20
Q

toxic side effects of leflunomide

A

headache, tremor, hypertension, Hirsutism, ○ Renal impairment

21
Q

anti-tnf therapy example

A

infliximab

22
Q

IL6 receptor inhibitor example

A

tocilizumab

23
Q

anti b cell example

A

rituximab

24
Q

anti t cell example

A

abatacept

25
Q

jak inhibitor example

A

tofacitinib

26
Q

C/I with anti-tnf therapy

A
  • hypersensitivity - severe infection/TB- mod - sev heart failure
27
Q

C/I with jak inhibitors

A
  • surgery/immobilisation - MI- HF- malignancy - age - obesity
28
Q

monitoring for biologics

A

before - FBC, eGFR, Cr, LFT, hep B during - every 6 months - FBC, LFT, renal

29
Q

use of anti-tnf in clinic

A
  • RA, crohns, psoriasis - IV over 2 hours plus 1 hr monitoring - antihistamine pre treatment (or SC)- once a week - blood disorder/TB symptoms report
30
Q

cautions with anti-tnf

A
  • infection - demyelinating disease - malignancy - mild HF - elderly
31
Q

jak inhibitors side effects

A
  • increased infection risk - hypersensitivity reactions - URTI - headache - pain
32
Q

serious side effects of jak inhibitors

A
  • new or worsening heart failure- delayed hypersensitivity- haematological reactions- demyelinating disorders- hepatobiliary events- malignancies- serious infusion reactions

year 3 exam 1 (44 decks)

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