Biologics, Mabs, & Gout Flashcards
10 questions
older, small molecule drugs
DMARDS
larger molecular weight drugs of biologic origin with recombinant DNA technology
biologics
what are the 4 DMARDS?
methotrexate
leflunomide
hydroxychloroquine
gold salts
what must be monitored regularly if a patient is using methotrexate?
liver and kidney
in which patients is methotrexate CI in?
pregnant patients
what are the uses of methotrexate? (2)
when NSAIDs are ineffective
chemotherapy
what are the 6 ADR of methotrexate?
fibrosis/cirrhosis
stomatitis
hepatic dysfunction
immunosuppression
neutropenia
teratogenic
how does methotrexate treat RA? (2)
inhibits T and B cells
reduces ICAM
an alternative drug to methotrexate in patients who cannot tolerate methotrexate and is also teratogenic
leflunomide
an immunosuppressive that inhibits terminal glycosylation of ACE2 (receptor that COVID targets for cell entry)
hydroxychloroquine
DMARD that is an immunosuppressive that has an ADR of severe immunosuppression
gold salts
drugs that bind tumor necrosis factor (TNF)-alpha (who is produced by synovial macrophages and lymphocytes to mediate tissue damage in cartilage and bones)
biologic DMARDS
ADR of biologic DMARDS? (2)
increase risk of infection
reactivate latent TB
what are the 5 uses of biologic DMARDS?
RA
psoriasis
psoriatic arthritis
ankylosing spondylitis
crohn’s disease
which biologic DMARDS is a fusion protein between the TNF receptor and IgG?
“etanercept between TNF and IgG”
etanercept
administration of etanercept?
SQ biweekly
monoclonal antibody that is given IV at 1, 2, 6 weeks and then every 8 weeks
indliximab
administration of adalimumab?
SQ q 2 weeks
administration of certolizimab?
SQ q 2 weeks
administration of golimumab?
SQ monthly
monoclonal antibody that blocks the IL-6 receptor
tocilizumab
ADR of tocilizumab? administration?
increased risk of infection
IV infusion 1/month
T-cell costimulatory inhibitor that prevents T cell activation by the antigen-presenting cells = leading to less autoinflammation
abatacept
used for “auto” inflammation
ADR of abatacept? administration?
increased risk of infection
IV infusion 1/month
T cell receptor inhibitor that binds CD25
basiliximab
T cell receptor inhibitor that binds CD3
moromonab
an antibody that is engineered to recognize a specific tumor cell and can initiate other immune processes that target the cell for death
naked antibody
cargo is added to the antibody to disrupt gene expression but will not distinguish between rapidly dividing tumor cells or rapidly dividing neural cells
conjugated antibodies
takes T cells from donor, engineer them invitro against tumor cell and the place them back so they can specifically target the tumor
antibody fusion to modified T cell
half of the antibody that is specific to T cell is put with other half that is specific for tumor cell, pull the specific agent toward the T cell to target the specific tumor cell
bridging antibody to recruit cytotoxic T cells
IL-1 receptor antagonist, (IL-1 is a proinflammatory cytokine that potentiates inflammation and tissue damage)
anakinra
administration of anakinra?
SQ
JAK inhibitor that blocks excessive cytokine signaling in autoimmune/inflammatory diseases
tofacitinib
ADR of tofacitinib? (2) administration?
neutropenia
increased cholesterol
oral
B cell depletor that binds to antigen found on B cell precursors and mature B cells = blocks B cell differentiation and division, and leads to B cell apoptosis
rituximab
what are the 2 uses for rituximab?
RA
non-hodgkins lymphoma
2 ADR of rituximab?
increased risk of infection
reactivation of viral infections
how does gout cause arthritis?
urate crystal collection in joints
what is gout therapy aimed at? (3)
suppressing leukocyte activation
increase renal excretion of urate
decrease urate production
drug that binds tubulin to prevent polymerization, leading to inhibition of leukocyte migration in gout
colchicine
what are the 2 uses for colchicine?
acute attacks
prophylaxis of recurrent episodes when uricosuric drug + allopurinol is not effective
4 ADR of colchicine?
“a DAAN would have gout”
Diarrhea
Abdominal pain
Alopecia
Neutropenia
what can be used instead, to avoid diarrhea in colchicine use?
indomethacin
prevent phagocytosis of crystals and transcription of inflammatory genes; initial therapy for gout
NSAIDs
increases renal excretion of urate since 75% of urate is reabsorbed in gout; reduces whole body urate levels
uricosuric drugs (probenicid)
use for probenicid?
after several acute attacks + plasma urate elevation
ADR of probenicid?
increase renal urate crystals
what is probenicid usually combined with to make urine alkaline?
acetazolamide
inhibits xanthine oxidase (enzyme that forms urate)
allopurinol
4 uses for allopurinol?
chronic gout
elevated plasma urate
recurrent urate stones
leukemia/lymphoma
what gout drug should be used in a patient with poor renal function?
allopurinol
why should we use a combo treatment when using allopurinol for gout?
can cause acute attacks on its own
more effective in decreasing plasma urate than allopurinol, so is used in the long-term treatment to reduce gout flares
febuxostat
