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Drugs, Biologics, Dermatology, DCNP Exam Lahey dermatology NP Fellows > Biologics Psoriasis > Flashcards

Biologics Psoriasis Flashcards

1
Q

What are TNF Alpha Inhibitors?

A

A class of medications used to treat autoimmune diseases by blocking tumor necrosis factor alpha

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2
Q

Name TNF Alpha Inhibitors

A

Etanercept (enbrel)
Adalimumab (humira)
Cetrolizumab (cimzia) ok preg
Golimumab (simponi)
Infliximab (remicade)

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3
Q

What is the trade name for Adalimumab?

A

Humira

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4
Q

Which TNF Alpha Inhibitors are indicated for both Psoriasis (PsO) and Psoriatic Arthritis (PsA)?

A

Entanercept
Adalimumab
Cetrolizumab
Infliximab

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5
Q

What are common side effects (SEs) of TNF Alpha Inhibitors?

A

All: Infections, Injection Site Reactions (ISR)

Rash:Adalimumab and Cetrolizumab

HTN: golimumab

Infusion related reaction and abdominal pain: infliximab

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6
Q

Which TNF Alpha Inhibitor has the indication for PsO and is associated with the lowest risk in pregnancy and lactation?

A

Certolizumab pegol

Known by the trade name Cimzia

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7
Q

What serious adverse effects (AEs) are associated with TNF Alpha Inhibitors?

A

Serious infections, Fungal infections, Hepatitis B reactivation, New/worsening heart failure, Low blood count, Lupus-like syndrome, Lymphoma, other malignancies

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8
Q

What are the absolute contraindications for TNF Alpha Inhibitor therapy?

A

Hypersensitivity, Active infection, Chronic infection (including TB), Concurrent administration with anakinra

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9
Q

Fill in the blank: The trade name for Infliximab is _______.

A

Remicade

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10
Q

What are relative contraindications for TNF Alpha Inhibitor therapy?

A

Congestive heart failure, Family history of demyelinating disease (ie MS), History of malignancies or lymphoma

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11
Q

What common side effects are associated with Infliximab?

A

Infections, Headache, Infusion-related reactions, Abdominal pain

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12
Q

What type of therapy is Ustekinumab (Stelara)?

A

IL-12/23 inhibitor
Targeted Biologic Therapy

Approved for Psoriasis (PSO) and Psoriatic Arthritis (PsA) for patients ≥ 6 years.

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13
Q

What are common side effects of Ustekinumab ( stelara)?

A

Cold or flu-like symptoms, URI, HA, fatigue

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14
Q

What are the types of IL-17a inhibitors mentioned?

A
  • Secukinumab (Cosentyx)
  • Ixekizumab (Taltz)
  • Brodalumab (Siliq)

IL-17a inhibitors are used in the treatment of psoriasis and psoriatic arthritis. Except brodalimumab

Cosentyx and taltz >6

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15
Q

What are the names of IL-23 inhibitors listed?

A
  • Tildrakizumab (Ilumya)
  • Risankizumab (Skyrizi)
  • Guselkumab (Tremfya)

IL-23 inhibitors are utilized for treating psoriasis and PsA except tildrakizumab

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16
Q

What is the generic name for Xeljanz?

A

Tofacitinib

Tofacitinib is a Janus Kinase (JAK) inhibitor for Psoriatic Arthritis (PsA).

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17
Q

What are common side effects of Tofacitinib?

A

HA, nausea, URI, vomiting

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18
Q

What are the warnings/precautions for IL12/23?

A
  • Serious infections (especially mycobacteria, salmonella, BCG vaccinations)
  • Malignancies
  • Posterior leukoencephalopathy

Patients should be screened for infections including TB.

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19
Q

What are the absolute contraindications for IL-17a inhibitor?

A
  • Known hypersensitivity
  • Active infection
  • Chronic infection including TB
  • patients with inflammatory bowel disease.

Other- bridalumab-rems- depression si

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20
Q

True or False: Brodalumab has a risk of depression and requires a REMS program.

A

True

REMS stands for Risk Evaluation and Mitigation Strategy.

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21
Q

Fill in the blank: IL-17a inhibitors are used in the treatment of _______.

A

psoriasis and psoriatic arthritis

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22
Q

What serious risks are associated with JAKs?

A
  • Serious infections
  • Mortality
  • Malignancy
  • Major adverse cardiovascular events (MACE)
  • Thrombosis
    Elevated liver enzymes, whipped, anemia, lymphoma, and other malignancies. G.I. perforations and ulcerations.
    Close monitoring is advised for patients on these therapies.
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23
Q

What type of infection screening is required before starting treatment?

A

Screening for tuberculosis (TB)

This is crucial for patients receiving immunosuppressive therapies.

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24
Q

What is the risk associated with combining targeted therapies with TNF inhibitors?

A

Increased risk of serious infections

This combination therapy should be approached with caution.

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25
What is the mechanism of action of TNF alpha inhibitors?
Binds to TNF-alpha receptors, reducing circulating levels of TNF alpha, a key cytokine in psoriasis pathogenesis ## Footnote TNF alpha is involved in inflammatory processes and psoriasis development.
26
What is the dosing regimen for Etanercept?
50mg SC twice weekly x 3 months, then once weekly thereafter ## Footnote For patients 4 years or older and less than 63 kg, the dose is 0.8 mg/kg subQ once weekly.
27
What is the dosing regimen for Adalimumab?
80mg SC day 0, then 40mg day 7, then 40mg every 14 days thereafter ## Footnote This regimen is used for the treatment of psoriasis.
28
What is the dosing regimen for Infliximab?
5mg/kg IV week 0, 4, then Q 8 weeks thereafter ## Footnote Infliximab is administered intravenously.
29
What is the dosing regimen for Certolizumab?
400mg every other week ## Footnote For patients less than 90kg, the initial dosing can be 400mg at Week 0, 2, 4, then 200mg every other week.
30
What is notable about the use of Certolizumab in pregnancy?
Safest to use in pregnancy (doesn't cross the placenta) ## Footnote This characteristic makes Certolizumab a preferred option for pregnant patients requiring treatment.
31
What baseline tests should be conducted for TNF alpha considerations?
TB, hepatitis B and C, HIV, CBC, LFTS, Chem 7 ## Footnote CBC refers to complete blood count; LFTS refers to liver function tests; Chem 7 refers to a basic metabolic panel.
32
What are some risks associated with TNF alpha treatments?
New or worsening CHF, neurological disorders, infections, malignancies, reactivation of hepatitis B ## Footnote CHF stands for congestive heart failure.
33
What types of screenings should be done for patients receiving TNF alpha treatments?
Infections, skin cancer ## Footnote Regular screenings help in early detection and management of potential complications.
34
How often should TB testing be conducted for patients on TNF alpha therapies?
Annually ## Footnote Annual testing is crucial for preventing TB reactivation.
35
How frequently should labs be re-evaluated for patients on TNF alpha treatments in the first year?
Every 4 months ## Footnote After the first year, re-evaluation can occur every 6 months.
36
True or False: Patients on TNF alpha therapies should only be screened once for infections.
False ## Footnote Ongoing screening is necessary due to the risk of infections.
37
What is the mechanism of action of IL-17 inhibitors?
Binds to IL-17, a key cytokine in psoriasis pathogenesis ## Footnote IL-17 plays a crucial role in inflammatory processes related to psoriasis.
38
What is the initial dosing for Ixekizumab (taltz)?
160mg SC initially ## Footnote SC stands for subcutaneous.
39
What is the dosing schedule for Ixekizumab (taltz) through week 12?
80mg SC every 2 weeks ## Footnote This dosing is to maintain therapeutic levels in the body.
40
What is the dosing for Ixekizumab after week 12?
80mg every 4 weeks thereafter ## Footnote This adjustment helps in long-term management of psoriasis.
41
What are IL-17 inhibitors used for?
They are used in the treatment of various autoimmune conditions ## Footnote IL-17 inhibitors target the interleukin-17 pathway, which is involved in inflammation.
42
What baseline testing is recommended before starting IL-17 inhibitors?
TB, Hepatitis B and C, HIV, CBC, CMP ## Footnote Baseline testing is crucial to identify any underlying infections that may be exacerbated by treatment.
43
How often should patients be tested for TB while on IL-17 inhibitors?
Yearly ## Footnote Regular testing helps to monitor and manage potential latent TB infections.
44
In which patients should IL-17 inhibitors be used cautiously?
Patients with a history of IBD ## Footnote Inflammatory bowel disease (IBD) may be exacerbated by IL-17 inhibition.
45
What is a notable side effect of Ixekizumab?
More severe injection site reactions ## Footnote Patients may experience increased pain, swelling, or redness at the injection site.
46
What monitoring is required for Brodalumab?
REMS monitoring for suicidality ## Footnote The Risk Evaluation and Mitigation Strategy (REMS) program is in place due to potential psychiatric side effects.
47
How often should patients be re-evaluated after starting IL-17 inhibitors?
Every 4 months for 1 year, then every 6 months thereafter ## Footnote Regular evaluations help assess treatment efficacy and safety.
48
What do IL-12/23 inhibitors bind to?
IL-12 and IL-23 receptors
49
What is the mechanism of action of IL-12/23 inhibitors?
Reduces levels of IL-23, a key cytokine in psoriasis pathogenesis
50
What is the weight-based dosing for Ustekinumab (stelara) for patients less than 100 kg?
45 mg
51
What is the weight-based dosing for Ustekinumab (stelara) for patients greater than 100 kg?
90 mg
52
What is the Ustekinumab (stelara) dosing for patients aged 6 years or older and less than 60 kg?
0.75 mg/kg subQ at weeks 0 and 4, then every 12 weeks
53
What is the Ustekinumab dosing for patients aged 6 years or older and between 60 to 100 kg?
45 mg subQ at weeks 0 and 4, then every 12 weeks
54
What is the Ustekinumab dosing for patients aged 6 years or older and greater than 100 kg?
90 mg subQ at weeks 0 and 4, then every 12 weeks
55
True or False: IL-12/23 inhibitors increase levels of IL-23.
False
56
What is the only IL 12/23 inhibitor currently on the market?
Ustekinumab (stelara)
57
What are IL-12/23 inhibitors used for?
They are used for various immunological conditions. ## Footnote IL-12/23 inhibitors target specific cytokines involved in inflammatory responses.
58
What baseline testing is required before starting IL-12/23 inhibitors?
TB, Hepatitis B and C, HIV, CBC, CMP ## Footnote These tests help assess the patient's eligibility and safety for treatment.
59
How often should patients be tested for TB while on IL-12/23 inhibitors?
Yearly ## Footnote Regular TB testing is crucial due to the risk of reactivation.
60
What is a notable characteristic of the safety profile of IL-12/23 inhibitors?
Favorable safety profile ## Footnote This indicates a lower incidence of adverse effects compared to other treatments.
61
How frequently are IL-12/23 inhibitors administered?
4 times a year ## Footnote This dosing schedule enhances patient compliance and convenience.
62
How often should treatment be re-evaluated during the first year of IL-12/23 inhibitor therapy?
Every 4 months ## Footnote This allows for timely adjustments based on patient response.
63
After the first year, how often should IL-12/23 inhibitor therapy be re-evaluated?
Every 6 months ## Footnote This reflects a more stable assessment of the patient's condition.
64
What is the dosing regimen for Il-23 inhibitors?
Four times a year dosing. Favorable safety profile consider reevaluating every four months for one year and then every six months thereafter
65
What is required for all biologic agents at baseline?
TB testing ## Footnote Tuberculosis (TB) testing is essential to ensure patient safety before starting treatment with biologic agents.
66
How often is TB testing required after the initial baseline for most biologic agents?
Annually ## Footnote Regular annual testing helps to monitor and manage potential TB infections.
67
Which class of biologic agents requires testing for Hepatitis B at baseline?
TNF alpha inhibitors ## Footnote Testing for Hepatitis B is crucial to prevent reactivation during treatment.
68
What is the dosing schedule for IL 12/23 and IL 23 biologic agents?
Week 0, 4 then Q12W ## Footnote This dosing schedule helps maintain therapeutic levels of the medication.
69
What special requirement does Brodalumab (siliq) have?
Registration in REMS program ## Footnote The Risk Evaluation and Mitigation Strategy (REMS) program is designed to ensure safe use of the medication.
70
Which biologic agent is considered favorable in pregnancy?
Certolizumab (cimzia) ## Footnote Certolizumab has a favorable safety profile for use during pregnancy.

Drugs, Biologics, Dermatology, DCNP Exam Lahey dermatology NP Fellows (8 decks)

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